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CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 08/30/2024 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME, Automatic Data Processing Insurance Agency,Inc. <br /> Automatic Data Processing Insurance Agency,Inc. HONE Ext: 1-800-524-7024 FAX No): <br /> E-MAIL <br /> ADDRESS: <br /> 1 Adp Boulevard 164ital skmW by n i NAIC# <br /> Roseland NJ 07068 INSURER ThE 'ie Insurance Company 21857 <br /> INSURED BACKHAUS DANAngie <br /> Acev~47r% PNtP( <br /> 11} . <br /> 4365 Johanna Ave . �a l <br /> INSURER D: <br /> INSURER'-: — 1 1 <br /> Lakewood CA 907133303 1 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 3825123 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> OCCUR DAMAGE TO S( RENTED <br /> CLAIMS-MADE <br /> PREMISES Ea occurrence) $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ <br /> JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> A OFFICER/MEMBER EXCLUDED? N/A N WCP11310148-000 09/07/2024 09/07/2025 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN <br /> City of Santa Ana,Attn: Risk Management Division ACCORDANCE WITH THE POLICY PR( <br /> Risk Manage.Inentl?ivisirnt <br /> 20 Civic Center Plaza,4th floor <br /> AUTHORIZED REPRESENTATIVE �?'� REVIEWED&APPROVED BY. <br /> � 11111119 A Aect,,44 <br /> Santa Ana CA 92702 Risk Managenient Specialist <br /> ©1988-2015 ACORD <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />