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ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) <br />05/23/2024 <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 endorsementtsl. <br />PRODUCER <br />Lamarche Insurance Agency, Inc. <br />PO Box 849587 <br />Los Angeles CA 99084 A _ _ • <br />INSURED <br />Brereton, Mohamed, Terrazas, LIP <br />L. <br />1362 <br />Pacific Avenue #221 Acevedo..,..­� <br />� <br />Santa Cruz CA 95060 'I _ 1 I <br />(831) 429-6391 1 INSURERF. <br />COVFRAr:FS .TA CFRTIFICATF NI IMIel r— rn 191 fit mFnnelnkl 1,111100r]0. <br />200- <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 <br />LTR <br />rypE OF <br />ADDL <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDIYYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />COMMERCIALGENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />EACHOCCURRENCE <br />$ <br />DAMAGED <br />PREMISES S Ea Ea occurrence <br />$ <br />MED EXP(My one person) <br />$ <br />PERSONAL B ADV INJURY <br />$ <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PECT RO- ❑ LOC <br />J <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COMP/OPAGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILELIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY ALUD <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />J <br />BODILY INJURY Pid (Par accent ) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Peraccident <br />$ <br />$ <br />UMBRELLALIAB <br />OCCUR <br />EACHOCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />PER OH_ <br />EMPLOYERS'LIABILITY YIN <br />STATUTE ER <br />EL. EACH ACCIDENT <br />$ <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBEREXCLUDED? <br />NIA <br />EL DISEASE -EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />E.L.DISEASE-POUCYUMIT <br />$ <br />DESCRIPTION OF OPERATIONS below <br />A <br />Professional Liability <br />WPPI653219 05 <br />02/19/2024 <br />02/19/202SPer <br />Claim <br />Aggregate <br />g 1, 000, 000 <br />$ 2,000,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) <br />City of Santa Ana <br />20 Civic Center Platte (M-29) <br />Ana CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PRE <br />AUTHORRED REPRESENTATIVE <br />©1988-2015 ACORD <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />Risk Mwgarlod.D[wfDn <br />;+j ,� _*C.. RBAEWBJ S, APPROVED BY: <br />Xf, Aav44 <br />Risk Management specialist <br />or <br />Page 1 of 1 <br />