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MATSONMA04 GROLLINGS <br />CERTIFICATE OF LIABILITY INSURANCE <br />DAT8129/202429/2024 <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 endorsements . <br />PRODUCER <br />Leo Rodriguez Insurance Agency <br />27174 Newport Rd <br />Suite 3 and 4 <br />Menifee, CA 92584 <br />NAMEACT Jay Janssens <br />Pp/`NNc, Ex[ 951 246-4003 1219 FAX <br />): ( ) INC. No): <br />ADDAIL . janssens@acrisure.com <br />INSURERS AFFORDING COVERAGE <br />NAIC N <br />INSURER A: State Compensation Insurance Fund Of California <br />35076 <br />INSURED <br />INSURER B : <br />INSURER C <br />Mark Matson dba Temecula Carriage Company, LLC <br />INSURER D <br />40001 Berenda Road <br />Temecula, CA 92591 <br />INSURER E : <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: REVISION NIIIIIII <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 />TYPE OF INSURANCE <br />ADDLSUBR INSD <br />MID <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPLTR <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />EACH OCCURRENCE <br />$ <br />DAMAGE TO RENTED <br />PREMISES ce <br />NED EXP (My one rson <br />PERSONAL B ADV INJURY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ PRO LOC <br />OTHER: <br />GENERAL AGGREGATE <br />PRODUCTS - COMP/OPAGG <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AS <br />AUTOS ONLY A�NOS ONLY <br />COMBI dED SINGLE LIMIT <br />$ <br />BODILY INJURY Per ersan <br />$ <br />BODILY INJURY Per accident <br />$ <br />Pe�aciiAenI AMAGE <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CIAIMS-MADE <br />EACHOCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION$ <br />A <br />WORKERS COMPENSATION Y/N <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNEWEXECUTIVE <br />(Mandatory in NH)EXCLUOEDEl ? <br />yes, describe under D <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />X <br />912$855.24 <br />2�2612024 <br />2�26�2025 <br />X PER OTH- <br />ER <br />EL EACH ACCIDENT <br />1,000,000 <br />E.L. DISEASE - EA EMPLOYE <br />1,000,000 <br />$ <br />E.L. DISEASE -POLICY LIMB <br />1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana <br />Parks, Recreation, and Community Services, M-23 <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />ACORD 25 (2016103) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE <br />THE EXPIRATION DATE THERED <br />ACCORDANCE WITH THE POLICY PR( <br />AUTHORIZED REPRESENTATIVE <br />tY. ee��e I�Muragmlml.DiyWoR <br />REV <br />Risk Management Specialist `e,{ <br />©1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />©1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />