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Ac RO o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM,°DIYYVY) <br /> 44.—/ 07/22/2024 <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♦ L.. coaracT Sariah Devereaux-Barrlentos <br /> Stattefarm PHONE FAX <br /> Sariah Devereaux-Bardentos (A/C.No,Ext1: 714-541-7280 RIC,No): <br /> 0O1417 S.Broadway Dews: sariah.devereaux,t81b@statefarm.com <br /> s <br /> INSURER(S)AFFORDING COVERAGE NAIC d <br /> Santa Ana CA 92707 INSURER A: State Farm General Insurance Company 25151 <br /> INSURED <br /> INSURER B <br /> CESAR VARGAS AND ASSOCIATES INSURER c: <br /> DQA MENTE,INC. INSURER D: <br /> 12664 CHAPMAN AVE UNIT 1419 INSURER E: <br /> GARDEN GROVE CA 928404034 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: 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 ADD SUB POLICY EFH POLILYEXP <br /> LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER (MMIDDIVYVY) IMMIDDIYYYY) LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES(Eaoccunence) $ 300,000! <br /> --_ _ MED EXP(Any one person) $ 5,000 <br /> A Y Y 92-EK-V825-4 05/16/2024 05/16/2025 PERSONAL INJURY $ 1,000,000 <br /> _w-__- —„ Y <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY JECT X LOG PRODUCTS-COMPIOP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE UABILITY COMBINED SINGLE LIMIT <br /> fEe accident) $ <br /> ANY AUTO BODILY INJURY(Per <br /> person) $ <br /> OWNED — SCHEDULED <br /> AUTOSONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED UOSNON-OWNEDOL Per aE AGE <br /> AUTOS ONLY _ AUTOS ONLY (Per accident) $ <br /> $ <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE $ <br /> DED I RETENTION $ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTEI FR $ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED/ N/A <br /> $ <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yea,describe under <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 RISK MANAGEMENT DIVISION AGREEN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 CIVIC CENTER PLZ <br /> AUTHORIZED REPRESENTATIVE <br /> SANTA ANA CA 92701-4058 This form was system-generated on 07l2212024 <br /> .l <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> 1001486 2005 155279 205 01-19-2023 <br />