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Commercial Certificate of Insurance M, a E RS -1i <br />Agency KIRK MILLER INSIMAINCF AGENC)' <br />Name * 5941 PACIFIC CENTER BLVD Issne Date (MNt/DD/YY) G4,2(} 1 1 <br />R * SUITE €P 300,SAN DIEC70. C;1 Q121 <br />y <br />Address !-f" 1 rerr pto is issued as a matter of information only and confers no rights <br />- <br />t <br /> ulx <br />m Ilse c, <br />f case holder, This certificate does not amend. extend nr alter the <br />t _ <br />36 A <br />`? coverage afforded by the policies shoos below. ? <br />Ker <br />Dist. <br />St <br /> Companies Providing Coverage; <br />Insured 4=ct )era+)y A l l in,unncr t .xrf qn- <br />CAFE EXPRESS MM <br />Nanw * Dba: George Ca ban r - Anca C.aban C?-,rwny D Farmers Irismatice Exchange <br />R• 1000 F.. SANTA ANA BLVD. C.on) o- r <br />ira.9v• 4 Mid-Century f EksrtranCe t_.7ptTlpiirty <br />Address SANTA ANA. CA 92741 Low <br />(-,rwly O <br />ZOO __ <br />Coverages <br />II115 is to certify that the pnlicrrx of insurance listed below have been issued rq the insured named above for the policy period indicated, Notwithstanding <br />any requirement, terns w, onditionof any contract or other docunent with respect to which this certificate may he issued or may pertain. the insurance <br />afforded by the policies described herein is subject to all the rerr us. ext lusions and conditions of sup l; policies. Limits shown may have been reduced by <br />paid clailim <br />Type of Insurance Palley Numi3er <br />Lu_ Poltev i it Ir. i'ui > 1 t iii m Policv Limits <br />Ltate MV t ,VV I l i <br />i, r? <br />11 General Liability 6047-34217 >l7 (i4??1 ?t 11 I (1.1 enr Ohl A i vv3r <br /> <br />_?7 _' <br />S4,040,Dp4 <br /> <br />X Commercial General ( <br />Proda?ist .?ntptlJPS <br />Aggregau <br />000 <br />400 <br />$2 <br />IaabllUs, <br />Personal fi . <br />, <br />X Occurrence 'Version Advertising lrijury T 2,000.000 <br />Contractual, Incidental Each Occurrence <br />000 <br />000 <br />g 1` <br />only fare Darnage , <br />, <br /> (•Anyonefin,J $ 250.000 <br />Owners fk Cot uractors Prot.' Medical rxpertsr <br /> (Anv one I rv)nl S 5,000 <br />Automobile Liability Combbx+t mgle <br />l All Owned Commercial i.imft ? S <br />Autos Rodily Injury <br />Scheduled Autos (Per persun) <br />5 <br />} Tired Autos Bodily Injury <br />Non-Owned Autos (Per accident} <br />Garage Liability Property Damage g <br /> Garage Aggregate ; <br />Umbrella Liability Limit <br />Workers' Compensation Statutory <br />and Each Accident <br />I <br /> <br />EmPto s` Liability Disease Nwh E''" <br /> Uisea c - Policy Limit <br />+ <br />........ .. <br />Description of (jprratic?r€slVehicles/i:cstric t tnnsl SFxa; sal items; <br />PERSONAL PROPERTY COVERAGES100,000 <br />City of Santa Ana. its officers, employees, agents, volunteers, and representatives art names as additional insured <br />Certificate Holder Cancellation <br />CITY of- SANTA ANA Shol of thv moue described policies be rancelled before the expiration date <br />Nante ATl"N: Christy Kindig f) i,-f I6r .),,,Ing cbrnpany wilt endeavor to mail 30 days written notice to the <br />EI 20 Civic Center Plaza certify ere holder named to the left, but failure to noel such notice shall Impose no <br />Adttr,em SANTA ANA. CA 42701 obligai tun or IiA,ifity of any kind upon the company. its agents or representatives. t <br /> KIRK MILLER <br /> Authorued Representative <br />... <br />56 Z4'J? 4 94 Copy Qirtribulinn: Service Center Copy , <br />and agent's Copy - -rr d3 <br /> <br /> <br /> <br />