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ACORO® CERTIFICATE OF LIABILITY INSURANCE P12/18/2024 <br /> ATE(MMIDD/YYYY) <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 <br /> endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A <br /> statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Hiscox Inc.d/b/a/Hiscox Insurance Agency in CA PHONE FAX <br /> 5 Concourse Parkway fAIC,E-MAIL <br /> ND Ext (ggg)202-3007 <br /> : Not: <br /> Suite 2150 ADDRESS: contacthiscox.com_ Cagy <br /> Atlanta GA,30328 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Hiscox Insurance Company Inc 10200 <br /> INSURED <br /> INSURER 8 <br /> MICHAEL RANESES INSURERC: <br /> 2409 MIRA MONTE CT <br /> Tustin,CA 92782 INSURER D: <br /> INSURER E: <br /> INSURER F: <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 I ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE D I WVD I POLICY NUMBER MMIDD/YYYY) (MMIODfYYYYI LIMITS <br /> X COMMERCIAL GENERAL LIABILITY <br /> EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES IEa occurrence $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> A Y P100.077.964.8 0210112025 02/01/2026 PERSONAL&ADV INJURY $ 0 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 <br /> X POLICY D PRO ❑ LOC <br /> JECT PRODUCTS-COMP/OP AGG $ S/T Gen.Agg. <br /> OTHER: S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED BODILY INJURY Per accident S <br /> _ AUTOS AUTOS ( ) <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE S <br /> EXCESS LIAB HCLAIMS-MADE AGGREGATE S <br /> DED I RETENTION$ S <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETORfPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? ❑ N I A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Digitally signed <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Nguyen <br /> Nguyen o8 z-2025.05.20 <br /> APPROVED <br /> By Tu Tran Nguyen at 8:24 am,May 20,2025 <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Planning and Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Santa Ana,CA 92701 <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />