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ACC)RbP DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 5/12f2025
<br /> 7'THlSCEPTIFICATF IS ISSUERS ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY
<br /> AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLL CI ES HFLOW.THI S CERTIFI CAT E OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETW EEN THE ISSUING INSURER(S),
<br /> AUTHORIZED REPRESENTATIVE OR PRODUCER,ANDTHE CERTIFICATE HOLDER.
<br /> IMPORTANT:IFthe certificate holder is an ADDITIONAL-INSURED,the pollcy(ies)must have ADDITIONAL INSURED provisions or be endorsed.if SUBROGATION IS WAIVED,subject to the terms and
<br /> conditions of the Policy,certain policies may require an endorsement.Astatementort th(s certificate does not confer rights to the certificate holder in lieu ofsuch endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Gabe Diaz
<br /> Gabriel Diaz(976132M) PHONE FAX
<br /> 2706 Harbor Blvd Ste 201 (A/c.NO,FXT):714-434-7600 (A/C,NO): n/a
<br /> E-MAIL
<br /> Costa Mesa CA 92626-5119 ADDRESS: gdiaz@farmersagent.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC N
<br /> INSURED INSURERA: Truck Insurance Exchange 21709
<br /> BOX 3158 O DEL ClELO, INC. INSURER B; Farmers Insurance Exchange 21652
<br /> PO BOX
<br /> f3Jri INSURERC: Mid Century Insurance Company 21687
<br /> INSURER D:
<br /> SANTA ANA CA 92703 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS I5TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED.NO-PAJITHSTANDING ANY
<br /> REQUIP.EMENT,7ERIV OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECTTO WHICH TH€S CERTIFICATE MAY BEISSUEDOR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE
<br /> POLICIES DESCRI BED HEREIN IS SUBJECTTOALL THE TERMS,EXCWSIONS AND CONDITIO NS OFSUCH POLICI ES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,r
<br /> INSR TYPEOFINSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD (Mint/DD/Y)rYY) (MM/DD/YYYY)
<br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> .�/CL DAMAGE TO RENTED $
<br /> AIMS-MADE OCCUR j�i PREMISES(E-1 Occurrence) 75,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y 604334509 03107/2025 03/07/2026 PERSONAL&ADVINJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIF APPLIES PER: GLNERAL AGGREGATE $ 4,000,000
<br /> I POLICY ❑ PROJECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,OCJO
<br /> i
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY
<br /> COMBINED SINGLE LIMIT $ 2000,000
<br /> {Ea accident}
<br /> ANVAUTO BODILY INJURY(Per person) $
<br /> OWNEDAUTOS SCHEDULED
<br /> A BODILYIN]URY(Peraccidenk)$
<br /> ONLY AUTOS y Y 604334509 03/0712025 03107/2026
<br /> HIREDAUTOS NON-05NNED PROPERTY DAMAGE $
<br /> ONLY AUTOSONLY (Peraccident)
<br /> $
<br /> UMSRELLA LIAR OCCUR EACH OCCURRENCE
<br /> EXCESS LIAR CLAIMS-MADF AGGREGATE $
<br /> DED I REfENfION$ $
<br /> WORKERS COMPENSATION PER OTHER $
<br /> AND EMPLOYERS'LIABILITY STATUTE
<br /> ANYPROPRIETOR/PARTNER,' Y/N E.L.EACH ACCIDENT $
<br /> EXECUTIVE OFFICER/MEMBER N/A
<br /> - EXCLUDED?(Mandatory in NH)
<br /> E.£.nISFASE-EA EMPLOYEE 5
<br /> j 0yes,descri he under DESCRIPTION OF
<br /> I OPERATIONS below E-L DISEASE-POLICY LIMIT 3
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> 00 W SANTA ANA BLVD,SANTA ANA,CA 92701;City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are to be covered
<br /> as additional insureds with respect to liability arising out of work or operations performed by or on behalf of the instructor including materials,parts,equipment,
<br /> nd personnel furnished in connection with such work or operations. Waiver of Subrogation applies.Location: Centennial Park-City of Santa Ana,3000 W
<br /> Edinger Ave.,Santa Ana,CA 92704,Concert in The Park. Digit,fly sign
<br /> Tu Tran byT-T-
<br /> 9vY1
<br /> CERTIFICATE HOLDER CANCELLATION Nguyen D.[e:m2s urn2
<br /> 07:24:23.01' '
<br /> City of Santa Ana,ATTN:Executive Director, SHOU LD ANY OF THE ABOVE D ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br /> Community Development Agency DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza,M-25 A U TH ORR VZ D A&P R ESENTATIVE Gabriel A.Diaz
<br /> SANTA ANA CA 92701
<br /> ACORD 25(2016/03) :cD1988-2015
<br /> 1-17b9 Il-IS The ACORD narne and logo are registered marks of ACORD APPROVED
<br /> By Tu Tran Nguyen at 7:23 am,Jul 02, 2025
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