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AC40R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
<br /> 04/0812025
<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(les)must be endorsed, If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder In lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Kathy Lamm(975534H) PHONE FAX
<br /> 2915 Red Hill Ave#F201 IAIS No.Ertl: 866 418-$939 AM NO:
<br /> E-MAIL
<br /> ADDRESS: I e sagent.carn
<br /> INSURERS AFFORDING COVERAGE NAIC
<br /> Costa Mesa CA 92626 INSURERA: Truck Insurance Exchange 21709
<br /> INSURED INSURERB: Farmers Insurance Exchange 21652
<br /> VAALA INSURER C: Mid Century Insurance Company E21687P.O.Box 20218 INSURERD; U.S.Liability Insurance Group
<br /> INSURER E; Sequoia Insurance Company 19755
<br /> Fountain Valley CA 92728
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br /> INSR TYPE OF INSURANCE ADp SUB POLICY NUMBER M�MILDICDmYY MOLJ pY EXP LIMITS
<br /> GENERAL LIABILITY
<br /> �i
<br /> EACH OCCURRENCE ;g 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO N U
<br /> PRFhiISES a oGtum3rtca S 100,000
<br /> CLAIMS-MADE ®OCCUR ! MED EXP(Any one person) I$ 5,000
<br /> D Y Y NPP1559963K 0211 012 02 5I02110120261PERSONALaADVINJURY s 1,000,001)
<br /> I I GENERALAGGREGAFE S 2,000,000
<br /> G£N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPtOP A29 S 2,00U,000
<br /> POLICY JECTPRO- LOG i Directors&Officers I s 1,000,000
<br /> AUTOMOBILE LIABILITY E aBl�Nnt51NGLE LIMIT $ 1,()00
<br /> O0tI
<br /> ANY AUTO BODILY INJURY(Per pemuft) S
<br /> D ALL OWNED SCHEDULED Y Y NPP1559963K 02/1012025 0211012026 BODILY IWURY(Peracriderol.3
<br /> AUTOS AUTOS
<br /> X HIRED AUTOS NON-OWNED I I PROPERTY DAMAGE $
<br /> AUTOS _(Per acLident
<br /> 8
<br /> UMBRELLA LIAR W OCCUR - EACH OCCURRENCE Is
<br /> EXCESS LEA$ CLAIMS-k9AOE AGGREGATE .$
<br /> DED RETENTION$ I I $
<br /> WORKERS COMPENSATION � WCSTATU- 1OTH-
<br /> AND EMPLOYERS'LIABILITY ❑� j X� Y1,IMQS. _....�.,
<br /> ANY PROPMETOR PARTNERfEXECUTIVE YIN I! IACCIDENT S 1,Q�D,000
<br /> E OFFICERlMEMBEREXCLUDED' Y NfA, QWCf390045 09/0112024 0910112025
<br /> (Mandatory in NH) i E.L.DISEASE-FA EMPLOYE0 S 1,000.000
<br /> Ify es,describe under I !
<br /> III ESCRIPTIONOF OPERATIONS below 3 E,L.DISEASE-POLICY UMIT�S 1,000,000
<br /> i i I I
<br /> I
<br /> DESCRIPTION OF OPERATIONS r LOCATIONS!VEHICLES(Attach ACORD tet,Addltional Remarks Schedule,it more space is required)
<br /> The City of Santa Ana,its City Council,officers,officials,employees,agents and volunteers are to be specifically named and covered as additional insureds on
<br /> the general liability and auto policy by separate attached endorsement with a waiver of subrogation in farce.30-day notice of cancellation applies.Event
<br /> Information:VAALA's Youth in Motion Filmmaking Workshop,Event Locations:Media Arts Santa Ana,1666 N.Main St.,Santa Arta,CA 92701,Southland
<br /> Integrated Services,9862 Chapman Ave,Garden Grove,CA 92841 and The Frida Cinema,305 E 4th St.,Suite 100,Santa Ana,CA 92701.
<br /> olgTu Tmnually signed
<br /> Tu Tran by
<br /> Nquyen
<br /> Nguyen o41:51 a� APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 10:41 ain;JuP 14,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana,Attn:Executive Director THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Community Development Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza M-25
<br /> Santa Ana,CA 92741 AUTHORIZED REPRESENT
<br /> ACORD 25(2010/05) @ 19 8- 10 ACO D CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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