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A`.---- OB/13/2025VVY)
<br /> Ro® CERTIFICATE OF LIABILITY INSURANCE DATE (M /2025
<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 BELOW.
<br /> THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE
<br /> 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. If
<br /> SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this
<br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> Maguire Insurance Agency,Inc.FWI NAME:
<br /> 1 Bale Plz Ste 100 PHONE FAX
<br /> Bala Cynwyd,PA 19004.1401 (AIC,No,Ext): (A/C,No):
<br /> 610,617.7900 E-MAIL
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC it
<br /> INSURER A: Philadelphia Indemnity Insurance Company 18058
<br /> INSURED INSURER B:
<br /> Dennys Diaz INSURER C:
<br /> 7143 Fulton Way
<br /> Stanton,CA 90680 INSURER 0:
<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 INDICATED.
<br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
<br /> ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS
<br /> OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR ADOL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDOIYYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY X PHPK2457612-003 09101(202S 08101/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMSMADE OCCUR DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) $100,000
<br /> X PROFESSIONAL LIABILITY MED EXP(Any one person) $2,500
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
<br /> POLICY ®PROJECT ❑LOC
<br /> R
<br /> PRODUCTS-COMP/OP AGG $6,000,000
<br /> SAM AGGREGATE $30Q000
<br /> OTHER SAM OCCURENCE $100,000
<br /> COMBINED SINGLE LIMIT
<br /> AUTOMOBILE LIABILITY (Ea accident) $
<br /> —
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ®OWNED AUTOS SCHEDULED AUTOS
<br /> ONLY BODILY INJURY(Per accident) $—
<br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE
<br /> ONLY _ AUTOS ONLY (Per accident) $
<br /> $
<br /> _UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$
<br /> $
<br /> WORKERS COMPENSATION PER OTHER
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE
<br /> ANYPROPRIETOR/PARTNEWEXECUTIVE r NIA
<br /> OFF10ER/MEMBER EXCLUDED? I E.L.EACH ACCIDENT $
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,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 /> It is understood and agreed that the following entity is added as an additional insured but only with respect(s)to the operations of the named Insured except that liability resulting from the additional insured's sole
<br /> negligence. Additional Insureds:City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Smite Ana,Attention:Parke,Recreation,and Community Services Agency SHOULDANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> 20 Civic Center Plaza,CA 92701,M-23 EXPIRATION DATE THEREOF,NOTICE W ILL BE DELIVERED IN ACCORDANCE WITH
<br /> Santa Ana,CA 92701 Dlgltally stoned by
<br /> Tu Tran Tu Van Nguyen THE POLICY PROVISIONS.
<br /> Nguyen p ,n-aroo.` AUTHORIZED REPRESENTATIVE
<br /> tit.„,s.
<br /> •
<br /> APPROVED •
<br /> By Pt.Trgn Nguysn at7;e3 10,Avg 14 702$,
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved. •
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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