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AC's > CERTIFICATE OF LIABILITY INSURANCE �iMxvnzxv,,rv� <br />TI{IS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONI Y AND CONFERS NO R1.GHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFiRmAY veLy OR NEGATIVELY AMEND, EXTEND OR A'LT'ER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW, THIS CEIRTIFICATE OF INSURANCE .DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSgRER(SI, AUTHORIZED <br />REPRIESENTAMVE OR PRODUCER, AND THE CERTIFICATE HOLDEP. <br />IMPORTANT! If the certifleate holder is an ADDITIONAL INSURED, the pollay(les) must be endorsed: If SUBROOATtON IS WAIVED, sub) t to the <br />Harms and condition3 of the policy; certain policies pray require an endorsement. A statement on this Certificate CIO" not -confer tights to tho <br />certillcate holder .In lieu of such endomement(4 <br />PRODUCERMIRNA <br />State Fern Insurance <br />2526 N. Lake Ave. #2 <br />Altadena, ICA <br />,� <br />SEiNA <br />(ATPHONE, 626-79 t-991 5 FAX N 626,791-5918 <br />Fa -MAIL ss; m[rna jdiehi.caM <br />PRODucOR <br />A ME <br />ENSURERS AFFORDING COVERA(;IT #d1AS0 It <br />_ <br />'INSURED <br />NETFI'LE <br />[N$URERASta16FarM Gerwal Inst ranee Company 35155 <br />fNSURER.8I Stale Farm Fire and Casus4 Carnpany 15143 <br />PO BOX 70 <br />IN 1(BRC: <br />DWOI12015 <br />AHWAHNEE CA 93601-0070 <br />INSURER R <br />*rAMx6MEMI a S 3130 <br />INSQRER � i <br />PEREpNAL & ApV INJURY $ 1 000,000 <br />C:UVr-K AA2t`..5 C:Ei#TIFICA-fE NLIMRER OMNI 4IAK? Alf IRA00a. - --- <br />• -- _. — .r.... <br />T1416 IS TO CeRlIFY THAT THE POLICIES OF INSURANCE UVED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TOE POUQY PERIOD <br />INDICATED. NOIWTHSTANDING ANY REQUIREMENT, TERMOR CQNDITiON OF ANY 'CONTRACT OR OTHER DOCUMENT WITH RESIP80T TO WHICK THIS: <br />CERTIFICATE MAY HE issUEp OR MAY PERTAIIN, THE WSURANC1✓ AFFQRDEQ BY THE POLICIES OESCRI13ED HEREIN 3S SuaJECT TO AIL THE TERMS, <br />I=XCLUS14N5 AND CON€1.11ON$ OF SUCH'POLIGIES, LIMITS SHOWN MAY HAVE BEEN REDUCED:BY PAio O);,MMS, <br />IM <br />TYPE OF INSURANGrs .... <br />DDL <br />U&R <br />- - - <br />OLlCY NUMBER <br />Mi ma Serna <br />GY P.............................. <br />N WD <br />LIMITS <br />A <br />GENT fiALWAaIUTY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIM"ADE [yCCUR <br />92 -XV -7702-4 <br />DWOI12015 <br />0011r416 <br />'EACH OCCURRENCE s 1,000,000 <br />*rAMx6MEMI a S 3130 <br />MED EXP (Arly one n d 5,3}Cb <br />PEREpNAL & ApV INJURY $ 1 000,000 <br />_ <br />GENESALAGGREGATE S 2,000,000 <br />N'LAGGR5-GAT UMITAPPLiIESPER: <br />"it tyOLIGY PRO- <br />T LOC <br />PROD()(GT*-COA%NOPAGG $ 2,000,000 <br />E <br />AUTOMOBILE <br />tJABILII YaOMMNED'91NGLE <br />ANY AUTO <br />— y <br />11BODILY <br />LIMIT <br />{fit!OCitlEnt} <br />INJURY (Per parson) $ <br />ALL OWNED AUT05 <br />il. .. i] <br />KOLYINJURY(Poraoddeh0 $ <br />9GFil:©ULEpAUTOS <br />HIRED -AUTO$ <br />PROPlEATY DAMAGE <br />(Per wddont} <br />Nor "E0AUT05 <br />f <br />UMBRELIJtilA9 DCCUR <br />RACFfi3GCCJRREFtC& $ <br />EXCESSIJh9 CLAIMS-11ADE <br />A60RECATE $ <br />DEDUCTMLE <br />$ <br />5 <br />RVEWtON <br />g <br />AND EMPL0Y6RS1tIA9ILI7Y WN <br />ANY PROPMETORIPARTNERSv9CUIVEE <br />OFSOERMirWoeREXCLUCED7 <br />NTA <br />92:XV=7711.24 <br />03101=18 <br />IkW01=16 <br />�( <br />L EACH ACCIDENT $ 1(lOD,440 <br />_ <br />-ElL =EASE: -EA EMPLOYE 8 1.,9 00.000 <br />CI69aodatorY+ Ilrn NHJ <br />as, d8a <br />Ir df a <br />...... <br />E.S.. DISEASE - POLICY UMIF $ 1 OOI7,a4O <br />He:un er <br />1'ECFdNOgL[3Y ERRORS IL tlMI55iC1NS <br />Y <br />Y <br />'342010 <br />OZ1112015 <br />ow'14 A1& <br />$2;Ap0,ao0 . EA.I'FI VVRC)C+t{3FtJLiSC't' <br />$2,WD;D00.TOTAL OMIT OF LLA81L" <br />DBSCMP'nON OF oMAA=NS) tocxnON9 f VfiMCLE$ iAttarzN ACORD t91, AddlSonal Remarks td*dule,irmre 3epoee in reglilredi <br />DATA AND INFORMATION STORAGE <br />CANCELLATION NOTICE: IF ANY In'OLICIES ARE CANCELM BEFORE THE EXPIRATION DAE, STATE FARM WILL TRY TO MAIL, A.WIRM, N N.LJTICE TO.. <br />THE CERTIFICXTE CERTIFICATEHOLDER 40 DA`fS BEFORE CANCtr"TION. <br />City of $OnW Ana"MLD <br />20 Civic Center Plaza <br />Santa Ana, CA 927'01 <br />� <br />1) ,, <br />Ary yv/ <br />ANY IF TH@ ABOVE DI SOPNED POLT01IRS BE CANCELLED BrF"I3 THE <br />CPIRliTIOU pATV THFREO TICS VALL SC III Agb. IN ARatORDANCE tl TH THe <br />POLICY PROVISION$, <br />fAUYrHORM D FIE' . SENTA. <br />Mi ma Serna <br />ACC IRO 20 (2009109) <br />i'9813- 1ORATION, All rights reserved. <br />The ACORD name and logo are. registered marks of ACORD 1401456 1329491.4 02-114010 <br />