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A e` CERTIFICATE OF LIABILITY INSURANCE izrsalzol5"' <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />CERTIFICATE DUES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />SELOEV, THIS CERTIFICATE OF INSURANCE DOES NOT CUNSTrrUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. - <br />IMPORTANT: If the cortlficater holder Is all ADDITIONAL INSURED, the policylles) must be endorsed, If SUBROOATION t$ WAIVED, subject to the <br />tome and Conditions of the policy, certain policles may require an endorsement. A statement on this Certificate does not confer rights to the <br />certificate holder In lieu of such endorsoment(s). <br />PRODUCER <br />Skate Farm Insurance <br />2525 N. Lake Ave. #2 <br />Altadena, CA 91001 <br />N B; MIRNA SERNA <br />PNDNE ®28791 9915 FAx 626.791-9918 <br />rl mlrna�Jdiehl Dom <br />mMfi IDU <br />plueg LIMITS <br />INSURERIAFFOROING COVEaAGE NIC r <br />_ <br />INSURED <br />__ _ <br />INSUR AR C FaRn General Insurance Company 76151 <br />NETFILB <br />Btale Fam Flreand CaSU01lyOOropBny 26143 <br />PO BOX 70 <br />NSUR C a <br />INSURRA <br />AHVVAHNEE CA 93601-0070 <br />INSURER1 _. <br />N-aC) 3 IIS <br />INSURER <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, LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />LTR <br />TYPE OF INSURANCa <br />ADDLIBURR <br />AUTHORIZED REPRaSENT <br />POUCY NUMBER <br />M D <br />plueg LIMITS <br />A <br />GENERAL LIABILITY <br />92 -XV -7702.4 <br />0310112015 <br />0310112017 EACH OCCURRENCE <br />$ 1,000,000 <br />x COMMERCIAL GENERAL LIABILITY <br />P I�,f�Bov&uIr4A0'i.....: <br />$ BOki000 <br />OLAIM"N" ZX OCCUR <br />Y <br />�.ry�� <br />I* -,.,a <br />MED EXP M one IDn _m <br />s - B1000 <br />— <br />PERSONAL .&ACV INJURY <br />$ 1,000100 <br />$ 2,000,000 <br />gENERALAGGREGATE <br />GEN'L AGGREGATELIMITAPPLIES PER: <br />$ 21000,000 <br />PRGD TS-COMP/OP AGG <br />X POLICY ,IF . LOO <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br />ANY <br />(Ea acgdan4 <br />S <br />BODILY INJURY(Perpamon7 <br />ULOME <br />BODILY INJilRY(Por <br />80HEDUEDAUTO <br />30HEDULEO AUTOB <br />PROpwtYOAMAGa <br />HIRED AUTOS <br />(Pora=14ent) <br />$ <br />$ <br />NON-OMED AUTOS <br />$ <br />UMBRELLA. UAB <br />OCCUR <br />EACH OCCURRENCE <br />S. <br />RXCRS$UA6 <br />CLAIMS -MADE <br />El <br />1:1$ <br />AGGREGATE <br />IS <br />DEDUCTIPLE <br />_._ <br />RE NTIO $ <br />B <br />WORt(ERS COMPENSATION <br />AND eMPLOYERS'UABILnY <br />Bi'^D.X^L't6Btf1 <br />ii'�ilili (i1$ <br />BBiDii211'tT <br />I + <br />ANY PROPRIETOFWARTNER£xECIRIVR <br />OFFICEWMEMBER EXCLUDED? Y <br />NFA <br />Y <br />E.L EACH ACCIDENT <br />III 1,p0p,Otl0 <br />E L DIS ASE -EA EMP DYE <br />$ 1,00D 000 <br />IMnndeton, In NHk <br />If as, dowbo under <br />E L mSEASE - CLICYLIMn '. <br />S 1,044;400 <br />f3 <br />TECHNOOLGYERRORS&OMISSIONS . <br />Y <br />Y <br />342011 <br />0211112DIG <br />02!1112017 <br />$2,000, , EACH YMONOPUL <br />ACT <br />10,000,000 . TOTAL LIMIT OF LIABILITY <br />DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (Attach ACORD 101, A4dlBenem <br />l Remarks Schedule, If morespaca to rsecired) <br />DATA AND INFORMATION STORAGE <br />CANCELLATION NOTICE: IF ANY POLICIES ARE CANCELED BEFORE THE EXPIRATION DAE, STATE FARM VALL TRY TO MAIL A WRITTEN NOTICE TO <br />THE CERTIFICATE HOLDER 30 DAYS BEFORE CANCELLATION. <br />CERTIFICATE HOLDER...... CANCELLATION <br />City of Santa Ana <br />SHOULD ANY 0P THO ABOVE 0060RIDOO POLIOISR a0 CANCELLED BEFORE THE <br />CIVIC Plaza <br />"PIRATION DATA THRREOP, NOTICE WILL BE DELIVERED IN ACCORDANCE MY`14 THE - <br />PDLICY PROVISIONS. <br />Sa <br />anta fleaa,, CCA A 92701 <br />�. <br />AUTHORIZED REPRaSENT <br />Nr s <br />ACORO 26 (2009108) <br />Irna erne 2 <br />Q 7960.2 09 MON OPRPORATION. Ail rightB reserved. <br />The ACORD name and logo are registered mar.,. of AOORD 1001488 132849,4 02.11-2010 <br />