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f%c ' CERTIFICATE OF LIABILITY INSURANCE °02/0�/22o a"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be Endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER VONNIEWIGGINSINSURANCEAGENCY 11757 BEACH BLVD STE 7 Statefarm JACKSONVILLE, FL 32246 NAME, BRITTANYMORRIS PHONE E,t) 9D4- 641.0090 _ nc No: 04-641.0098_ iKI56I I BRITTANY,MORRIS.Ui EY(<dSTATEFARM.COM _ IN30RERI$I AFFORDING COVERAGE NAICR _ INSURERA:Sl91e F8rm Florida insurance Company -, ' 10799 INSURER B: INSURED ELM, INC. 1035 KINGS AVE JACKSONVILLE FL 32207 -831 ,AI DrJi3 °lD� INSURER C: INSURER D: INSURER E _.. INSURER F: _. -.. COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHCWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN LTR TYPEOFINSURANCEu_ DL POLICYNUMBEE POLICY EFF MMIDOIWYY POLICY E %P MMIDOPP/YY - LIMES GENEHALUABILITY 7% COMMERCIAL GENERAL LIABILITY CLAIMS.MADE XOCCUR Y ❑ 98 -R4- 6632 -3 S 10/28/2013 10123!2014 EACHOCCURRENCE $ 1,000,000 PREMISES E2 occurrence $ ICED EXP (Any one person) _ 5 PERSONAL 8 ACV INJURY _ $ —_ -. GEN'LAGGREGATE LINT APPLIES PER POLICY LOG GENERAL AGGREGATE A 2,000,000 PRODUCTS - COMPIOP AGO $ i $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS _ AUTOS HIRED AUTOS q�TOSCO ❑ ❑I � -- COMBINEDSINGL LIMIT _,(go ao�d rl) $ BODILY INJURY (per Person) - $ --- BODILY INJURY (Per a depD - $ PROPERTY DAMAGE -Ter accidenll _ - S b EXCES LA IS E %LESS LIAR OCCUR CLAIMS -MADE EACH CCCURRENCF $ $ AGGRFGATE UEU RETENTIONS WORKERS COMPENSATION ;ANDEMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER •EXECUTIVE YIN OFFICEIMEMBER EXCLUDED? � IManpatory In NH) If yes, Gescnt a under DESCB1271QN OF OPERATIONS Eclo, NfA 77 ( WC STATLL GTH- _ TORY L[Ma .... 'R E. L EACH AC ACCIDENT ._ 5 E L DISEASE. EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS (VEHICLES (gtta4) ACOND 1011,, AddrWorol Rodr. kys)Schedule, Ifmnre spece la re9uiredl Oil NI T °O `v0. City of Santa Ana 20 Civic Center Plaza, M36 Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, All rinhfe rca.n —n AwnU zb (ZU9UIU51 The ACORD name and 10 go are registered marks of ACORD 1001486 132840.8 01 -23 -2013