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f^7�{ CC1 /'D� ��. CERTIFICATE OF LIABILITI(INSURANCE DATE iMMIESDFYYYY) 051MI2017 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 EY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEI+I THE ISSUING II $UPER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) muse: have ADDITIONAL INSURED provisions or 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 StateFam RIC WEISSINGER, AGENT- LIC #OC68161 WEISSINGER INSURANCE AGENCY INC cONTACT CAROLE COOK NAME: PUHONe Exc, 714-377-1111 No: 714-377-1611 EWAIL ADDRE5S: INSURER(S) AFFORDING COVERAGE E MAIC 9 ' 5922 WARNER AVE iNSURERA: State Farm General Insurance Company 25;51 HUNTINGTON BEACH, CA 92649 INSURED INSURER 8 WSURER C: OC SAFETY INC INSURER D. 1946 N TUSTIN ST, STE 103 INSURER E ORANGE, CA 92865-4642 INSURER F: 07!0112018 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, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH PESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE WSURA;ICCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEAMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. !NSR LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER AOLICY EFF M POLICY EXP MMIDBIYYYY LIMITS COMMERCIAL QENERAL LIABILITY EAC14 OCCURRENCE S 1,000,000 X j CLAII�iS R7ADE OCCURP A ! I A ' 92 -EA -V145-9 I 10710112017 07!0112018 10D,C10E3 EAIS R Jrr8h92 g__—,— MED EXP (Any one person) A..5-()0() PERSCNALaADV INJURY $ 1,000.000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE 3 2,000,000 I I I POUCY CET 17_LOC } i I PIOP AGG 5 2,000.00Q 3 OTHER: i I AUTOMOBILE LIABILITY ANY AUTO [ ! i I CSG RINFDSINGLF LIMIT 'S BODILY i NJURY ;Per person) S ov�NEDSCHEDULED AUTOS ONLY I AUTOS AIRED NON•OWNED AUTOS ONLY AUTOS ONLY I I BODILY INJURY (Per accident) 5 PROPERTY DAMAGE Per accident' � 3 UMBRELLA G LIAR � OCCUR ; j EACH OCCURRENCE S AGGREGATE S EXCESS LLAB CLAIMS MADE i DED I I RETENTION 5 S WORKERS COMPENSATION AND EMPLOYERS' LLABILATY YIN ANY PRPFRIETOR/PARTNERfEXeCUTIVE ❑ OFFICERiMEMSER EXCLUDED? N f A PIAT TEPH- E.L, EACH ACCIDENT ! s -- E.L. DISEASE -EA EMPLOYEEI S (Mandatory in Nit) Ifes describe under D£StRIPTION OF OPERATIONS below ! E1. DISEASE - POLICY UMET � X BUSINESS PROPERTY I i j 92 -EA -V145-9 ! 10710112017 !! 0710112018 i DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It morn space is required) LOC 01 - 1940 N TUSTIN ST, STE 103, ORANGE, CA 92865 CERTIFICATE HOLDER, ITS OFFICERS, AGENTS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED IN REGARDS TO GENERAL LIABILITY E€�.3i#lt�L+S;.lia�l��E�l�'► �liili�i��=fiE� CITY OF SANTA ANA ATTR: PURCHASING DEPARTMENT 20 CIVIC CENTER PLAZA SANTA ANA; CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE=D BEFORE THE EXPIRATION [SATE THEREOF, NOTICE. WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED FtE�rA e 1988-2015 ACORID CORPORATION. All hts reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001406 132949.12 03-15.20;6 1 `3