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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDNYYY)
<br />4/2/2017
<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
<br />BELOW. THIS CERTIFICATE OF INSURANCE, DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE 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.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such enclorsement(s).
<br />PRODUCER
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA. LIC #0726293
<br />21011 Warner Center Lane
<br />Woodland Hills CA 91367
<br />INSURED
<br />Downey Vendors
<br />"I Up -
<br />6814 Suva Street
<br />Bell Gardens CA 90201
<br />Erika Sokolik
<br />All 8 ' 18-53 ' 4- ' 3558
<br />Erika Sokol ika.aia.com
<br />West American Insurance Corn
<br />American Fire and Casualtv Cc
<br />COVERAGES CERTIFICATE NUMBER: 1636867327 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
<br />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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR jADDL'SUSR POLICY I E I IF I EXP
<br />,ObLIIIY
<br />LTR I I VrE OF INSURANCE INSD WVD POLICY NUMBER IMMIDDN Y oYYYI
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY Y
<br />BKW56585014
<br />1411/2017 4/1/2018
<br />1 EACH OCCURRENCE $1,000,000
<br />I CLAIMS -MADE X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES .-CE@..occurrence} _._..$100,000
<br />MED EXP (Any one person) $10,000
<br />.
<br />. . . . .... . ............. ... . ... ..... .. ........... ........ . . ............. . ........ ....
<br />PERSONAL & ADV INJURY $1,000,000 . ......... ... ... ... ..
<br />GEN'L AGGREGATE LIMIT APPLIES PER: i
<br />GENERAL AGGREGATE $2,000,000
<br />� RO- I
<br />JECT X POLICY LOC
<br />RODUCTS-COMPIOPAGG $2,000000P.. . ........................ .. .
<br />OTHER
<br />A AUTOMOBILE LIABILITY
<br />BAW56585014
<br />4/1/2017 411/2018
<br />COMBINED IN LE LIMIT
<br />(Ea ,accident) 1 1 1 1 1 '0010,0010, . ...................
<br />ANY AUTO
<br />80DILY INJURY (Per person) $
<br />OWNE SCHEDULED
<br />AUTOS 0ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />HIRED X NON -OWNED
<br />X
<br />PROPERTY DAMAGE
<br />AUTOS ONLY AUTOS ONLY
<br />(Per accidi
<br />I
<br />Uninsd moto Corn $1,000,000
<br />B X UMBRELLA LIAR X OCCUR USA565850 14 4111 411/2018
<br />EACH OCCURRENCE $10
<br />00 0 00 0
<br />LIAB CLAIMS-MADEi 90 "
<br />. . . ...... .... . .. . .. ..
<br />$10,000,000
<br />__J_EXCESS
<br />, N
<br />_DED _7RETENT_______ - I i
<br />'AGGREGATE
<br />�$ -
<br />,, f, c
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN�
<br />PER
<br />STATUTE ER
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />E.L. EACH ACCIDENT $
<br />[--]
<br />OFFICER/MEMBER EXCLUDED? iNIA
<br />(11
<br />tM andatoTy in NH)
<br />EL DISEASE - FA FMPLOYFF, $
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E1 DISEASE -POLICY LIMIT $
<br />Hired Auto PD
<br />SAW56585014 411/2017 4/1/2016
<br />Comic & Coll Ded $50,000
<br />Hired Auto PD
<br />$1,000
<br />DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES JACORD 101, Additional Remarks Schedule, may be attached It more space is required)
<br />Re: Operations of the Named Insured for the Certificate Holder.
<br />City of Santa Ana, Santa Ana City
<br />Hatt, Santa Ana Police Dept,, Santa Ana City and Santa Ana City Yard and Santa Ana
<br />Library of Santa Ana its officers, employees
<br />agents, volunteers and representatives are named Additional Insureds with Primary Wording per attached form CG 8810 0413.
<br />CERTIFICATE HOLDER
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center, Btb^Ffoor ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />1988-2015 ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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