|
CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM /ODIyYYYI
<br />08116/2016
<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 BE THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. IIf SUBROGATION IS WAIVED, subject to the
<br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsament(s).
<br />PRODUCER Eddie QUillares Jr.
<br />State Farm Agency
<br />..�415 N. Broadway
<br />,., Santa Ann, CA 92701
<br />INSURED DOWNTOWN INC
<br />200 N MAIN ST FL 2
<br />SANTA ANA CA 92701
<br />COVERAGES r^C6TIbha7•e cn,naecn.- .�.,, -�
<br />NA TACT E -ttdie Quilfares
<br />PRONE 14.617750. ACN0:714.fi17 158
<br />aooA'LS : Eddie eddie insurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC B
<br />INSURER A: State Farm General! surance CDm an
<br />INSURER a;$a Fire and Casual Com
<br />2
<br />5 43
<br />INSURERC:
<br />92 -CE- 0933.0
<br />INSURER 0:
<br />0610512017
<br />INSURER E:
<br />PREMISE a wens, $ 300,000
<br />INSURER F:
<br />CLAIMS MADE X OCCUR
<br />i
<br />THIS
<br />INDICATED.
<br />CERTIFICATE
<br />EXCLUSIONSAND
<br />N$R
<br />Lm
<br />IS TO CERTIFY THAT THE POLICIES
<br />NOTWITHSTANDING ANY REQUIREMENT,
<br />MAY BE ISSUED OR MAY
<br />CONDITIONS OF SUCH
<br />TYPE OF INSURANCE
<br />OF
<br />PERTAIN,
<br />POLICIES.
<br />ADDL
<br />INSURANCE
<br />11.1Y°"
<br />LISTED BELOW HAVE BEEN
<br />TERM OR CONDITION OF ANY
<br />THE INSURANCE AFFORDED BY
<br />LIMITS SHOWN MAY HAVE BEEN
<br />POU YNUMBER
<br />ISSUED TO
<br />CONTRACT
<br />THE POLICIES
<br />REDUCED BY
<br />POLDICY EFF
<br />THE INSURED
<br />OR OTHER
<br />DESCRIBED
<br />PAID CLAIMS.
<br />MPOMADOON
<br />REVISION NUMBER:
<br />NAMED ABOVE FOR THE POLICY PERIOD
<br />DOCUMENT WITH RESPECT TO WHICH THIS
<br />HEREIN IS SUBJECT TO ALL THE TERMS,
<br />LIMITS
<br />A
<br />GENERALLIABIUTY
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />92 -CE- 0933.0
<br />0610572016
<br />0610512017
<br />EACH OCCURRENCE 1,00,000
<br />PREMISE a wens, $ 300,000
<br />CLAIMS MADE X OCCUR
<br />i
<br />i
<br />MED EXP fAry one Peraw, $ 6,000
<br />PERSONAL &AI1V INJURY $ 1,000,000
<br />GENERAI.AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /GP AGO $ 2,000,000
<br />POLICY PROF LOC
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />ALL O$ SCHEDULED
<br />HIRED AUTOS
<br />HIRED AUTOS AUTOS
<br />ENED 1 ULL MIT $
<br />ncident $
<br />BODILY INJURY (Per perswn $
<br />$
<br />BODILY INJURY (For acddent) $
<br />Per wideniDAMAb $
<br />$
<br />OCCURRENCE $ 1,000,000
<br />A
<br />X UMBRELLALIAB X OCCUR
<br />EXCESS LIAB CLAIMS -MADE
<br />Y
<br />Y
<br />92 -GE "07$1.7
<br />66165/2016
<br />0610512017
<br />AGGREGATE AGGREGATE $ 2,000.000
<br />Pro X RETENTION$ 10000
<br />WORKERS COMPENSATION
<br />AND EMPLOYERT LIABILITY
<br />ANY PROPRIErORMARTNMEXECUTWE YIN
<br />OFFICEIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />n yes, desalbe under
<br />NIA
<br />92- CPAS30.9
<br />0610512016
<br />06105/2017
<br />$
<br />WO STATU- OTH-
<br />LI X 1,000,000
<br />Y
<br />—
<br />E.L. EACH ACCIDENT $ 11000,000
<br />E.LDISEASE -EA EMPLOYE $ 100,000
<br />E. L. DISEASE - POLICY LIMIT % 11000,000
<br />POND-AMOUNT $ 500,000
<br />A
<br />FIDELITY eoND
<br />Y
<br />FYI
<br />92 -WV- 60445 -F
<br />10103112016
<br />10103/2017
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES (Altaeh ACORO 101, Addit[Onal Remarks Schedule, Nmore apace Is tegWm4I
<br />Location: 2nd Street Promenade, 200 E. Alley, 100 E. Alley, East End Promenade, Plaza Calls Cuatro L\
<br />City of Santa Ana Its officers, agents, employees and volunteers are named as additional insureds
<br />Additional Insured endorsement Issued for certificate holder with Wavler of Subrogedon
<br />i
<br />CFRTIP1(tATF Hnl nPo _...____ _
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA SANT ANA, CA 92702
<br />ATTENTION RISK MANAGEMENT
<br />BRIZA MORALES
<br />SHOULD ANY OF THE ABOVE
<br />THE EXPIRATION DATE. T
<br />AUTNORRRO REPRESENTATIVP
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />POLICIES BE CANCELLED BEFORE
<br />)TICE WJLL PE,- MMVeRED IN
<br />'.AI ION. All rights reserved.
<br />1001486 132849,7 03.01 -2012
<br />
|