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CERTIFICATE OF LIABILITY INSURANCE <br />DAT00/E (MM/DD/YYYY) <br />30/2018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THECERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELYOR NEGATIVELY <br />AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE ACONTRACT BETWEEN THE ISSUING INSURER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. <br />IMPORTANT: If thecertiRcate holderis an ADDITIONAL INSURED, the pelcynes) must haveADDITIONAL INSURED pmvlsionsor be endorsed. RSUBROGATION IS WAIVED, suhlectto the terms and <br />conditions ofthe policy, certain policies may require an endorsement. A statementon this cerdficatedoes notconfer rights to thecertificate holder In lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />POLICY EXP <br />(MM/DD/YYY`O <br />NAME: BLAKE E. CORNISH <br />Blake Cornish(2925320) <br />PHONE <br />Fax <br />8816 S Sepulveda Blvd Ste 108 <br />(A/C, NO, EXT): 310-215-3638 <br />(A/c, NO): 310-496-0627 <br />E-MAIL <br />Los Angeles CA 90045-4852 <br />ADDRESS: bcornlsh@farmersagent.com <br />INSURERS) AFFORDING COVERAGE NAIL# <br />INSURED <br />INSURERA: Truck Insurance Exchange 21709 <br />INSURER a: Farmers Insurance Exchange 21652 <br />CONSTANT 8 ASSOCIATES <br />INSURERC: Mid Century Insurance Company 21687 <br />3655 TORRANCE BLVD STE 430 <br />INSURER D: STATE FUND <br />TORRANCE CA 90503 <br />INSURER E: <br />INSURER <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TH E INSURANCEAFFORDED BYTHE <br />POLICIES DESCRIBED HEREIN IS SUBJ ECT70 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />Abort. <br />INSR <br />SUBR <br />MD <br />POLICY NUMBER <br />POLOYEFF <br />(MM/DD/YYYY) <br />POLICY EXP <br />(MM/DD/YYY`O <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 2,000,000 <br />CLAIMS-MADEX❑ OCCUR <br />DAMAGE TO RENTED $ <br />PREMISES (Ea Occurrence) 75,000 <br />MED EXP (Anyone person) $ 5,000 <br />PERSONAL a ADV INJURY $ 2.000,000 <br />C <br />Y <br />N <br />604655924 <br />06104/2016 <br />06/04/2017 <br />GEN'L AGGREGATE UMITAPPLIES PER: <br />GENERALAGGREGATE $ 4000000 <br />X POLICY ❑ PROJECT ❑ LOC <br />PRODUCTS COMP/OPAGG $ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ 1,000,000 <br />(Eaaccldent) <br />BODILY INJURY (Per person) $ <br />ANYAUTO <br />BODILY INJURY (Per accident)$ <br />C <br />OONNEDAUTOS X SCHEDULED <br />AUTOS <br />604655924 <br />06/04/2016 <br />06/04/2017 <br />PROPERTY DAMAGE $ <br />(Peracdden0 <br />X HIREDAUTOS X NON OWNED <br />ONLY AUTOS ONLY <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />PER <br />STATUTE <br />OTHER $ <br />D <br />ANY PROPRIETOR/PARTNER/ Y/N <br />EXECUTIVE OFFICER/MEMBER <br />EXCLUDED? (Mandatory in NH) <br />N/A <br />Y <br />9150620-2016 <br />01/11/2016 <br />01/11/2017 <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE 1,000,000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,000 <br />If yes, describe under DESCRIPTION OF <br />OPERATIONS below <br />D <br />PROFESSIONAL LIABILITY <br />Y <br />RTP0004928 <br />01/10/2016 <br />01/10/2017 <br />Aggregate limit: <br />3,000,000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101, Additional Remarks Schedule, may beattached if more space is required) <br />Location: 3655 TORRANCE BLVD STE 430, TORRANCE, CA 90503 <br />Certificate holder, ("City of Santa Ana Its Council Members, Commissioners, officers, employees and agents.") are named as additional insured in regards to <br />General liability. `10 days notice of cancellation for non payment. <br />CERTIFICATE HOLDER CANCELLATION <br />THE CITY OF SANTA ANA, SHOULDANYOF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />ATTN: Purchasing Department DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THEPOLICY PROVISIONS. <br />20 CIVIC CENTER PLZ AUTHORIZED REPRESENTATIVE - -f <br />ACORD 25(2016/03) ©1988-2015 ACORDCORPORATION. All Rights.Reserved <br />31-1769 11-15 The ACORD name and logo am registeeredplarks ofpACORD SEP 016 <br />(0)�� sY: <br />