GREATER SANTA ANA VITALITY FOUNDATION - SANTA ANA CHAMBER OF COMMERCE-2016

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`` " CERTIFICATE OF LIABILITY INSURANCE D11/11/20 6W) 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(los) 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 Eddie Quillares Jr. State Farm Agency 415 N. Broadway Santa O StAna, CA 92701 CONTACT NAME: Eddie QUlllares Jr. PNGNE 4.617.7150. ac No: 714.617.7 EMAIL AODREss: eddie eddie insurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: State Farm Fire and Casualty Company 25143 INSURED The Greater Santa Ana Vitality Foundation 1631 W. Sunflower Ave STE C35 Santa Ana, CA 92704 ATTN: Marty Perterson INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 75-0450 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 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTypE LTR OF INSURANCE ''. ADDL SUBR POLICY NUMBER POLICY EFF MMIDDInYYY POLICY EXP fAMIDDIYYYYj LIMITS A GENERAL LIABILITY Y ❑ 92 -ER -5754-4 11I11I2016 11/11/2017 EACHOCCURRENCE$ 1,000,000 X COMMERCIAL GENERAL LIABILITY D DAMMAGEAGE TTOO RE D PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 1,000 CLAIMS -MADE F–I OCCUR PERSONAL$ ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 SENT, AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AEG $ 2,000,000 POLICY PES LOC $ OMOBILE LIABILITY ❑❑ COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO '.. q ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR El EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE LED I I RETENTION$ I $ WORKERS COMPENSATION WC STATU- OTH - AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEIMEMBER EXCLUDED? � NIA E-1 TORY UMTSER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses 2�D performed by or on behalf of the named insured, IA J City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2010/05) ,nacLea��evL•Jcl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE (d) 19RR-2010 ACnRn rierhlc r ... n,.A The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012