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

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"� �® CERTIFICATE OF LIABILITY INSURANCE DATE 11/22/2017ry1 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(ies) 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 g y Eddie Quillares Jr. State Farm A enc CONTACT NAME: Eddie Quillares Jr. PNONE 714617.7150. Ae No: 714.617.7158 415 N. Broadway O Santa Ana, CA 92701 A aooaless: eddie eddie insurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: State Farm Fire and Casualty Company 25143 92 -ER -S754.4 INSURED The Greater Santa Ana Vitality Foundation INSURER B: INSURERC: 1631 W. Sunflower Ave STE C35 INSURER D: Santa Ana, CA 92704 ATTN: Marry Perterson INSURER E: DAMAGE 10 KLNTE—D PREMISES Ea occumence $ 300,000 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF (MMa]DrYyYYI POLICY EXP MWDDNYYYl LIMITS A GENERAL LIABILITY[y]❑ 92 -ER -S754.4 11/11/2017 11/11/2018 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE 10 KLNTE—D PREMISES Ea occumence $ 300,000 CLAIMS -MADE OCCUR MED FXP(Any one person) $ 1,000 PERSONAL &ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,000 POLICY PEO, LOC1 1$ AUTOMOBILE LIABILITY ❑ F-1 COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS S AUTO BODILY INJURY (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Pe.... actltlent $ $ UMBRELLA LIAR H OCCUR [:]Fl EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOMPARTNEMEXECUTIVE❑ WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ OFFICOMEMBER EXCLUDED? NIA F-1 E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) E.L. DISEASE -POLICY LIMIT 1 $ If yes, DESCRIPTI NOF OPERATIONS heb, antler 1-11-1 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 performed by or on behalf of the named insured. / CERTIFICATE HOLDER CANCELLATION Cil of Santa Ana Ty SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE �Q/Qi of� 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012