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7 ® DATE (MMIDD/YYYY) <br />'�� — CERTIFICATE OF LIABILITY INSURANCE 8/20/2019 <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 pulicy(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 endorsement(s). <br />CONTACT <br />PRODUCER NAME: Paul Romero <br />PHOC <br />ROMERO INSURANCE AGENCY W, NO. <br />o ExI: 805-582-4C,55 A)C, INC) <br />IUN <br />1 197 E. LOS ANGELES AVE. UNIT C199 ADDRESS: romaroins(aaol.com <br />INSURER(S) AFFORDING COVERAGE NAIC p <br />SIMI VALLEY CA 93065 INSURER A: SCOTTSDALE INSURANCE CO. <br />INSURED INSURER B : CALIFORNIA AUTOMOBILE INS. CO <br />MAJOR LEAGUE INFIELDS INC INSURER C : ICW GROUP <br />508 E. CHAPMAN AVE INSURER D : <br />INSURER E: <br />FULLERTON CA 92832-2015 INSURERF: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THATTHE 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 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 />R TYPE OF INSURANCE INSO WVd POLICY NUMBER MMIOOIYYYY MMIDDIYYYY LIMITS <br />COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br />CLAIMS -MADE FxI OCCUR PREMISES IEa uu:errgnco $ <br />A <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />1-1PRO- <br />POLICY JECT <br />OTHER: <br />AUTOMOBILE LIABILITY <br />x ANY AUTO <br />B OWNEDTOSCHEDULED <br />AUS ONLY AUTOS <br />HIRED Px <br />NON -OWNED <br />tC AUTOS ONLY AUTOS ONLY <br />UMBRELLA LIAB OCCUR <br />EXCESS LIAB CLAIMS -MADE <br />RETENTION $ <br />Y I Y I CPS3179689 <br />Y I I BA040000025174 <br />AND EMPLOYERS' LIABILITY YIN <br />NY P110PRIETORIPARTNERIERECUTIVE ❑ NIA Y W SA504570200 <br />C 0FFFICFRIMEMBER EXCLUDED? <br />JMnlidatory in NH) <br />II yes. describe under <br />171. 'RIPTIONOFOPERATIONSbelow <br />07/l/19 <br />07/01/20 <br />MED EXP (Any one porson) $ <br />PERSONAL &ADV INJURY $ <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMP/OPAGG $ <br />$ <br />12/22/2018 <br />12/22/2019 <br />F� occrdenl $ <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />(Pararcldono $ <br />EACH OCCURRENCE $ <br />AGGREGATE Is <br />$ <br />01/01/19 01/01/20 E.L. EACH ACCIDENT is <br />E.L. DISEASE - EA EMPLOYEE $ <br />E.L. DISEASE - POLICY LIMIT $ <br />2,000,000 <br />100,000 <br />5,000 <br />2,000,000 <br />3,000,000 <br />3,000,000 <br />1000000 <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS RESPECTS TO THE OPERATIONS OF TI F, NAMED INSURL'D. WITH RESPECT TO CLAIMS <br />ARISING OUT OF THE OPERATIONS PrRFORMED BY OR ON BFHALF OF THE: NAMED INSURED, SUCH 1NSURANCI, AS 1S APFORUED' A THIS POLICY IS <br />PRIMARY AND NOT ADDITIONAL TO OR CONTRIBUTING WITH ANY OTHER INSURANCE CARRIED BY OR FORTH[; BENEFIT OF THE; DDI"I'IONAL <br />INSURED. 10 DAY NOTICE FOR NON PAYMENT OF PREMIUM, 30 DAY PRIOR WRITTEN NOTICE OF CANCELLATION REVIEWED & APPROVE L <br />By Risk MANAGEMENT DIVISI( N <br />CERTIFICATE HOLDER <br />CITY OF SANTA ANA RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA, 4TH FLOOR <br />SANTA ANA, CA 92702 <br />ELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED <br />THE EXPIRATION DATE THEREOF, NOTICE VAU <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />