GARCIA, CLAUDIA - 2017 - Laserfiche WebLink

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CERTIFICATE OF LY CHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN[ BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITL REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. INPORTANT: If the certificate holder is an ADDITIONAL -INSURED. the I terms and conditions of the policy, certain policies may require an ei certificate holder in lieu of such ondorsement(s), ........ Eddie Quillares Jr, State Farm Agency 415 N, Broadway W Santa Ana, CA 92701 INSURED Claudia Garcia 125 N Broadway Santa Ana, CA, 92701 I DATE (MMMWYYYY) BILITY INSURANCE 1 0510312017 .Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THiS , EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES TE A CONTRACT BETWEEN THE ISSUING INSIURER(S), AUTHORIZED Iollcy(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to the dorsement. A statement on this certificate does not confer rights to the NAWI CT FddieQuillares PHONE _wQ,AQ,Exth2_14617.71 50,/C_hLq ____LL L714 617 7158 E-MAIL A .APPI`CESSL�eddie ed#e(linsurance.corn NAIL -INSgRER -INSURER-B: INSURER q INSURER0 .............. -INSUREFIE-: . . . . . . ..... ... INSURER F - .-M I � Ivulwor-r-'; fo.U4aU REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF —INSURANCE LISTED 13ELOW 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 W-11CH 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. INSR DL LTRTYPE OF INSURANCE POLICY NUMBER LICYEFF _ji_0L1CY_--'' A GENERAL LIABILITY _(MM100!L0=I IMMIDOffYYYI LIMITS Y 92 -EX -K512-8 05/06/2017 06/0612017 EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY _DA%%T7UAMqTEU F:71 PREMISES (Ea=gMtnC* $ 300,000 CLAIMS -MAIL-'. OCCUR J __ MEnFXP (Any page Person) $ 5,000 PERSONAL, & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000'000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP-AGG $ 2=0'000 POLICY LLOC $ AUTOMOBILE LIABILITY COM IN D S$N LF LIMIT ft ANY AUTO BODILY INJURY IPer Person) AUTOS ALL OVOTED SCHEDULED f, ALI'or BODILY INJURY LPeraccident) $ NON-OVNED HIRED AUTOS AUTOS UMBRELLA LIAR $ OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE r $ AGGRECIATE 1_DED RETENTION $ WORKERS COMPENSATION DTH - ANO EMPLOYERS'LABILITY WC STATU _JffSTATffIl- RY LIM ANY PROPRIETORIPARTNERIEXECUTIVE YIN Y U ER OFFICEIMEMPER EXCLUDED? NIA E.L EACH ACCOENT $ fMandatory in NH) E.L. DISEASE - EA EMPLOYE 1. S If yes, desc6be under E.L. _..DEr1CR 2TION Or OPEHADQUS tInlow . . . . ........ . DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS lVEHICLES (Attach ACCRO 101, Additional Remarks Schedule, if more space Is required) Cinco De Mayo Celebration in Downtown Santa Ana, Claudia Garcia will perform at the Main Stage on 4th/Bush during the hours of I pm - 3pm, THE CITY OF SANTA ANA, IT'S OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVE ARE NAMED ASADDMONAL INSURED IWREGARDS TO GENERAL LIABILITY PER ATTACHED EXHIBIT B ADDITIONAL INSURED FORM. CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA 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 RVE A�R_FPRESENTATIVE AU7rHOR17 SONIA BATRES @1988-2010 ACORD CORPORATION. / 11All rights reserved. ACORD 25 (2010105) The ACORD name and logo are regis"tered mdyks of AC16RO" 1001486 132849.7 03-01-2012