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V CERTIFICATE OF LIABILITY INSURANCE DATE (13120Y 7 06!13!2017 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(les) 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 O415 N. Broadway ASanta Ana, CA 92701 pa°M Eddle Quillares_ _ _ PnnrpN,Na..EF P 714.617.7i¢4_._.._ _ a NoL714,617.7155� &MAIL ADDRESS eddie�Wedtlleginsurancecoin_.___._ NSURERlSZAFFORDING COVERAGE NAIC# INSURER A: State Farm General Insurance Company 151 INSURED DOWNTOWN INC INSURER B: State Farm Fire and Casualty Company 2614 INSURER C: EACH OCCURRENCE 200 N MAIN ST FL 2 INSURER D: $ 300,000 SANTA ANA CA 92701 X COMMERCIAL GENERAL LIABILITY INSURER F: CLAIMS -MADE 7OCCUR 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 18SUED 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. IN$R LTR —____..- TYPE OFINSURANCE ADDEs BR PtlLICV NUMBER PGLICY EFF MM/DDIYYYY POLICY EXP MMI /YYYY _..___..._«._.. LIMITS A GENERALLIABILITY Y Y 92 -CE -Q933.0 06(0512017 06/0612018 EACH OCCURRENCE $ 1,000,000 PREMISES Lao DA AGETO w ce $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7OCCUR MEDEXP(Anydneperaon s 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,0_00,0_00 PRODUCTS -COMPIOP:AGO _ $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY PEOT LOC $ AUTOMOBILE LIABILITYCO BINEO. SING _ LIMI Ea acolden> $ BOD6.Y INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident} $ NON -OWNED _ P OPERTY.DP.MAGE __- HIRED AUTOS AUTOS Per accltlenl $ _ $ A X UMBRELLA LIARMCOCC UR Y Y 92 -CE -Q781-7 06/06/2097 06105(201$ EACH OCCURRENCE .- $ 1,000v000 _.._._ EXCESS LIABMS-MADE AGGREGATE $ 2,000,000 DED i< RETEN10,000 $ B WORKERSCOMPENSATION AND EMPLOYERS'LIABILITY 9&EK-X669.4 06105/2017 061051201$ I WCSTATU- X 0TH- T Y Ir _ 1,000,000 E.L. EACH ACCIDENT _ $ 1,000,000 YIN ANY PROPRIETORIPARTNEMEXECUTIVE � N/A ^ ll y l —' E.L. DISEASE - EA EMPLOYEE $ 1,000,000_ OFMCEIMEMBER EXCLUpE07 (Mandatary in NH) C.L. 121SEASC-POLICY LIMIT $ 1,000,000 I ESCRIPTIOeunder N FQPFRA71r)IQ9hN.. 11 A FIDELITY BOND Y Y I 92 -WV -60445-F 10/03/2016 1010312017 BOND -AMOUNT $ $Dooco DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES (Apach ACORD 101, Additional Remarks Schedule, if more space IS regUired) City of Santa Ana Its officers, agents, employees and volunteers are named as additional insured. Additional Insured endorsement issued for certificate holder with Wavier of Subrogation and non-contributory 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 SANTA ANA, CA 92702 ACCORDANCE WITH THE POLICY PROVISIONS. ATTENTION RISK MANAGEMENT AUTHO IZED NETRESENTA IVE BRIZA MORALES 67 1 988-201 0 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012