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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 9/14/2017 __ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 7HE 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 CONTACT Keiko MOchina a NAME: 9 Aegis Risk Management Insurance Services, inc. CA License 0735928 PHONE ,(310)793-1309 1FAx Nom:. -MAIL (310)993-1314 ADDRESS: keiko.mochinaga@aegisrm. corn 3424 Carson Street Suite 300 INSURER(S) AFFORDING COVERAGE NAIC# _ INSURERAMitSni Sumitomo Ins Co of Amer _ 20362 Torrance CA 90503 INSURED INSURERBMitSUi Sumitomo Ins USA Inc. (Aioil_ INSURERC: Boyu America Co., DBA: Samy Company MED EXP (Any one person) 6265 Phyllis Dr. INSURERD: X INSURER E INSURER F: 19/1/2018 Cypress CA 90630 COVERAGES CERTIFICATE NUMBER:EVENT: GL (No PL) AUTO WC 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. INSR ADOL SUBR'. POLICY EFF POLICY EXP LTR TYPE OFINSURANCE IN WVO'. POLICY NUMBER MMIDDIYYYY MMIDDIYYYYLIMITS R NNOTICE WILL BE DELIVERED IN X COMMERCIAL GENERAL LIABILITY VISIONS. '.,. EACH OCCURRENCE__ $ 1,000,000 A 1. CLAIMS -MADE 1-36 OCCUR _ DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 X PKG3126680 9/1/2017 19/1/2018 PERSONAL &ADV INJURY $ 1,000,000 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 GEN X POLICY PRO- ECT❑ LOC PRODUCTS - COMP/OP AGO $ OTHER: $ AUTOMOBILE - _ LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS - BVR8406337 9/1/2017 9/1/2018 BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE _(Peraccidenl)_ $ _. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ $ EXCESS LIAR CLAIMS -MADE AGGREGATE DED RETENTION$ -_— $ 8 iWORKERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVENIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) I.If yes, describe under WCP9112657 '.. 9/1/2017 X PER OTH- STATUTE ER EL EACH ACCIDENT — - 9/1/2018 E.L. DISEASE - EA EMPLOYEE — $ 1,000,000 ---- -- --- - $ 1,000,000 --- — . DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space Is required) The City of Santa Ana, its officers, employees, agents, and representatives are Additional Insured for Commercial General Liability when required by written contract per endorsement MS6401 05 15 with respects to the named insured's participation at The City of Santa Ana, 20 Civic Center Plaza, Santa Ana CA 92701 - Fiestas Patrias for the period 9/16/2017 to 9/17/2017. The Commercial Be Liability olicy is primary and noncontributory per endorsement MS 64108 05 15. This certifi-rhk$ upersede ny certificate previously issued. �j\QiVV�� ®\1 CERTIFICATE HOLDER CANCELLATION . ri. ACORD 25 (2014101) INS02519014nn ©1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE AS 1(�?OLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION R NNOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE W THE VISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE Kiku Yenny/RENE ACORD 25 (2014101) INS02519014nn ©1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD