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A� o® CERTIFICATE OF LIABILITY INSURANCE DAM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 2/05/M/OD/YYYY) 12/05/2017 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(ies) must have ADDITIONAL INSURED provisions or 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 CONTANAME: CT MELISSA WATANABE PHONE 714-580-6871 FAX No: 714-241-1790 MELISSA WATANABE INSURANCE AGENCY EDDRIESS: 17280 NEWHOPE., SUITE 6 INSURERS AFFORDING COVERAGE NAIC# FOUNTAIN VALLEY, CA 92708 1_ -2 2 r EACH OCCURRENCE $ 1,000,000 INSURERA: TRUCK INSURANCE EXCHANGE 21709 INSURED INSURER e: FARMERS INSURANCE EXCHANGE 21652 INSURER C: CARD INTEGRATORS CORPORATION INSURER D: DBA: CI SOLUTIONS 3624 SERPENTINE DRIVE A LOS ALAMITOS, CA 90702 INSURER E : N 6062345-06 INSURER F : COVERAGES CERTIFICATE NUMBER: 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. ILITR TYPEOFINSURANCE ADD SUBR2= POLICY NUMBER POLICY EFF MMIDDIYYYY LIMITS X COMMERCIALGENERALUABILPY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F_x1 OCCUR PREMISES EaEawnanca) $ 500,000 MED EXP (Any one person) $ .5,000 A Y N 6062345-06 06/06/201 06/06/201 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLI ES PER: GENERAL AGGREGATE $ 2000000 X POLICY JECT LOC PRODUCTS- COMP/OPAGG $ 1000000 $ OTHER: AUTOMOBILE LIABILITY COMBINdeEDSINGLEnt LIMIT $ 1,000,000 Ea acd BODILY INJURY (Per penton) $ ANYAUTO A OWNED ASCHEDULED AUTOS ONLY UTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 60623-45-06 06/06/201 06/06/201 BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIMB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERTLIABILITY YIN J PER OTH- STATUTE ER ANYPROPRIETOR/PARTNEWEXECUTIVE E.L. EACH ACCIDENT $ OFFICEWMEMBEREXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) H yes, descdhe under DESCRIPTION OF OPERATIONS belax E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more space is required) The City of Santa Ana, its officers, employees, agents, volunteers and r9loires7elsiltivers as additional insured(s) Als,� d I (# r(r b The City of Santa Ana 60 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORDs provided by Forms Boss. www.FormsBoss.com; (c) Impressive Publishing 600-208-1977 7 'sus: