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ACCO m CERTIFICATE 4F LIABILITY INSURANCE Fa" t,,1ztoft8 <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 INSURERS), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and c9ndiborm of the policy, certain policies may require an endorsemeaL A va'tement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsemont(s). <br />PRODUCER <br />St.teh-= KIM FORSYTH INSURANCE AGENCY, INC. <br />$02 AVENIDA TALEGA, SUITE 106 <br />SAN CLEMENTE, CA 92673 <br />LN$URED <br />MONICA SIMPSON A LANDSCAPE <br />ARCHITECT CORPORATION <br />305 N COAST HWY STE T <br />LAGUNA BEACH CA-1651-1681 <br />949-356.0320 <br />Idm oold(womyth.com <br />INSURER A: State Farm Fire'and Casualty Company <br />INSURER i - State FArm A OAI Automobile Insurance Cam <br />INSURER Ee-- <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />949-36&3322 <br />26179 s <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOT%AfMSTANDING ANY REQUIREMENT, TERA1 OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VM'H RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFMDED BY THE POLICIES DESCRIBED HEREIN IS SU13JE-CT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LRAITS SHOWN IUTAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />1N5R , --,__-TYPEOF{NSURANCE �'--� ( N att 0D/YEFF Y l L1CYEXP LIMITS <br />COMMERCIAL GENERAL. LIAel MY <br />f CLAIMSA1PAE OCCUR <br />1 <br />EACH OCCURRENCE <br />Cr�4 Z:Ert0RE:� '��- <br />S 1,000.000 <br />' , <br />MED ExP µm arm parsm) <br />S 5,000 — <br />pF.RSONAL4,AWINJUR1r <br />s I'DwAw <br />A <br />Y <br />92-CD-K584-0 <br />()41047015 <br />04104l2019 <br />GEAMA^w.OFMCATELIMIT APPLIESPER <br />VOUCY Qipe%El LOC <br />GENERAL AGW4ATE <br />5 ZDDDA <br />FRODUCM-COW"WAGG <br />5 Z000=1 <br />S <br />OTHEk <br />AUTOMGBIALIMILrTY <br />- <br />44"57S-008•i5C <br />09;031V18 <br />r�3,0,812}19 o ;ram _L <br />— <br />s 1,000,WD <br />ANY AUTO <br />f aOpILY IkJIAtY Lhar Pasm+1 <br />S <br />B <br />AAJTOOWNED SCHEDULED <br />AUTOS ONLY ppUT N <br />HIRED NONI7NNED <br />AUTO$ONLY AUTCS ONLY <br />800ILY INJLRY IPeraa 09M <br />r pRAPERIY 5w.1AGE <br />S <br />S <br />UMYRELLALMt6 O=F, <br />ETCH OCCURRENCE <br />S <br />S <br />BxCESS L1TRfi CLAIMS-%%A..r <br />DED I R_,DMONS <br />AGGREGATE <br />VIORNFRS COMPENSAUM <br />AND 91SP.OY07 UA5%JJy Y1 R <br />ANY otG*rLTLTC,A,?ARTN,;h :XCMTW- <br />CFFICERVEMBTRM-LU EM <br />NIA <br />A <br />. <br />EL HI SCQ7ENr <br />.. -. <br />g <br />S <br />_. <br />1 $ <br />IMWntlsbory bft NMi <br />ar 11 yet. desvibau+!D <br />DESCRIPTI4N CF UPERA71pALS b4aw <br />E L D6EASE. EA EMPLOYE <br />_.z <br />F.L DLSEASE- POLICY LILUT <br />OESCRr-T1ON OF OPFRATIONS t LOCATIONS 1 VENICLES (ACOM 101, Additicr,al :temarka Schedule, nay Lx at=.ichad i!.M m xpaca is moy"d) <br />) <br />REVIEWED BY: EUNICE HEREDIA (PG ' OFZ/ lei <br />vm i trig-m i r, n�jwctc <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 927U1 <br />SHOULD ANY OF THE ABOVE MOROW POLICIES 9E CANCELLED BEFORE <br />THE EXPIRATION LATE THEREOF, NOTICE WILL BE DIELIIVERED IN <br />ACCOROANCE WITH THE POLICY PROVISIONS. <br />UTMoRM NEPRFS€NTATIVE <br />0198$-2019 ACORB CORPORATION. All rirrhtc ea= <br />ACORD 25 (2016103) Tna ACORN flame and logo are registered maAs of ACORD <br />10014M 122B4912 C`a�IB,'Atilt <br />