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.41CC�]!?0°ATE � CERTIFICATE OF LIABILITY INSURANCE D08/02/2019 )
<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 INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the
<br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER CT
<br />Eddie Quillares Jr. rvONT CT ONACT
<br />Qulllaras _
<br />PHONE FAX
<br />State Farm Agency Ext): 71416.17.7150. tArG. No]; 7tQ 11„7MO
<br />EMAIL
<br />415 N. Broadway A DRl Ss.- addle eddi insu(attce.com
<br />a Santa Ana, CA 92701 INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: State Farm General Insurance Company5151 _
<br />INSURED DOWNTOWN INCORPORATED INSURER B:State Farm Fire and Casualty Company 2514
<br />204 E 4TH STE STE T INSURER C ;
<br />SANTA ANA, CA 92701-4668 INSURER D
<br />INSURER E
<br />INSURER F
<br />rnvr Dnr_oe !^CRTICI( ATF IUIIMRFR•7�RArn RFVIRION NIIMRFR-
<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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
<br />DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
<br />HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR TYPE OF INSURANCE ADD L SUBR POLICY NUMBER POLICYIYYY POLIO . EXP
<br />LTR
<br />LIMITS
<br />A GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />92-CE-Q933-0
<br />06/05/2019
<br />06/05/2020
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />$ 300,000
<br />WA f
<br />PREMISES tEa occurrence
<br />I CLAIMS -MADE X OCCUR
<br />MED EXP (Any one person)
<br />$ 5.000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />I
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />1 GE_N'L AGGREGATE LIMIT APPLIES PER:
<br />$
<br />X POLICY PRU I LOC
<br />A
<br />AUTOMOBILE LIABILITY
<br />El
<br />❑ 621 5237-F28-75
<br />0612812019
<br />1212812019
<br />COMB NED SINGLE WiT
<br />f£s acprSent)
<br />$
<br />BODILY INJURY (Per person)
<br />$ 1.000,000
<br />ANY AUTO
<br />BODILY INJURY (Per accident)
<br />$ 1,000,000
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS NOT OWNED OS
<br />YROFETM DAVA -E
<br />er rcident)
<br />$ 1,000,000
<br />Deductible
<br />$ 250
<br />_
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X OCCUR
<br />Y
<br />l Y
<br />92-CE-Q781-7
<br />06/05/2019
<br />06/05/2020
<br />EACH OCCURRENCE
<br />$ 1.000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION$ 10,000
<br />$
<br />B WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN 92-GA-H506-1 06/05/2019 06/05/2020
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICE/MEMBER EXCLUDED? Y❑ N / A
<br />(Mandatory In NH)
<br />WC LJMIT_ X OTH- _ 1,000,000
<br />.I.gR.'L LJMI.TS E,3_ —
<br />E L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br />If yes, describe under
<br />T IONS
<br />DFSCgIPTiQN OF OPERAbeow
<br />A FIDELITY BOND Y ❑Y 92-WV-6044-5 10/03/2018 10/03/2019
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />BOND -AMOUNT $ 500,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
<br />Scheduled Auto: 2002 GEM 825 PICKUP VIN: 5ASAK27492FO28166
<br />REVIEWED &APPROVED
<br />BY RISk MANAGEMENT DIVISION
<br />City of Santa Ana its officers , agents, employees and volunteers are named as additionally insured.
<br />Additional insured endorsement issued for certificate holder with waiver of subrogation and non-contributory.
<br />(1
<br />UG v 2 2019
<br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation
<br />A GA.Z
<br />V4-I141! Iv1"11 P-
<br />CITY OF SANTA ANA
<br />- ----- -- - -
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />RISK MANAGEMENT DIVISION
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA 4TH FL
<br />AUTHORIZED REPRESENTATIVE
<br />SANTA ANA, CA 92702
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<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012
<br />
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