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01 <br />ACORV CERTIFICATE OF LIABILITY INSURANCE <br />s%zn%2oie ' <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 poilcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder In Ileu of such endoreement(a). <br />PRODUCER <br />Speed Insurance Agency <br />1000 Town Center Dr #100 <br />Oxnard, CA 93036 <br />ONTACT <br />PHONE F <br />a ,yGNa.(805)604-9603 <br />s,su annel0 pensda <br />ADOREss:suzanne@apeadagency.net <br />INBURER(e) AFFORORKi COVERAGE <br />NNti <br />INSURERA: Intagon National Insurance Company <br />29742 <br />INSURED US National Corp <br />INSURER B <br />dba Jimenez Painting Company <br />INSURER C: <br />10205 San Fernando Road <br />INSURER D: <br />Pacoima, CA 91331 <br />INSURER E: <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTTRR <br />TYPE OF INSURANCE <br />a0 <br />p <br />I POLICY NUMBER <br />IAWDD <br />MM/DD <br />LIMITS <br />M MERCML Gf L "ILITY <br />CLAP78-MADE ❑OCCUR <br />EACH OCCURRENCE <br />$ <br />PREMISEES Ea ocaxrase <br />$ <br />MED EXP (Any. person) <br />It <br />PERSONAL a ADV INJURY <br />It <br />GENT AGGREGATE LIMIT APPLIES PER: <br />POUCY 0 jECOT- LOC <br />OTHER: <br />GENERAL AGGREGATE <br />It <br />PRODUCTS - COMP/OP ADD <br />It <br />It <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANYAWO <br />OWNED D <br />AUTOSONLY R SCHE AUTO$ULED <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />2003917069 <br />06/03/2036 <br />O6/03/2D19 <br />En ecddent) <br />$ 1 OOO OOO <br />r r <br />]( <br />SODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per acident) <br />$ <br />X <br />R <br />IP.r.crcentj <br />$ <br />s <br />UMBRELLA UAB <br />EXCESS LAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEB I I RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOPIPARTNEWIDECUTIVE <br />OFMCERMIEMMet FJ(CLlAm1 ❑ <br />(Meeaerery In WE <br />If Yee, describe Lester <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />It <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Sc Iedele, may be attectred if more space is required) <br />10 day notice of cancellation for non-payment / <br />-2v l i)Z� <br />City of Santa Ana <br />20 Civic Center Place M-16 <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />reserved <br />ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD <br />