GREATER SANTA ANA VITALITY FOUNDATION - SANTA ANA CHAMBER OF COMMERCE (3)

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A� � CERTIFICATE OF LIABILITY INSURANCE °11122/zo 7 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(les) must be endorsed. If SUBROGATION I$ WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not center rights to the certificate holder In Ileu of such endoraement(s). PRODUCER Eddie Quillares Jr. State Farm Agency 415 N. Broadway NAME: Eddie Quillares Jr. INCN.. Ex .714.81 .7150. 0 Not: 714.617715$ E-MAIL _ MAIL s eddle@eddleglnsurance.cpm__._____ Santa Ana, CA 92701 INSURERSI AFFORDING COVERAGENAIC4 INSURERA: Slate Farm Fire and Casualty Company 5143 ,.,,.,, INSURED The Greater Santa Ana Vitality Foundation INSURER B: INSURER C: 1631 W. Sunflower Ave STE C35 INSURER 0: Santa Ana, CA 92704 INSURER E: ATTN: Marty Patterson PRODUCTS - COMP/OP AGO $ 2,000,000 $ INSURER F: COVERAGES CERTIFICATE NUMBER: 75.0450 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, ILTR TYPE OF INSURANCE AO Santa Ana, CA 92701 POLICYNUMBER POLICY EFF MMIODIYYYY) POLICY EXP fMM1DDNYCr.L LIMITS A BENERALLIABILITY %' COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR �Y 92-ERS754.4 11/11/2017 11111/2018 EACHOCCURRENOE $ 11000,000 PREMISES Be mcu ante $ 300,000 MED EXP (Any one person) $ 1,000 PERSONAL$ ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1JECTFRI LOU PRODUCTS - COMP/OP AGO $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL AUTOSNED AUTOSULED()$RPeraccitlon[ AUTOS X NON-OWNEDTY AUTOS ❑❑� ED SINGLE LI IT ent$ NJURY (Psgnl$ VETc' $HIRED DAMAGE &nl $ UMBRELLA LIAR I OCCUR EXCESS LIAR CLAIMS -MADE DEO '. 1 RETENTION$ ❑ EACH OCCURRENCE $ AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORAPARTNEMEXECUTNE YIN OFFICOMEMBER EXCLUDED? (Mandatory In NH) F Eyae, describe under QF11-1-111- I OPERATIONS behd� NIA ❑ E I WRTATU- OTH- 7 L T ER E.L. EACH ACCIDENT $ E.L. DISCASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORDIS1,AdtlHlonal Romerke Schetlule,ilmorespacelsraqulred) Additional Insured: /l The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; It officers, employees, agents and representative are named as additional Insureds ("additional Insureds") with regard to liability and defense of sults arising from the operations and uses performed by or on behalf of the named insured. J l _ CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE © 1998.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01.2012