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A-2o115 •o47 • of <br />. ';' <br />i\�•���c= <br />�.r.� CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYVJ <br />12/10/2018 <br />THISCERTIFICATE 15ISSUED ASA MATTEROF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THECERTIHCATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELYOR NEGATIVELY <br />AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OFINSURANCE DOES NOT CONSTITUTEACONTRACTBETWEENTHELSSUING INSURER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If thecertificatehoider isan ADDITIONALINSURED, Ulepolicy(ies) musthave ADDITIONALINSUREO ProAsionsor beendorsed. If SUBROGATION IS WAIVED, subject1mtmbvmI <br />conditirma of the pol'Iry, certa in po l is ies may "tureen endorsement A st ate ment on th is ce rb fieate does rmt co nfer rights to Me eeNl fiwte ho lder in lieu of such endomemerlt(s). <br />PRODUCER <br />CONTACT <br />NAME: Michael Brandon <br />Michael Brandon Insurance Agency <br />PHONE <br />31629 Outer Hwy 10 S. <br />WC, NO, EXT): 90949"191 <br />I (a C/ , No): 909-794-8193 <br />Suite A <br />Redlands, Ca. 92373 <br />E-MAIL <br />ADDRESS: mbrandon@farmersagent.com <br />INSURER(S)AFFORDINGCOVERAGE <br />NAIL# <br />INSURED <br />INSURERA: Northfield Insurance <br />INSURERS: AIG Insurance <br />I WATER INC. <br />12 GOODYEAR STE 130 <br />INSURERC: Mid Century Insurance Company <br />--- <br />21687 <br />INSURER D: <br />IRVINE CA 92618 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVEBEEN ISSUED TO THE INSURED NAMEABOVE FORTHE POLICY PERIOD INDICATED. NOTWRHSTANDINGANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WDH RESPECT TO WHICH THIS CERTIFICATE MAY BEISSUED OR MAYPERTAIN, THE INSURANCE AFFORDED BY THE <br />POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONSAND CONDUIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPEOFINSURANCE <br />ADDTL <br />INSD <br />SUER <br />WVO <br />POUCYNUMBER <br />POLICY EFF <br />(MM/DD/YYYY) <br />POUCYEXP <br />(MM/DD/YYYY) <br />LIMBS <br />A <br />X <br />COMMERCIALGENERALUABILRY <br />CLAIMSd,N1DE OCCUR <br />Y <br />VVHG06655 <br />10/27/2018 <br />10/27/2019 <br />EACHOCCURRENCE <br />$ 1,000,00 <br />DAMAGETORENTED <br />PREMISES(E. Occurrence) <br />$ 100,00 <br />MEDEXP(Anyoneperson) <br />$ 5,00 <br />PERSONAL&ADVINJURY <br />$ 1,000,00 <br />GENT AGGREGATELIMITAPPLIES PER: <br />POLICY O PROJECT ❑ LOC <br />OTHER: <br />GENERALAGGREGATE <br />$ 2,000,00 <br />PRODUCTS -COMP/OPAGG <br />$ 2,000,00 <br />$ <br />C <br />AUTOMOBILELIABiUTY <br />ANYAUTO <br />OONNEDAUTOS X SCHEDULED <br />HIREDAUTOS X NON -OWNED <br />ONLY AUTOSONLY <br />Y <br />05861643 <br />09/04/2018 <br />09/04/2019 <br />COMBINED SINGLE LIMN <br />(Ea accident) <br />$ 1,000,00 <br />BODILY INJURY (Per perm.) <br />$ <br />BODILY INJURY(Peraccitlem)3 <br />PROPERTY DAMAGE <br />(Peracadem) <br />$ <br />B <br />UMBRELLAUAB <br />EXCIMLUB <br />X <br />OCCUR <br />CLAIMS -MADE <br />EBU017518628 <br />10/27/2018 <br />10/27/2019 <br />EACHOCCURRENCE <br />$ 4,000,00 <br />AGGREGATE <br />$ 4.000,OOC <br />DEED RETENTION$ <br />$ <br />WORKERSCOMPENSATION <br />ANDEMPLDYERS'LIABILITY <br />ANYPROPRIETOR/PARTNER/ Ylx <br />EXECUTIVE OFFICER/MEMBER <br />EXCLUDED?(Mandatory in NH) <br />Ifyes, des nbe under DESCRIPTION OF <br />OPERATIONSIEd. <br />N/A <br />PER <br />STATUTE <br />OTHER <br />$ <br />E.LEACHACCIDENT <br />$ <br />E.L. DISEASE- EA EMPLOYEE <br />EL DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES(ACORD 101, Additional Remarks Schedule, may beattached Emeespaceis regVu�¢j ""^ <br />Additional Insured: City of Santa Ana IhgY/LL/ <br />U <br />Is-/llf 1l?,/ P4j" I o f 3 <br />CERTIFICATEHOLDER CANCELLATION <br />i—ty OfSanta Ana SHOU OFTH V SCRI D LICIESBECAN LED BEFORE THE EXPIRATION <br />20 Civic Center Plaza .N BED D ce WDHTHE POLICY PROVISIONS <br />Ross Annex (M-1) AUTH IZE <br />Santa Ana, CA 92701-40511 <br />ACORD 25(2016/03) <br />37-1769 11-15 <br />01988-2015 ACORD CORPORATION. All Rights Reserved <br />The ACORD name and logo are registered marks ofACORD <br />