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ACO oa/o2//201 CERTIFICATE OF LIABILITY INSURANCE DATE (M) 019 s 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dori Jared-Ferranto Assistance Insurance Agency PHONE (714) 245-2777 FAX (714) 245-2788 MC No Et : APC No 123 E. 9th Street E-MAIL S: djared�assistantx3ins-oom _ADDRE Unit 314 INSURERIS) AFFORDING COVERAGE NAIC # Upland CA 91786 INSURERA: State Compensation Insurance Fund INSURED INSURER B : Manuel Huante, DBA: Stage Plus, Inc. INSURER C : 2330 S. Susan St. INSURER D : INSURER E : Santa Ana CA 92704 INSURER F : r'OVFRArrA r.FRTIFI('ATF NIIMRFR• 19-20 WC REVISION NUMRER- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. 1L7R TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD�Y LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE 1-1 OCCUR PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OPAGG $ $ OTHER; 1 AUTOMOBILE LIABILITY COMBINED SINGLE UMFF Ea accident $ BODILY INJURY (Per person) ANYAUTO $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE s AGGREGATE EXCESS LIAB CLAIMS -MADE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIR/PARTNERIEXECUTIVE OFFICER/MEMBMB ER EXCLUDED? (Mandatory in NH) NIA 1786318-19 05/01/2019 05/01/2020 PER OTH- STATUTE I IER $ 1.000,000 EL EACH ACCIDENT E.L DISEASE- EA EMPLOYEE $ 11000.000 it yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) By RISk MANAGEMENT DIVISION The City of Santa Ana, its officers, employees, agents, volunteers and representatives Proof of Insurance (� O �a z,_ FRANCINE R. VILLAREAL LLKlit-[ :AIL HULLlth( City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CA 92702 I Z�1d4G rcl 4QRR-9n15 ACORr1 ('ORPORATION All rinhtC rPCPmarl ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD