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Phone:(949)743-4396 <br />o® CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MmmomvY) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER 1 THIS <br />CERTIFICATE DOER 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: Othe certificate holder is an ADDITIONAL INSURED, the policy1 ie moat have ADDITIONAL INSURED provisions or he 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 coMer rights to the certificate holder in IIaU of sneH <br />AA Lares Insurance Services, Inc. <br />NRMEpC <br />Gahy Chevlre <br />1163 N. Tustin St. <br />PNCNE 1s 2es B Do - <br />-(�G'-!%g,u1 � �AIC, (714)28B-2873 <br />Orange, CA 92867 <br />A(MMESS: <br />NRI: <br />gchavira@laresinsumnce.com <br />License #: OD99282 <br />INSURERIS) AFFORDING COVERAGE NAII <br />INSURED <br />INBURER A:.._ <br />_ L bertv �t{ -- <br />ai Insurance <br />Geraldine Valencia <br />INSURER e: <br />"— <br />A: GStars Dance and Gymnastics Academy <br />INSURER C: <br />—----------- — <br />2 W Park Central Ave <br />PISURERD: <br />— <br />Orange, CA 92868-4917 <br />INSURER E. <br />— <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, <br />E BEEN ISSUCONED TO THE INSURED NAMED ABOVE FOR THE <br />TERM <br />POLICY <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br />EXCLUSIONS AND CONDITIONSSUCH <br />OR CONDITION ANY <br />THE INSURANCE AFFORDED BY THE POLICIES D SCRSED CT OR OTHER HERE NE 5 SUBJECT <br />POLICIES. <br />PERT( <br />TO <br />TERMS, <br />_OF <br />iSR <br />TO ALL <br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />THWHICH <br />TYPE OF INSURANCE <br />R <br />POLICYNUMBER - M LICO�YEFk MMIODAnOP <br />A �( COMMERCIAL GENERAL LIABIUtt <br />y BKW60622486 QMIrs <br />_. CLAIMS.MpDE I X I OCCUR <br />01101/2020 01I0112021 EACHOCCURRENCE <br />-W,7AAOETO-RERfED..—. <br />$ t,a <br />.� <br />MIR EXPIMyoMPeTsgn <br />s — <br />GENLAGGREGATELIMRAPPUESPER <br />PERSONALS ACV INJURY <br />S 1.O <br />X POLICY _ JE,% L... _ LOC <br />GENERALAGGRE_GATE <br />$ 410 <br />OTHER: <br />PRODUCTS-COMP,OPAGG <br />I3 20 <br />AUTOMOBILE LIABILITY <br />BUSIOBss Pro e <br />E <br />ANY AUTO <br />(2 a¢N 81 G UMR <br />tl .._. <br />S <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Pa pgraeR) <br />S -- <br />HIRED AUTOSO ONLY <br />AUTOS ONLY AUTOS ONLY <br />BODILY INJURY lPe gcdtlgntl <br />TD9XUf�— <br />E <br />_— <br />_ 11�BPECGNtl <br />--- <br />S <br />UMBRELLA LIAR OCCUR <br />y�EXCESSUAS <br />S -- <br />__CLAIMSMADE' <br />I EACH OCCURRENCE <br />S___ <br />DEC RETENTION <br />AGGREGATE— <br />S <br />WORKERS COMPENSATION <br />S <br />AND EMPLOYERS' LABILITY <br />ANYPROPRIETORIPARTNENEXECUTIVE YIN <br />OFFTCERIMEM9ER EXCWOEDT <br />ATUTE <br />NIA <br />(Ma-daMory In NH) <br />EL EACH ACCIDENT <br />$-- <br />DESCRIPTION OF OPERATONS I LOCATIONS? VEHICLES (ACORD IOI, Adtlillonal R..I. echetlule, may be mmched irmore apRw b roqtl City of Santa Ana, officers, agents, employees, and volunteers are named as additional insuulrerods) on this policy pursuant to <br />written contract, agreement, or memorandum of understanding. Such insurance as Is afforded by this policy shall be primary, <br />and any Insurance carried by City shall be excess and noncontributory. <br />& APPROVED <br />City of Santa Ana I U SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.TION DATE THEREOF, NO nCE BE DELIVERED IN <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 AUTHOM D RIEPPYESTITIVI <br />ACORD 25 (2018I03) <br />®1988.2015 ACORD CORPORATION. All rights reserve The ACORD name and logo are registered marks of ACORD <br />Pdnted by GLL on January 15, 2020 at 01:51 PM <br />