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AOORLf CERTIFICATE OF LIABILITY INSURANCE <br />DATE IMMMDA'YYYI <br />o3rDBnot9 <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 714E ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED, the polloy(los) must have ADDITIONAL INSURED provisions or be endorsad. <br />It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, contain policies may require an endorsement A statement on <br />this certificate does not confer rights to the certificate holder In lieu of such endorsomant B , <br />PRODUCER <br />I PAMELA PAGAN <br />StateFaf7Tl LORI GREEK GARABEDIAN INSURANCE AGENCY INC <br />PHONa 949 858 4400—��P�— <br />-Rn-E.in: we x I. 949.247.7015 <br />STATE FARM INSURANCE <br />Eami . PAMELAGLGGINSURANCE.COM <br />"' 29809 SANTA MARGARITA PKWY STE 101 <br />INSURERISI AFFORDING COVERAGE <br />AIDA <br />RANCHO SANTA MARGARITA CA 92688 <br />INSURER A: State Farm General Insurance Company <br />25151 <br />INSURED <br />INSURER a I State Farm Fire and Casualty Company <br />25143 <br />Syen, LLC DSA Young Renthrand(s <br />INB RERC: <br />P.O. Box 1793 <br />INSURERD: <br />Tustin CA 92781-1793 <br />IN UR <br />INSURER : <br />COVERAGES CERTIFICATE NUMBER- Rev!q!0M An Musson. <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 />EXCLUSION$ AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS. <br />ILTRNSR <br />TYPE OF INSURANCE <br />IA <br />SUER <br />POUC N Me <br />PO <br />POLNCDY P <br />LAMBS <br />A <br />COMMERCIALOENERALLL401UTY <br />CLAW"ADE ® OCCUR <br />92.GG-8281.8 <br />11/29/2018 <br />11l2912019 <br />EACH OCCURRENCE <br />S 2.000,000 <br />y I <br />MED EXP n one ram <br />p 300,000 �W <br />I t0_,000 �~ <br />PERSONAL S ADV INJURY <br />S 2,000,000� <br />GEN'L AGGREGATE LIMIT APPLES PER: <br />POLICY ElwT LOC <br />OTHER: <br />%NERALAGOREDATE <br />S 4,000,000 <br />PRODuCT3•COMPA)p AGa <br />s 4,000,000 <br />S <br />AUTOMOO <br />LE LWBIUrr <br />ANY AUTO <br />AUTOS ONLY AUTOS <br />WNED <br />AIRED UTOSONLY AUTOS ONLY <br />a MID <br />90DiLY INJURY (Par palm) <br />9 <br />BODILY INJURY(PW aWdwt) <br />S •_-- <br />PR <br />S <br />S <br />UMBRELLA LMe <br />EXCESSIUAH <br />OCCUR <br />CLMMS.MADE <br />Jn� <br />Carmen n <br />lJ <br />ggta <br />EACHOCCURRENCE <br />S <br />AOOREOATE <br />f <br />DEC) <br />RET NT S <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />OFPICE"eMEBTER eXCLUDEDT EDLxIVE Y l <br />IMLndstory In NNt <br />B 56FOI M Nmdx <br />DESCRIPTION OF OPERATIONS befW <br />NIA <br />T3 Adgecreaft0r.S <br />iC <br />92-00-$283.2 <br />11/29I2018 <br />17/2SI2018 <br />E.L BAcx acaDENT <br />s 58D,000 <br />E.L. DSEASE-FA EMPLOYE <br />S 600,000 <br />E.L. DISEASE• POLICY LIMIT <br />S 50,000 <br />DESCRIPTON OF OPERATONS t LOCATIONSI VEMCLES (ACORD SOt.0.ddltlomi Renudu 30heNW.-Myth WAclnd a,bon "date nquindt <br />ADDITIONAL INSURED: THE CITY OF SANTA ANA <br />THE CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA <br />CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRI9ED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE MTN THE POLICY PROVISIONS. <br />ALVRY AD tAU twua) I no AW VKU name ano toga are regunerea mat9s Of ACORD <br />IOG1486 132&9.12 00-M-2016 <br />