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7709/ACRo" CERTIFICATE OF LIABILITY INSURA M""°°"""' <br />NCE04/2019 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DO S 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: If t certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and con itions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder i lieu of such endomement(s). <br />PRODUCER CON q T <br />AMEQuality Plus Insurance <br />N_ <br />QIIALITY PLUS INSURANCE AGENCY, INC. PHONE F�AICINI. 714-245-1201 <br />I.-xa Xt). 714-245-1200 <br />1450 N TUSTIN AVE E-MAIL <br />STE 221 AopREss: gualityplus2009@gmail.com <br />SANTA ANA $ AFFO INSURERRDWGCOVEMGE NAICp _ <br />_ _ CA 92705 _ INSURERA: GOLDEN BEAR INSURANCE CO <br />INSURE° <br />Victor Sandov 1 <br />INSURERB:SIRIUS AMERICA INSURANCE CONPAIM <br />— <br />dba:Super Ant_ jitos Express wsuseac: <br />1702 N. Brie to St.Ste DINSURER 0: ------- <br />Santa Ana CA 92708 INSURER E: <br />— <br />INSURER F <br />CnVFRAriFS _. <br />THIS IS TO CERTIFY <br />-- ""'—"'—"""••'"` <br />THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE <br />KtVISIUN NUMBER: <br />INDICATED. NOTWI <br />BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />HSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT <br />CERTIFICATE MAY E <br />E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY <br />OR OTHER DOCUMENT WITH RESPECT TO <br />THE POLICIES DESCRIBED HEREIN IS <br />WHICH THIS <br />EXCLUSIONS AND C <br />NDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN <br />SUBJECT TO ALL <br />REDUCED BY PAID CLAIMS. <br />THE TERMS, <br />INSR <br />LTR' TYPE OF <br />A6DC SUEFRT --- <br />NSURANCE POLICY NUMBER <br />YVYYF <br />�I COMMERCIAL GENERAL <br />MMI00 ryPiM�OOYiVYvr LIMnS <br />- <br />CLAIMS MA <br />�LIABILITY <br />E ! y OCCUR 7ITBI9451O <br />EACH OCCURRENCE $ <br />08/30/19', 08/30/20 DAMAGE REN D <br />1,000,000 <br />- <br />PREMISESEaoccuTWXXI $ <br />100,000 <br />I MED EXP (AN one person) $ <br />5 ,. 0 0 a <br />PERSONAL 6ApV INJURY $ <br />_... <br />1 1 OOO 1 OOO <br />GEML AGGREGATE L <br />M IT APPLIES PER I I <br />IGENERALAGGREGATE $ <br />2,000,000 <br />PI <br />CY j <br />Ci `_� LOC <br />PRODUCTS-COMPlOP AGG $ <br />�— <br />1, 000, OOO <br />R: <br />j <br />ILE LIABILIC, <br />LIMIT <br />AUTO <br />f a rier tSINGLE <br />BODILY INJURY(Perperson) <br />S <br />OINED <br />SCHEDULEDS <br />I <br />BODILY INJURY(Per amdent)DAUTOS <br />AUTOS <br />NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />Per acad ntELIA <br />LIAR. <br />OCCUR I <br />LIAB <br />_ CLAIMS -MADE I <br />EACH OCCURRENCESS <br />DEC <br />AGGREGATE <br />RET <br />WORKERS COMPENS <br />AND EMPLOYERS LI <br />NTIONS <br />ON ! <br />ILITY YIN ➢7C17418-19 <br />E <br />08/13/19110 a/ 13/20 STATUTE OERH <br />ANY PROPRIETORIPAR. <br />B OFFICEWMEMBER EXC <br />NER/EXECUTIVE <br />UDEO? N/A -- <br />EL_ EACH ACCIDENT $ <br />1,000,000 <br />(Mandatory in NH) <br />Ifyyas, descdbe under <br />! <br />E.L. DISEASE - EA EMPLOYE S <br />1, 000, 000 <br />•DESCRIPriONOF OPE <br />ATIONS below <br />EL. DISEASE -POLICY LIMIT $ <br />1, 000, 000 <br />DESCRIPTION OF OPERATI <br />$/LOCATIONS/VEHICLES IACORD 101, AddlOpnal Remarks ScM1eduM, may ba aHacbed If more apace le raeelred) <br />RESTAU <br />**CERTIFICATE <br />HOLDER IS ADDITIONAL INSURED PER FORM (=2010)** <br />REVIEWED & APPROVED <br />CPRTIFICATF Uni n <br />o IC ANACCMcnIT nncln : <br />City of Santa a <br />Risk Nanagernen IDivisian <br />20 Civic Cent,} Plaza <br />Santa Ana <br />ACORD 25 (2014/01) <br />142019 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES CANCELLED BEFORE <br />ItaW,l,)4 THE EXPIRATION GATE THEREOF, NOTICE WILLLL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />SA NTHA M. LAMB RZEO ftEPRE VE <br />CA 92702 <br />©1988-4)14 ACORD CORPORATION. -Aft rights reserved <br />The ACORD name and logo are registered marks of ACORD <br />