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Commercial Certificate of Insurance <br />FARM_ E R s� <br />Agency GA13IRL A. DIAZ <br />Name 2706 HARBOR BLVD, STE <br />& <br />Issue Date (MIvVDD/YY) 08/27/1� <br />COSTA MESA, CA 92626���JJJJ <br />Address 714- 34-7600 <br />This certificate Is issued as a matter of Information only and confers no rights <br />upon the certificate holder. This certificate does not amend, extend or alter the <br />St 97 Dist, 61 Agent 32T'f <br />coverage afforded by the policies shown below. <br />Companies Providing Coverage: <br />Insured <br />Company A Truck Insurance Exchange <br />REL-AMPAGO DEL CTELO, INC. <br />Name DBA: BALLET FOLKLORICO <br />Company B Farmers Insurance Exchange <br />& 600 W. SANTA ANA BLVII <br />Latta <br />company C Mid -Century Insurance Company <br />Address SANTA ANA, CA 92704 <br />Learr <br />Company <br />Letter <br />Coverages <br />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 <br />any requirement, term or condition of any contract or other document with respect to which this certificate may be Issued or may pertain, the insurance <br />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 <br />paid claims. <br />Co' <br />Ltr. <br />Type of Insurance <br />Poll Number <br />Policy Effective <br />Date ehtn4lIM" <br />Policy Expiration <br />Date (MMrDD M <br />poll Limits <br />cY <br />X <br />General Liability <br />6043345-09 <br />03/07/19 <br />03/07/20,, <br />General Aggregate <br />$4,000,000 <br />X <br />Commercial General <br />Products-Comp/OPS <br />Aggregate <br />$2,000,000 <br />Liability <br />B <br />X <br />- Occurrence Version <br />Personal ng I <br />AdveNsingfn(ury <br />$2,1X10,000 <br />Contractual - Incidental <br />Each Occurrence <br />$2,000,000 <br />Only <br />Fire Damage <br />(Any one f re) <br />S 100,000 <br />Owners & Contractors Prot, <br />Medical Expense <br />i (Any one person) <br />$5,000 <br />Automobile Liability <br />i Combined Single <br />All Owned Commercial <br />Limit <br />S <br />Autos <br />Bodily rn,'tury <br />Scheduled Autos <br />(Per person) <br />S <br />Hired Autos <br />Bodily fnjury <br />$ <br />Nan -Owned Autos <br />REVIEWED <br />& APPROVE <br />(Per accident) <br />Garage. Liability <br />By Risk MAN <br />DEMENT Divisi <br />N <br />Property Damage <br />S <br />Garage Aggregate <br />$ <br />Umbrella Liability <br />Limit <br />$ <br />workers' Compensation <br />FRANCINE <br />'SiLMRTAF <br />Statutory <br />and <br />Each Accident <br />$ <br />Disease - Each amptoym <br />S <br />Employers' Liability <br />Disease - PolicyLlmit <br />S <br />Description of OperatlonsNehicles/Restrictions/Special items: <br />CERTIFICATE HOLDER BELOW (ALSO LISTED AS ADDITIONAL INSURED ON POLICY) City of Santa Ana, officers, agents, <br />employees, and volunteers are named as additionally insured <br />on this policy pursuant to written contact, agreement or memorandurn of <br />understanding, This insurance coverage shall I be primary, and any insurance carried by the City shaU be excess and noncontributory. <br />Certificate Holder <br />Cancellation <br />City of Santa Ana <br />Should any of the above described policies be cancelled before the expiration date <br />Name Risk Management Division <br />thereof. the Issuing company will endeavor to mail 30 days written notice to the <br />& 20 Civic Center Plaza, 4th Floor <br />certificate holder named to the left, but failure to mail such notice shall Impose no <br />Address Santa Ana, CA 92702 <br />obligation or liability of any kind upon the company its agents or representatives. <br />Gabriel A. Diaz Agency; 97-61-32M <br />a we <br />66-2492 4.94 Copy Distribution: Service Center Copy and Agent's Copy War <br />