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a`c`.�izn CERTIFICATE OF LIABILITY INSURANCE DATE
<br />0 /02/2o 9
<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 THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the
<br />terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Eddie QUlllares Jr.
<br />CONTACT _
<br />"Ail Eddie Oulllares
<br />State Farm Agency
<br />FA
<br />_(kc.Ne.EM1: 714,617?t50... _ - _ Atc Ne1LZ 14,617 7158
<br />415 N. Broadway
<br />EMAIL
<br />_nPORESS:eddie@eddleginsurancecom
<br />Santa Ana, CA 92701
<br />INSURERS) AFFORDING COVERAGE NAIC N
<br />INSURER A Stale Farm General Insurance Company 25151
<br />INSURED
<br />DOWNTOWN INCORPORATED
<br />INSURERa;. Slate Farm Fire and Casualty Company
<br />_ 25143.
<br />204 E 4TH STE STE T
<br />INSURER c
<br />SANTA ANA, CA 92701-4668
<br />INSURER D: _
<br />INSURER E : _
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 75-n4511
<br />REVISION NUMBER:
<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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />IN8R ADD0Sf1en POLICYEFF- POLmvYE—"
<br />LTR TYPE OF INSURANCE NqR I wVn POLICY NUMBER IMMIDDIYYYYV (MWODWWILIMITS
<br />GENERAL A LIABILITY
<br />IF—Y Y
<br />92•CE-0933.0 0e/05/2019
<br />O610512020
<br />EACH OCCURRENCE S 1.000,000
<br />X I COMMERCIAL GENER�AL LIABILITY
<br />DAMAGE TOTO RENTED
<br />PREMISES 300,000
<br />CLAIMS -MADE `^I OCCUR
<br />MEDEXP(Anyoopeson) $ 5,000
<br />PERSONAL& ADV INJURY _S 1,000,000
<br />_
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'LAGGREGATELIMIT APPLIES PER
<br />PRODUCTS -COMP_/OP AGG $ 2,000,000
<br />x POLICY PRp7 LOC
<br />3
<br />AUTOMOBILE
<br />LIABILITY
<br />6215237-F28-75
<br />0612812019
<br />12128/2019
<br />COMBINED SINGLE IMR
<br />ANY AUTO
<br />BODILY INJURY (Per parson)
<br />s 1.000.000
<br />ALL
<br />AUTOS OWNED X SSCH OLEO
<br />j
<br />BODILY INJURY Pill accident)
<br />8 1,000,000
<br />NON -OWNED
<br />PROPENE! DAMAGE
<br />$ 1,000,000
<br />HIRED AUTOS AUTOS
<br />(Per acndpn)
<br />Deductible
<br />S 250
<br />A
<br />X UMBRELLA LIAB X I OCCUR
<br />Y
<br />Y
<br />92-CE-O781-7
<br />O6/OS/20t9
<br />Ofi105f2020
<br />EACH OCCURRENCE
<br />— --—.. _-
<br />s 1.000,000
<br />EXCESBLIAB CLAIMS -MADE
<br />AGGREGATE
<br />$ 2,000,0([0
<br />LED %� RETENTIONS 10,000
<br />s
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />WC STATU- IOTH
<br />92-GA-H506.1 06105/2019 06/05/2020 1 1 TORY LIMITS X ER
<br />1,000,000
<br />YIN
<br />ANY PROPRIETORIPARI NEFUEXECUTIVE
<br />EXCLUDED? V❑ NIA
<br />Y
<br />❑
<br />IEI EACHACCIDENi
<br />$ 1,000,000
<br />-
<br />OFFICEIMEMBER
<br />IMandalorYleNH)
<br />EL DISEASE - EA EMPLOYE,
<br />5 1,000,000
<br />II yes, de cl under
<br />OF QPFRA11QNS bein,
<br />E.L DISEASE -POLICY LIMIT
<br />I S 1,000,ODO
<br />A FIDELITY BOND
<br />Y
<br />_DESCRIPTION
<br />�Y 92-WV-6044.5 1010312018 10/0312019 BONO-AMOUNT s 500,01ND
<br />DESCRIPTION OF OleERATIONSI LOCATIONS I VEHICLES (Aitach ACORDIBI,Addibanal Remarks Schedule,itmarespaselanq.1rvdl
<br />REVIEWED & APPROVED
<br />Scheduled Auto: 2002 GEM 825 PICKUP VIN: 5ASAK27492FO28166
<br />By RISk MANAQENIENT DIVISION
<br />City of Santa Ana its officers , agents, employees and volunteers are named as additionally Insured,
<br />Additional Insured endorsement issued for certificate holder with waiver of subrogation and non-contributory UG 02 2019
<br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation
<br />A7
<br />er,c,rn7•e um nee rAMrri I ATInM • •-• -• -- — •-• • ••--- ^-_, -
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />RISK MANAGEMENT DIVISION
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA 4TH FL
<br />AUTNOft12ED REPRESENTATIVE
<br />SANTA ANA, CA 92702
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012
<br />
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