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CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDIYYYY) <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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the 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 endomement(sl. <br />PRODUCER <br />Van Wagner Agency <br />135 Crossways Park Drive <br />P.O. Box 9017 <br />Woodbury NY 11797 <br />INSURED <br />Casa De La Familla <br />Karina Palma -Rojas <br />Karina Palma -Rojas <br />1650 E. 4th Street #101 <br />Santa Ana CA 92701 <br />COVERAGES CERTIFICATE NUMRFR: 1917543n79 RFVIRION NLIMRFR- <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 />INSR LTR <br />TYPE OF INSURANCE ADOL.SUBR <br />POLICY NUMBER MOLICY EFF POLICY EXP <br />LIMBS <br />A <br />TCOMMERCIAL GENERALLIABILITY <br />CLAIMS -MADE ^ OCCUR <br />Y <br />Y GLP 42%334504 <br />502019 55202D <br />EACH OCCURRENCE <br />s I.WO,OD0 <br />PREMISES Ea ocammre <br />5100= <br />MED EXP (Any one person) <br />$5.000 <br />PERSONAL S ADV INJURY <br />$1,000.000 <br />GENE <br />X <br />AGGREGATE OMIT APPLIES PER: <br />POLICY PET �] LOC <br />GENERAL AGGREGATE <br />$3.0DO,ODO <br />PRODUCTS - COMPIOP AGG <br />S3,000.000 <br />$ <br />OTHER <br />AUTOMOBILE <br />LABILITY <br />I E MBa NEDSINGLE LIMITS <br />BODILY INJURY (Per prawn) <br />S <br />ANYAUTO <br />ALL OL"MED AUTOS ED <br />AUTOS <br />BODILY INJURY (Per abdet) <br />S <br />NON-0WNED <br />HIREDAUTOS AUTOS <br />PROPERTY DAMAGE <br />P acod rd <br />$ <br />5 <br />UMBRELLA LAB I <br />OCCUR <br />EACH OCCURRENCE <br />s <br />AGGREGATE <br />§ <br />EXCESS LAB _ <br />CLAIMS -MADE <br />OED RETENTIONS <br />§ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LABILITY YIN <br />ANY PROPRIETOR PARTNERIEXECUTiVE <br />OFFICERMEMBER EXCLUDED? ❑ <br />MIA <br />TH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />§ <br />E.L DISEASE - EA EMPLOYEE <br />S <br />(Mandslo y In NH) <br />If y tlaemDo urge <br />OESG�RIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />S <br />A <br />Proressi" LebNly <br />Y <br />Y <br />GLP429.33< <br />6b2019 5WO20 <br />Each IlXideM $1,000.000 <br />Aggregate $3.000.000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional RemAs Schedule, may ba anacMd K mrs space le r ulr•d) <br />Services at the Santa Ana Police Department's Family Ju tice Center. The City of Santa Ana. it's officers and employees are included as an additional insured <br />on General liability policy <br />EVI ED & APPROVED <br />Ris MANAGEMENT DIVISION <br />J N 17 2020 <br />SAMANTHA M. LAM EWOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza 4th Floor <br />PO BOX 198E AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92701 fln n <br />CK•]:1ZU:L\ I([•7: �dl�'7fitTLiL�T:7S'1 <br />ACORD 25 (2014101) <br />The ACORD name and logo are registered marks of ACORD <br />