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ACC) ® DATE(MM/DD/YYW) <br />�►i CERTIFICATE OF LIABILITY INSURANCE 051OW020 <br />THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AKIRMATIVELYOR NEGATIVELY <br />AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OFINSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. <br />IMPORTANT: lithe certificate holder is an ADDITIONAL INSURED, the pies) nmstheve ADDITIONAL INSURED Provisions or be emorsed. ItSUBROGATION IS WAIVED, UIbiset to theterms and <br />conditions of the policy, certain policies may "Ulm an endorsement. AstatemeMon M(sarHBea4dou not ConfarnBhtstotMeerUBeate hokkar in lieu of suchandorsement(s). <br />PRODUCER <br />Theresa Simes(9744576) <br />1716E Ne.Yhope St Ste F <br />Fountain Valley CA 927D8.4230 <br />INSURED _._.. <br />WLLIAM H NUESSE M <br />867 S TUSTIN ST <br />ORANGE CA 928M <br />COVERAGES CUnFICATENUMBER: <br />CONTACT <br />NAME: Theresa Slmes <br />PHONE FAX <br />(A/C. NO. EXT): 714.966 W -3000 C.NO).'714.988-3013 <br />EMAIL <br />ADDRESS: tSlmes(Mtarmersagent oom <br />INSURER(S) AFFORDING COVERAGE <br />INSURERA Truck Insurance Exchange <br />INSURERS: Famiers lnsurencelEX191al <br />INSUREAC: M_M Century Insurance Company <br />INSURER D: <br />INSURERE: <br />INSURER F. <br />REVISION NUMBER: <br />NAICa <br />_r..__....IC# <br />21709 <br />21652 <br />21687 <br />THIS IS TO CERTIFY TH0.T71,1E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT TERM OR CONDITION OF MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHX91 THIS CERTIFICATEMAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BYTHE <br />POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMNS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ITR TYPEOFINSUAANCE <br />ISD <br />WVD <br />POUCYNUMSFR <br />POLICY POUC/EX► <br />(MM/DD/YYW) � (MM/DD/YYYY) <br />LIMM <br />COMMERCIALGENERALUABIUTY <br />C WMS-MADE OCCUR <br />❑ <br />/ <br />se <br />I <br />EACH OCCURRENCE <br />S 2,000. <br />DAMAGETORENTED <br />PREMISES(EaOmxml <br />$ SM.000 <br />MEDEXP(A"Wepenen) <br />S s5. <br />PERSONAI.SADVINJURY <br />S 2,0 <br />A <br />Y <br />N <br />378275 <br />OfL29/2020 <br />o5129l2021 <br />GENTAGGREGATEUMRMPUESPER: <br />POLICY ❑ PROJECT 71 U LOC <br />GENERALAGGREWTE <br />S 4000 <br />PRODUCTS-COMP/OPAGG <br />f 2,DDD, <br />AUTOMOBILE LMSILRY <br />ANYAUTO <br />/ <br />COMBINED SINGLE UMrT <br />(Eaaoeident) <br />S 2.000, <br />BODILY INJURY (Per Perron) <br />S <br />`, <br />O NEDAUT05 SCHEDUAUTOS LED <br />378278 <br />OEd2972020 <br />OW=021 <br />BODILY INIURY(PwacNdnO) <br />f <br />_ <br />PROPERTY DAMAGE <br />(Per accident) <br />S <br />��HIREDAUTOS x NON -OWNED <br />ONLY AUTOS ONLY <br />f <br />UMBOR UAS <br />OCCUR <br />_-- <br />EACHOCCURRENCE <br />S <br />AGGREGATE <br />j <br />EXCESS UAS <br />CLAIMS -MADE <br />DED RETENTIONS <br />j <br />AI <br />"DEMPLOYERS-LIABRUTY <br />C1 <br />REVIEWED APP <br />VED <br />PER <br />STAT UTE <br />f <br />ANY PROPRIETOR/PARTNER/ Y/N <br />EXECUTIVE OFFICER/MEMBER <br />N/A <br />1� <br />y R(sK MANAGEMFNT <br />iVISIUN <br />E.L. EACH ACCIDENT <br />S <br />E.LOISEASE-EAEMPLOYEE <br />EXCLUDED?(Mamlatoryln NN) <br />"yes, describe under DESCRIPTION OF <br />OPERATIONS below, <br />5 2()2 <br />E.L DISEASE-PDLIDYLMIT <br />S <br />AFiEA7CEVEdD <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (/ICBRD 101. Additional Remarks Schedule, may be attached Itmere spa; is Required) <br />7 S TUSTIN ST, ORANGE, CA 92866 <br />Certificate of Insurance shall provide thirty(30) day prior written notice of cancellation <br />CERIIFIGTEHOLDER CANCELLATION <br />CITY OF SANTA ANA ISK MANAGEMENT DIVISIC SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />20 CIVIC CENTER PLZ J/ DATE THEREOF. NOTICE WILL BE DENUANCE IN THE POLICY PROVISIONS. <br />AYlH01@ED REPR[SENTpTIVE i <br />SANTA MIA CA-92701-� ... <br />ACORD 25 (2016/03) 01988-201S ACORD CORPORATION. All Rights Reserved <br />3I- I769 11.15 The ACORD name and logo are registered marks of ACORD <br />r_ <br />