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Policy, Number: Date EnrrP••t---ere•••---d: 1/8/2009
<br />CERTIFICATE OF LIABILITY INSURANCE ATE tMMlaD YYY)
<br />e , innnn
<br />THIS CER11FICATE 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 INSURERS), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />iMPORTANT:. it the certificate hotdor Is an ADDITIONAL INSURED, the polfcylios) must have ADDITIONAL INSURED provisions or be ondorsed,
<br />if SUBROGATION IS WANED, subject to the terms anti conditions of the policy, certain policies may require an ondorsoment. A statement on
<br />PRoaucsR
<br />VICTORIA INSURANCE AGENCY
<br />Chris D. Victoria
<br />1740 West Katella Ave #H
<br />Orange, CA 92867
<br />GUADALUPE MEDINA
<br />15644 PALOMINO DRIVE
<br />CHINO HILLS, CA 91709-5510
<br />[KiI*1�7cTN"«F r s u. t x •. , ¢ c
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 />LTR TYPE OF INSURANCE UU USR POLICY NUMBER PglCY EFF PO YEYy LIMITS -
<br />ATOOMMEROIALBENERAI.
<br />LIABILITY/
<br />EACH OCCURRENCE g1, 000, Q40
<br />5/
<br />CLAIMSQAOE CKO=R
<br />60366-65-69
<br />3129/�a
<br />A•A TETO ITED -
<br />3/29/2021 F g 75,000
<br />✓� 3AE6 EXP cne g 5,000
<br />PERSONAL &Aov R+JURY $1,000,000
<br />GENERAL AGGREGATE A2,011,001
<br />GENY. AGWEGATE UNIT APPLIES PErt
<br />RO- 0 Ux
<br />POLICY f-1 PJECT
<br />PRODUCTS-$1., 000, 000
<br />C MPfOPACd".
<br />OTHER,
<br />$
<br />AumMosEE LIABILITY,.
<br />COMBINED +.d..
<br />$1r000, ODD
<br />ANYAUTO
<br />MALY INJURY{PIr per" 3
<br />CYNE
<br />AUTOONLY AUTOO 5C3t0GFi Hk.Er
<br />60486-94-07
<br />1/01/2020
<br />1101/2 1 8G31LY INJURY 4Per ar�irAVP} §
<br />H FIRED NnNowNED
<br />I G §
<br />:.... AUTO$ ONLY ....... AUTOS ONLY
<br />nIUA
<br />�
<br />a
<br />A uM0REL1A lIA0
<br />_..
<br />EACH OCCINFRENCE $
<br />EXCESS DAa CIAihSS•ltApE
<br />60499-63-93
<br />33/29/20210
<br />1/2.9/2022 AG,".RECJTE $21000,000
<br />CEO RE1T..NTit?N g1D,D0D
<br />g —
<br />WORKERS COMPENSATION
<br />iN
<br />ANOEMPLOYERTUABURY YIN
<br />lUf R
<br />ANY rR#CtPRiFTORfFlARfiNEWEXECUPNB
<br />B ANY PROPRIETORPARTNRAI Y
<br />to
<br />0931-60-44
<br />"1'15/201a
<br />2/15/2020- F.L. EACH ACCIDENT g r000, 000
<br />[Msrdatary in NH1
<br />N,/'
<br />„�""� E.L DISEASE-EA1l1PU1Y11 111000,000
<br />SCRIP TONOFOF°PAnONSDEbw
<br />EL DSEAE•POLICY LidTr $1,000,000
<br />.
<br />A EMPLOYEE DISH=STY
<br />60366-65-69 --
<br />)3/29/2020
<br />3/29/2021 $100,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS !VEHICLES IA 11010,ArMAJ..I RPrPI SaIlc4We, may Ca atdtbW S more IF. W requime
<br />30 DAY NOTICE OF CANCELLATION
<br />,s
<br />RE: WRSTEND SUBSTATION - 3750 W. MCFADDEIN SUITE 41 SANTA ANA, CA 92704 ,{
<br />CITY OF SANTA ANA, THEIR OffICERS, AGENTS, .EMPLOYEES, AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED
<br />PURSUANT TO WRITTEN CONTRACT, AGREEMN 4, i' t�^I�yCE IS PRIMARY NON-CONTRIBUTORY.
<br />RISK MANAGEMENT DIVISION M } I b1OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA, 4TH FLOOR THS EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ICO RDA.NCE WITH THE POLICY PROVISIONS.
<br />SANTA AEA, CA 9z7oz ANG& Ac Ldta --
<br />AUTHORUO REPRESENTATIVE -
<br />ORRIS VICTORIA4n���
<br />IS 1988.2015 ACORD CORPORATION. All rights reservad,
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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