VENTURA BUSINESS SYSTEMS, INC. (3)

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Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2021.12.09 1129,08-08'00' CERTIFICATE OF LIABILITY INSURANCE D1zosi202 "' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DARRYL NIND INSURANCE AGENCY NAME: DARRYL NIND, AGENT 4378 EILEEN ST o SIMI VALLEY, CA 93063 A/C. PHONE Ext : 805 823-8373 FVC No): 805 823-8377 E-MAIL ADDRESS: darryl.nind.rebi@statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: State Farm General Insurance Company 25151 INSURED VENTURA BUSINESS SYSTEMS, INC INSURER B: State Farm Mutual Automobile Insurance Company 25178 INSURERC: C/O TREVOR YATES INSURERD: 2582 FIG ST SIMI VALLEY CA 93063-2416 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 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 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 PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY ❑ ❑ 92-W4-0493-7 04/26/2021 04/26/2022 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Ea occurrence) $ CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC JECT $ B AUTOMOBILE LIABILITY 1-1 ❑ 051 5512-A18-75N 01/18/2022 07/18/2022 COMBINED SINGLE LIMIT Ea accident $ X ANY AUTO BODILY INJURY (Per person) $ 1,000,000 X ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ 1,000,000 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ 1,000,000 UMBRELLA LAB OCCUR ❑ ❑ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? ❑ N / A ❑ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) There is no Workers Compensation policy for Ventura Business Systems as all employs are officers of the corporation. Officers of the Corporation are not required to have a Work Comp policy in the State if California. CERTIFICATE HOLDER ADDITIONAL INSURED: City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th floor IZED RE RESENTATIVE SANTA ANA, CA 92701 7 u" cF ` ILLi3RMwag't'.Ih12t'lt DMsiun REVIEWED & APPROVED SY: © 1988-2010 ACORD C( ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD _ _— Wsk Management Analyst