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ggl[aflysignetl by Tori Pierson <br />Tori Pierson nme 2.2M3.g111:53'35 <br />wow <br />A`�Ro� CERTIFICATE OF LIABILITY INSURANCE <br />°ozizai2022 <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 Quillares Jr. State Farm Agency <br />415 N. BroadwayPNONE <br />Santa Ana, CA 92701 <br />CONTACT <br />NAME: Eddie Quillares Jr. <br />.714.617.7150. uc Ng:714.61 .7158 <br />nDDRlESS: addie@)eddieqinsurance.com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Stale Farm General Insurance Company <br />2515 <br />INSURED Santa Ana Chamber of Commerce <br />1631 W. Sunflower Ave STE C35 <br />Santa Ana, CA 92704 <br />ATTN: Marty Perterson <br />INSURER B: State Farm Fire and Casualty Company <br />25143 <br />INSURER C: State Farm Mutual Automobile Insurance Company <br />25178 <br />INSURER o: <br />INSURER E: <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 75-0450 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 PEI <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />rypE OF <br />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />IMMIDDrYYYYI <br />POLICY UP <br />(MIWDDIYYYYILIMITS <br />A <br />BENERALLIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />Y <br />❑Y <br />92-CM-E499-2 <br />03/0112022 <br />03/01/2023 <br />EACH OCCURRENCE <br />$ 3.000,000 <br />PREMISES (Ea occurrence) <br />S 300,000 <br />MED EXP (Any one person) <br />$ 10.000 <br />PERSONAL S ADV INJURY <br />$ 3,000,000 <br />GENERAL AGGREGATE <br />$ 6.000.000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY M JECTPRO LOC <br />PRODUCTS - COMP/OPAGG <br />$ 6,000,000 <br />$ <br />Q <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />❑ <br />El431 <br />6546-COl-75 <br />03/0112022 <br />03/01/2023 <br />eos socNED <br />i.ro SINULE LIMIT <br />S <br />BODILY INJURY (Per person) <br />S 1,000,000 <br />BODILY INJURY (Par accident ) <br />$ 1,000,000 <br />PROPERTY DAMAGE <br />Per accident <br />$ 1,000,000 <br />UMBRELLA LIAR <br />EXCESS LIAR <br />OCCUR <br />CLAIMS -MADE <br />❑ <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTIONS <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNEWEXECUTIVE <br />OFFICEIMEMBER EXCLUDED? FL]N <br />(Mandatary In NH) <br />If yes, descdhe under <br />nFqrR!PTION OF OPERATIONS below <br />IA <br />❑Y <br />92-G6-N843-2 <br />02/01/2022 <br />02I0112023 <br />�( WC STATU- 0TH- <br />ITS <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,000 <br />A <br />Professional Liability: Egos&Omissions <br />PS0000004555909 <br />03/01/2022 <br />03101/2023 <br />LIMIT'$1,000,000 per claim <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insured with respect to General and Auto Liability per the attached <br />endorsement as required by written contact. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Workers' Compensation & General <br />Liability <br />30 Day Notice of Cancellation with 10 days for Non-payment of Premium in accordance with the policy provisions. <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA 4TH FLOOR <br />SANTA ANA, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE _ _r RLk Managnecd Ulddon <br />IREinevm6 mIBr. <br />laze %»icw,fnon <br />ArnRrl" Rah Nlmv9.10cialAfde <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD v ........... ..._., ,,,, „. _2 <br />