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FDA�lE(MM/DD/YYYY) <br /> ACORN® CERTIFICATE OF LIABILITY INSURANCE <br /> /29/2024 <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 have ADDITIONAL INSURED provisions or be <br /> endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A <br /> statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Hiscox Inc.d/b/a/Hiscox Insur ce Agency in C.* PHONE <br /> pd <br /> 5 Concourse Parkway � � I � E-MAIL <br /> EXt: (''P8) o. <br /> Suite 2150 ADDRESS: C( itacA@hiscox.com <br /> Atlanta GA,30328 _v VERAGE 4NAIC# <br /> INSURERA: lisCl nsurance C a I c 0 <br /> INSURED INSURER B <br /> Andres Hernandez DBA OrgINsuRERc <br /> Guerra Acevedo <br /> 12041 Cole St INSUF=R <br /> Unit 1 INSURER E: <br /> Garden Grove,CA 92841 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR I POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE � PREMIDAMA OCCUR E ( RENTED <br /> PREMISESS Ea occurrence) $ 0 <br /> X CGL is on BOP Form MED EXP(Any one person) $ 10,000 <br /> A Y P103.826.022.1 08/28/2024 08/28/2025 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY❑ PRO ❑ <br /> JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBEREXCLUD ED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana Risk Management Division <br /> 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Santa Ana,CA 92702 THE EXPIRATION DATE THEREOF. NOTICE WILL RE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PRC <br /> RiekManaganentDivisirnt <br /> AUTHORIZED REPRESENTATIVE r REVIEWED&APPROVED BY: <br /> Risk Management Specialist <br /> ©1988-2015 ACORD <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />