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CERTIFICATE OF LIABILITY INSURANCE <br />091102; <br />THISCERORCATEISISSUMD AMAT OFINMRMANONONLYANDCONEERSNORIGHTSUPONTNECERUiWM E HOWE0.MISCOMRCATEDOESNOTMRRMATIVELYORNEGATIVELY <br />AMEND,EKiENDORALTERTHECOVERAGEMMROEDWY EPOLICIESRELOW.T ISCEMPICATE OFINSURAMEDOESNMCONSIRUIEACONIRACTBETWEFNTHE155UINGINSUgER(S), <br />AUTHORV"WRESENTATIVEORPRODUCER,ANDTHECERNRCATEHOLDER. <br />IMPORTA(fCNMeceNflcateholderisanMDMONALINSURED,thepolicVae )musthaveMDMNALINSUREDpmvWs wbeendorsed.tfSUBROGATIONMWANED,.bjMto thetermcand <br />mnd(dowofthepolicy,ce "lidwmayrec dmanendorsement Astatememonthisce WedoesnotconhrtlghtetothecWMMeholderInlieuofsudsandwumenl(a). <br />PRODUCER <br />CAMACr <br />2706 Harbor Blvd SIB 201 <br />Gabriel Dior(Blvd Ste) A n i e <br />NAME: Gat B D— I� : ^ ' ' <br />v I U <br />(A/c,xo, EKD '•14-434_76f� <br />WCND)!-' a <br />g <br />Costa Manta CA 92626-5„ <br />�R�: 91-Am. eiremAcevedo <br />NSURE_R(S)1FF_ORDING COVERAGE <br />"cif <br />INSURED <br />INSURERA Trucl h, UPI {dhan-Mjd <br />,709 <br />DEL CIELO <br />PO BOX 3158 Acevedc <br />msuRaP s: Fn„n In�flw_sArsi � <br />t, <br />16URELAMPAGO <br />WSUR.RG Mid <br />to In I <br />e � ny <br />21652 <br />— <br />MS',RERO: <br />00 <br />SANTA ANA CA 92703 <br />.4SURERe <br />INSLRERP. <br />COVERAGES CMRC mNUMBER: REVIMONNUMBER <br />THISISTOCEUIFYTHATTHEPOUCIE50F INSURANCELISTED BELOW HAVE BEEN ISSUED TOTHEINSUREDNAMEAaUVEFORTtIEPOUCY PERIOD INDICATED. NOTWITMSIANDINGAM <br />REQUIREMEMWRMORCONDMONOFAMCOMMa OROTHERDOCUMENTWRHRESPECTTOWHICHTHISCERTIFICATEMAYBEI$BUMORMAYPERTMN,THEINBURANCEAFFORMDBY7 E <br />POLICIMDESCRIOEDHEREIN 6SUBJECTTOALLTHETEBMS, EXCWSIONSMDCUNOmONSOFSUCH POUCIES. UMRSSHOWN MAYHAVEBEEN REDUCED BYPMO CIAIMS. <br />MSR <br />in <br />TYPE OFINBURANCE <br />ADDR <br />$UBR <br />WVD <br />PoLKYNUMBER <br />PoLICYEFE <br />(MM/DD/YYYY) <br />PoLICYEXP <br />(MM/DD/YYYY) <br />DMTii <br />COMMERCUILGENERALWIBILRY <br />CLVMSMAOE OCCUR <br />EACH OCCURRENCE <br />$ 2,000,00 <br />DAMAGETO RENTED <br />PREMISES(Ea Ocons ) <br />f 75,000 <br />MEDEXP(Alrymeperson) <br />$ 6000 <br />PERSCINALSADVINJURY <br />S 2,000,00 <br />A <br />Y <br />Y <br />604334509 <br />03/07/2024 <br />03/07/2025 <br />GEN'L AGGREGATEUMITAPPoFSPER: <br />POLICY ❑ PROJECT ❑ LOC <br />GENERALAGGREGATE <br />$ 4000000 <br />PRODUCTS-COMP/OPAGG <br />$ 2,000.000 <br />$ <br />OTHER <br />AUTOMoMLELIABILM <br />COMBINED SINGLELIMIT <br />(Eeeaid.t) <br />$ 20�,D <br />ANYAUTO <br />BODILYINJURY(Fefperson) <br />$ <br />A <br />OWNED AlR05 SCHEOULED <br />ONLY AOTOS <br />N <br />604334509 <br />03/07/2024 <br />03/07/2025 <br />BODILY INfURY(Pma¢iderlpf <br />PROPERTY DAMAGE <br />DW.cddem) <br />$ <br />HIREDAUTOnt V NON -OWNED <br />ONLY /� AUTOSONLY <br />$ <br />umou ALMS <br />OCCUR <br />EACHOCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESSLMa <br />CIAIMSMADE <br />DED RETEMIONI <br />$ <br />WORKERSCOMPENSADON <br />ANDEMPLOYERS'LIABILI'IY <br />PER <br />STATUTE <br />OTHER <br />$ <br />ANY PROPRIETOR/PARTNER/ Y/N <br />EXECUTIVE OFFICER/MEMBER <br />N@ <br />E.L. EACH ACCIDENT <br />$ <br />E.LDISEASE-EAEMPLOYEE <br />EXCLUDED?(Mandatary in NH) <br />I(yes, desariheunder DESCRIPTION OF <br />OPERATIONS below <br />ELOISEASE-POUCYUMIT <br />$ <br />DESCRIPTION OFOPERATIONS/LOCANONS/VEHICLES(ACORD 101. AddiUmal Remarks Schedule, maybe aaached Nmorespare la required) <br />00 W SANTA ANA BLVD. SANTA ANA, CA 92701; City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be IXWered <br />s additional Insureds with respect to liability arising out of Work Or operations performed by or on behalf of the Instructor Including materials, parts, equipment, <br />and personnel Pomishad in Connection with such work or operations. <br />I <br />CERnF MMOI.DER CANCEt1ANON <br />City of Santa Ana, Attention: Library Agency SHOULD ANY OFTHEAROVEDESCRIBED POUCIFSBECANCELLED SEFORETHE UPIR47ION <br />No Patty Lopez OAN THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WRHTHE POLICY PROVISIONS. <br />20 Civic Center Drive # M-42 AM a RFYRES Gabriel A. Diaz <br />SANTAANA CA 92701 <br />ACORD 25(2016/03) <br />31-1769 11-15 <br />@1988-201 S ACORD CORPORATION_ An R .k*,I Ra.r.,nd <br />TheACORD name and logo are registered marks ofACORD <br />Risk MMugement. Dittslon <br />REVIEWEDfa APMovMBY: <br />`®- Risk Management speualist <br />