PAINT BLAST US (STENCIL BLAST US, INC)

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ACORBI CERTIFICATE OF LIABILITY INSURANCE `� DATE(MM/DD/YYYY( 1 10/14/2024 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER NAME,CONTACT OFFICE MANAGER NAME: StateFarm TRAVIS FOSTER INSURANCE AGENCY INC PHONE 530-242-1411 ac NR: 530.242-1311 1007 DANA DR STEC auu gES: CERTREQUEST@TRAVISFOSTERAGENCY.COM ® BEDDING CA 96003 003 INSURERS AFFORDING COVERAGE NAIC N INSURERA: State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER B: State Farm General Insurance Company 2$151 PAINT BLAST US INSURER C: STENCIL BLAST US INC INSURER D : PO BOX 1196 INSURER E: SUNSET BEACH CA 90743 INSURER F: COVERAGES CERTIFICATE NUMBER: PEVlclnM MI 18110=0 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. INSRLTR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER POLICYEFF MMXH)/YYYY1 PODCYEXP IMMUDOA`YYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RE TIED PREMISES (Ea awunence $ MEDEXPIAnycne arson) $ PERSONAL &ADV INJURY $ AGGREGATE LIMIT APPLIES PER POLICYPRO- ❑ JECT LOG GENERAL AGGREGATE $ GENT PRODUCTS-COMP/OP AGG $ $ OTHER: OTHER AUTOMOBILE LIABILITY Y Y 598-0382-EO6-55 05/06/2024 05/06/2025 OMBBINEDt SINGLE LIMITEa $ 1,000,000 ANYAUTO BODILY INJURY (Per person) $ A OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY neracddent) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Peraccidant $ UMBRELLA IJAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LMB CLAIMSfMADE DED I I RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETOMPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA PER OTH- 'TATUTE FOR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) It yes, describe under E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B INLAND MARINE 90-E7-D773-2 05/06/2024 05/06/2025 MOBILE EQUIPMEN 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, AddlUonal Remarim Schedule, may be aMached It more space Is required) Project Name— Public Arts - Crosswalk Ad &Sidewalk Poetry - Mockup. Project Addresses: - 20 Civic Center Plaza Santa Ana, CA 92701. The City, its City Council, its officers, officials, employees, and volunteers are to be covered as additional insureds on the automobile liability policy with waiver of subrogation. This insurance is primary and non-contributory. 30-day notice of cancellation. APPROVED By Cynthia Mora_at 1:42 pm, Nov 211" rE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana - Public Works Agency ACCORDANCE WITH THE POLICY PROVISIONS. Attention: Isabel Gomez 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 AC,16a4 7e&614, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-162016 24