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DATE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 06/10/2025 <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 endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Elida Garcia Cervantes <br /> NAME: <br /> StateFarm EDDIE QUILLARES JR. PHHCONN Ext: (714)617-7150 FAX No): (714)617-7158 <br /> STATE FARM AGENCY ADDRESS: Elida.GarciaCervantes.VAF5S3@StateFarm.com <br /> ��c 415 BROADWAY <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> SANTAANA CA 92701 INSURERA: State Farm Fire and Casualty Company 25143 <br /> INSURED INSURERB: State Farm Mutual Automobile Insurance Company 25178 <br /> COSMOS EVENT RENTALS LLC INSURERC: <br /> 1773 W LINCOLD AVE STE S INSURERD: <br /> INSURER E: <br /> ANAHEIM CA 92801 INSURERF: <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 INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE 1:1OCCUR PREMISES <br /> (E.occurrence) <br /> ccurrrence) $ <br /> MED EXP(Any one person) $ <br /> A PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY❑ PRO- <br /> JECT ❑ LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY Y Y 698 1115-0O2-75A 03/02/2025 03/02/2026 COEaMBINED accidentS INGLE LIMIT $ 1,000,000 <br /> X ANY AUTO 867 6798-F20-75 06/20/2025 12/20/2025 BODILY INJURY(Per person) $ <br /> B OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED 195 7791-F12-75D 12/12/2024 12/12/2025 PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> City of Santa Ana, its officers,officials,employees,agents,and volunteers are to be covered as additional insureds with respect to liability arising out of work or <br /> operations performed by or on behalf of the permittee including materials,parts,equipment,and personnel furnished in connection with such work or operations. <br /> Library Services Agency Programming in the City of Santa Ana Digitally signed <br /> Tu Tran byTuTran <br /> Nguyen <br /> Nguyen D04430250oo9 APPROVED <br /> By Tu Tran Nguyen at 10:44 am,Jun 19,2025 <br /> CERTIFICATE HOLDER CANCELLATION <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 /> City of Santa Ana,ATT: Dylan Dario,Library <br /> Services Agency, M-75 AUTHORIZED��,ry REPRESSEE/NTATIVE <br /> Santa Ana,CA 92701 C �M,404 <br /> @ 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> 1001486 132849.13 04-22-2020 <br />