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CERTIFICATE OF INSURANCE This certifies that 0 STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois I2l STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois o STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario o STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida o STATE FARM LLOYDS, Dallas, Texas insures the following policyholder for the coverages indicated below: Policyholder ONG, ALFREDO DBA CHESS PALACE Address of policyholder 12872 VALLEY VIEW ST STE 5 Location of operations GARDEN GROVE CA 92845-2518 Description of operations CHESS The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY PERIOD LIMITS OF UABILlTY POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period) 92-09 0508-1 G Comprehensive 6 1-06 CONTINUOU S BODILY INJURY AND Business Liability PROPERTY DAMAGE ---------~------------------- t:f ProductS- ~ C,iiiipl6ted -OperatiOns - - - - - - - - - - - - - - - - - - - - - - - - - -- This insurance includes: o Contractual Liabirrty o Underground Hazard Coverage Each Occurrence $1,000,000 o Personal Injury o Advertising Injury General Aggregate $ 2, 000, 000 o Explosion Hazard Coverage o Collapse Hazard Coverage Products - Completed $ 2, 000, 000 0 Operations Aggregate 0 POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date : Expiration Date (Combined Single Limll) o Umbrella Each Occurrence $ o Other Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY NONE Wor1<ers' Compensation and Employers Liability Each Accident $ Disease - Each Employee $ Disease - Policy Limit $ POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period) THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HER If any of the policies are canceled before its expi' te te Farm' 0 mail a written no . 0 rtifica der 30 days before ncel ver, we fail to mail such notice, I or liability will be imposed on State r lis ag ts or representatives. Name and Address of Certificate Holder ADDITIONAL INSURED: CITY OF SANTA ANA;ITS AND REPRESENTATIVES 20 CIVIC CENTER PLAZA STATE FARM INSURANCE CO'S JOHN FULWILER INSURANCE AGENCY,INC. (714) 895-7882 (f!!f~L7 Signature of Auth rized Represe JOHN FULWILE nle Agent's e Stamp Date SANTA ANA,CA.92701 AFO Code 556-994 a.4 11-12-2002 Printed in U.S.A.