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Ac"® DATE(MM/DD/YYYY) �a� CERTIFICATE OF LIABILITY INSURANCE 0 1/1 812 02 5 THIS CERTIFICATE 15 ISSUED AS A MATTEROF INFORMATION ONLYANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATIVELY 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 IN SU RER(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.VS UBROGATION 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 endorsement(s). PRODUCER CONTACT NAME: Van GOrdon(97153A1) PHONE FAX 8927 Westminster Ave (A/C,NO,EXT):714-903-5555 (A/C.NO):(657)200-2550 E-MAIL Garden Grove CA 92844-2609 ADDRESS: vgordon@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURERA: Truck insurance Exchange 21709 TOOINSURERB: Farmers Insurance Exchange 21652 1381 V ALENCIA AVEE DESIGNS, INSURERC: Mid Century Insurance Company 21687 381 INSURER D: STE G INSURER E: TUSTIN CA 92780 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIESOF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAME ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUI REM ENT,TERM OR CONDITION OFANYCONTRACT OR OTHER DOCUMENTWITH RESPECTTOWHICH THIS CERTIFICATE MAY BE ISSUED ORMAY PERTAIN,THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONSOF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPEOFINSURANCE ADDTL SUBR pOLICYNUMBER POLICYEFF POLICYEXP LIMITS LTR IN$D WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 2,000,000 DAMAGETO RENTED CLAIMS-MADE OCCUR PREMISES(Ea Occurrence) $ 1,000,000 MED EXP(Any one person) $ 10 000 B Y Y 607113383 01/18/2025 0111BY2026 PERSO NAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMiTAPPLIESPER: GENERAL AGGREGATE $ 4,000000 X POLICY ❑ PROJECT ❑ LOG PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ OWNEDAUTOS SCHEDULED ONLY AUTOS N BODILY INJURY(Per accident)$ HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ ONLY AUTOSONLY (Peraccident) UMBRELLA LIAR OCCUR EACH OCCU RRENCF $ EXCESS LIAB CLAIMS-MADL AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY X STATUTE OTHER $ ANY PROPRIETOR/PARTNER/ Y/N E.L EACH ACCIDENT $ 1,000,000 EXECUTIVE OFFICER/MEMBER N/A N 09523307 01/1812025 01/18/202fi EXCLUDED?(Mandatory In NH) Y F.L.DISEASE-EA EMPLOYEE 1,000,000 Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Digitally ig-d N Tu Tran g.y APPROVED guy¢„ Nguyeno-2 0�' By Tu Tran Nguyen at 3:19 pm,Mar 19,2025 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is requ 1381 VALENCIA AVE,TUSTIN,CA 92780 The City of Santa Ana,the entity,its officers,officials,employees,agents,and volunteer are the additional insured and the Certificate Holder The policy is on a primary and non-contributory basis. A Waiver of Subgrotaton is in the favor of the Certificate Holder CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA AUTHORIZED REPRESENTATIVE tCai,� /n SANTA ANA CA 92701 ACORD 25(2016/03) 01 9 88-20 1 5 ACORD CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD