ZEPEDA DE LEON, ILIANA C. - Laserfiche WebLink

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ACo CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) OS/2812028/2025 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 endorsement(s). PRODUCER CONTACT NAME: Next First Insurance Agency,Inc. PHONE t (855)222-5919 FAX PO Box 60787No. Palo Alto,CA 94306 E-MAIL ADDRESS: support@nextinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: State National Insurance Company,Inc. 12831 INSURED INSURER B Iliana Zepeda De Leon Iliana Zepeda De Leon INSURER C: 1000 E Bishop St Santa Ana,CA 92701 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:893032668 REVISION NUMBER: 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DPOLIDIYCY EYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS-MADE �OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $100,000.00 MED EXP(Any one person) $15,000.00 A X X NXT9YLJKKK-00-GL 05/19/2025 05/19/2026 PERSONAL&ADV INJURY $1.000,000.00 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000.00 X POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG S2,000,000.00 OTHER. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION SPERTUTE OERTH- AND EMPLOYERS'LIABILITY Y 1 N TA ANYPROPRIETOPJPARTN ERIEXECUTI VE OFFICERlMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT 5 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S Each Occurrence: $1,000,000.00 A Professional Liability NXT9YLJKKK-00-GL 05/19/2025 05/19/2026 Aggregate: $2,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate Holder is City of Santa Ana,Attention:Executive Director,Community Development Agency.A Waiver of Subrogation applies in favor of this Certificate Holder on the following policies:General Liability.This Certificate Holder is an Additional Insured on the General Liability policy on a primary and non-contributory basis.This Certificate Holder is an Additional Insured on the General Liability policy with respect to ongoing operations.This Certificate Holder is an Additional Insured on the General Liability policy with respect to completed operations.All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured,and are subject to policy terms and conditions. Name of event: Clay in the Community Tu Tra n Dig,Wlys,gnedby APPROVED Location:1000 E.Bishop St.Santa Ana CA 92701 Tu Tran Nguyen Nguyeoa:26:56 07'00' g Tu Train Nguyen of 4:25 m,May 29,2025 n 16r26:56-0T00' YP Y CERTIFICATE HOLDER CANCELLATION City of Santa Ana,Attention:Executive Director, LIVE CERTIFICATE Community Development Agency — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Civic Center M-25 Santa THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana,CA 92727011 ACCORDANCE WITH THE POLICY PROVISIONS, r• AUTHORIZED REPRESENTATIVE Click or scan to view ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD