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--1 aib,i CERTIFICATE OF LIABILITY INSURANCE GATE 10DMlY lI 6e12lzelz924 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 poiicy(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 Maguire Insurance Agency,Inc,FVM NAME: 1 Bala Piz Ste 100 PHONE FAX Baia Cynwyd.PA 19004-1401 IAlC,No,Ext): IAIC,Ni 610.617.7900 E' M A ❑R An INSURE S)AFFO G COVERAGE I NAIC N INS ERA:PtilladelphloAdermity Insurance Co an 18058 INSURED IN Dernys Diaz 7143 Fulton Way !.'SURER C. Stanton,CA 90680 IN u • rry RE e. _PH in !N F COVERAGES CE IC U R: SI MBER: 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. INSR I ADDL SUER POLICY€FF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDlYYYYI IMMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X PHPK2457612-002 0910112024 OW0112025 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S100,000 X PROFESSIONAL LIABILITY MED EXP(Any one person) $2,500 PERSONAL&ADV INJURY $11,00,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $3,000,000 PR OLICY ❑PROJECT El IPRODUCTS-COMPIOP RGG 53,000,000 OTHER SAM AGGREGATE $300,000 SAM OCCURENCE S10D,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (ra accident) S ANY AUTO BODILY INJURY(Per person) S 1112E❑AUTOS SCHEDULED AUTOS ONLY BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Peraccidenl) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EEXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION PFR OTHER AND EMPLOYERS'LIABILITY YIN STATUTE ANY PROPRIETOPJPARTNFRIEXFCJTiVE OFFICERIMEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT $ (Mandatary in NH) E.L.DISLASL-EAEMPLOYEE S If yes,describe order DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) It is understood and agreed that the following entity is added as an additional insured but only with respects)to the operations of the named insured except that liability resulting from the additional insured's sole negligence. The City of Santa Ana,its officers,officials,employees and volunteers are covered as additional insureds on the CGL paficy with respect to fiability adsing out of work or operations performed by or on behalf of the Perri including materials,parts,or equipment furnished in connection with such work operations. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 20 Civic Center Piz Santa Ana CA 92701 EXPIRATION DATE THEREOF,NOTICE WILL.BE DELIVERED IN ACCORDANCE WITH , THE POLICY PROVISIONS. RiakMnnag>:tnetl VMslmt Icon AUTHORIZED REPRESENTATIVE I�EVI€W€b&APPROVED BY.' iBY.. A,.�;a r�ceurda eta -�� RiskrAanagement Speciah3 t ialist ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(20161 The ACORD name and logo are registered marks of ACORD