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' 1 AC©R" CERTIFICATE OF LIABILITY INSURANCEE(MM7DDfYYYY) 70118T/27/2025 l� 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 havo 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: Hiscox Inc.d/h/al Hiscox Insurance Agency in CA PHOJAIC,NE (888)202-3007 uc No 5 Concourse Parkway E•MAILQ Suite 2150 ADDREss: contact@hiscox.Gam Atlanta GA,30328 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Hiscox Insurance Company InG 10200 INSURED INSURER B: Andres Hernandez DBA Organizacion Osos de California Banda de INSURER C Guerra 12041 Cole St INSURER D Unit 1 INSURERE: Garden Grove,CA 92841 INSURER_F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I WV0 POLICY NUMBER MMIDDIYYYY MMIDD1YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1.000,000 CLAIMS-MADE O OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 0 X CGL is On BOP Form MED EXP(Any one person) 5 10,000 A Y Y P103,826.022,2 08128/2025 08128/2026 PERSONAL&ADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,000,000 X POLICY l] PRO- JECT LOG PRODUCTS-CDMPIOPAGG s 2A04,000 OTHER: 1 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 Ea accident ANY AUTO BODILY INJURY(Per person) 5 AAll UTOS OWN Ell SCHEDULED P103.826.022.2 08/28/2025 08/2812026 BODILY INJURY(Per accident) S AUTOS A NON-OWNED PROPERFY DAMAGE X HIRED AUTOS X AUTOS Per accident 5 CGL HNOA Limit 5 1,OQp,000 er occurrence UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR , CLAIMS-MADE AGGREGATE $ DED RETENTIONS 5 WORKERS COMPENSATION PER O YIN TH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETORIPARTNERfEXECUTIVE E.L.EACH ACCIDENT $ OFFICERfMEMSEREXCLUDEDi NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 If yes,desenbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD t e1,Additional Remarks Schedule,may be attached if more space is required) To Tra-n- en Nguy Tu Trdn Event and Location: Fiestas Patrias Event 2025 Santa Ana,CA Date: Nguyen 25.09.03 Nguyen 08:25:22-07'00' APPROVED By Tu Tran Nguyen at 8:24 am,Sep 03,.2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana,CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I C 1988-2015 ACORD CORPORATION. Ad rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD