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0 F <br /> AC I?" CERTIFICATE OF LIABILITY INSURANCE GATE(MM1001YYYY} <br /> 11/1212025 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT EDDIE QUILLARES JR <br /> NAME: <br /> StateFarm EDDIE QUILLARES JR. PHO NE 714.617.7150 FAX <br /> Ale No <br /> STATE FARM INSURANCE AGENCY &MAIL <br /> •• ADDRESS: EDDIE@EDIJIEQINSURANCE.COM <br /> 415 BROADWAY INSURERS AFFORDING COVERAGE NAIC# <br /> SANTA ANA CA 92701 INSURERA: State Farm Fire and Casualty Company 25143 <br /> INSURED INSURERB: State Farm General Insurance Company 25151 <br /> INSURER C: <br /> TRAVEL SANTA ANA INSURER 0, <br /> 1631 W SUNFLOWER AVE STE C 35 INSURER E: <br /> SANTA ANA CA 92704 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 75-C450 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER MMlDD1YYYY MM1001YYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE Fx_1 OCCUR DAMAGE TO RENTED PRFMISFS Fa occurrence $ 300,000 <br /> MED EXP(Any one person) $ 5,000 <br /> A Y Y 92-A0-0888-3 01/01/2021 01/01/2027 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> POLICY JEo LOC PRODUCTS-COMPIOPAGG $ 2,000,000 <br /> OTHER I I S <br /> AUTO MOBILE LIABILITY Y Y 699-8732-009.75A 03/01/2021 03101/2026 COMBINEDSINGLELIMIT $ 1,000,000 <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) S 1,000,000 <br /> A X OWNED SCHEDULED BODILY INJURYiPeracddentj S 1,000,000 <br /> AUTOS ONLY AUTOS _ <br /> X HIRED NON-OWNED PROPERTY DAMAGE S 1,000,000 <br /> AUTOS ONLY /� AUTOS ONLY Per accident _ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DEO RETENTION S $ <br /> WORKERS COMPENSATION X STATUTE CRH <br /> AND EMPLOYERS'LIABILITY <br /> ANY PRO PR IETORIPARTNERIEXECUTIVE YIN F.L.EACH ACCIDENT S 1,000,000 <br /> B OFFICERrM EMBER EXCLUOED? Y❑ N/A Y 92-TA-QO41-9 03/01/2023 03/01/2026 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPE RATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Tu Tr8 n n,g raI Y ,9 ed h�TuTranNgLVen <br /> Nguyen p tl Oa[e 2035 3zz <br /> �V _ 00' <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> City of Santa Ana,its City Council,its officers,officials,employees.agents and volunteers are Additional Insured with respect to General Liability per the <br /> attached endorsements as required by written contract. Insurance is Primary and Non-Contributory. <br /> Cancellatfon Clause:City will be mailed 30 days'written notice of policy cancellation and the references"endeavor to"and"failure to mail such notice shall <br /> impose no obligation or liability of any kind upon the company, its agents or representatives"shall be removed or crossed out. <br /> APPROVED <br /> By Tu Tran Nguyen at 7:46 am,Dec 2Z 2025 <br /> CERTIFICATE HOLDER CANCELLATION —— <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> CITY OF SANTA ANA <br /> ATTENTION:COMMUNITY DEVELOPMENT AGENCY AUTHORIZED REPRESENTATIV.E 20 CIVIC CENTER PLAZA.M-25 � /• r�GLG�X /L� <br /> SANTA ANA CA 92701 �•'!.� C2� <br /> Q 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> 1001486 132649.13 04-22-2020 <br />