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_ ft -#-zo rr 1 <br />A� CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDOA'YYY) <br />05/16/2017 <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 />tMPgRTANT: If the canl0cate holder fa an ADDITIONAL INSURED, the pDlicypas) must be eudersed, if SUBROGATION I I WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER Sariah Barrientos- Devereaux, Agent <br />Santa Ana CA 92703 ADDRESS: sapah.devareaux.t <br />St PHONE —' <br />G No ,r 1vF' 7141_7280 ,PV„ c,_rvo�: 714- 304,3692_ <br />' S Sa 81b $tatefalm.Cpm <br />1. <br />IN9URCRi91 AFFpkOlNta muaaane _T <br />INSURED Mente Inc. <br />6543 E Via Fresco <br />Anaheim, CA 92807 <br />COVERAOFS ncri U <br />-- - I- "— I- "� "'Q4 ^` REVISION NUMBER: <br />THIS IS TO CERTIFY -THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO Tf1E INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION <br />OF <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED <br />ANY CONTRACT OR OTHER DOCUMENT VMTH RESPECT TO WHICH THIS <br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE <br />BEEN <br />ILTR AbT1lF&�I Bl� "— _ —. - -�, <br />REDUCED BY PAID CLAIMS. <br />.. <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />GENERAL LIABILITY <br />POLICY EFF POLICY EXP_ " —' —" —.... <br />MIDD/YYVY MIDU/ LIMITS <br />MERCIAL GENERAL L BILttt 62EBJSD50 <br />COMIA <br />OS /1Sf20ib 0611612077 EACH OCCURRENCE $ 2,000,000 <br />CLAIMS -MADE I, OCCUR ' <br />..PREMISS La ocrutta_ b 1,000,000 <br />—'" <br />— <br />MEDEXP(AnymePerson § 5,000 <br />"' - -'' -- <br />II� <br />PERSONAL &ADV INJURY g- <br />W^ ' - - "— <br />1 GENLAGGREGATELIMITAPPUESPER: <br />GENERAL AGGREGATE $ 200,000 <br />- ---. —. <br />POLICY hPRO- LDO <br />PRODUCTS- COMP/OP AGO $ _2,000 <br />AUTOMOMLE LIABILITY <br />❑ <br />ANY AUTO <br />C M81N I L LI <br />a rimeent <br />ILL 0 ED <br />BODILY INJURY (Per <br />(AUTOS LED <br />Person) $ <br />AUTOS <br />NON�OVMED <br />BODILY INJURY (Peramida,N) $ <br />HIRED AUTOS gUT.0 <br />'PAR PERwN bf4 II�A6E <br />R <br />— <br />UMSRELLA LIAB OCCUR ' <br />EXCESS LIAR i <br />Ll ,' <br />CLAIMS-MAD <br />EACH OCCURRENCE $ <br />—" - -'- <br />"' — "— <br />DEO RETENTION$ <br />AGGREGATE § <br />WORI(ERS COMPENSATION <br />$ <br />ANY EMPLOYERS'LIABILITY <br />ANYPROPRIETOR/PA BILITYF.XECUTIVE YIN' <br />W I IT 0 H- -- <br />�TORVTATU- R <br />OFFICEAIEMRER EXCLUOEV! [::] NIA <br />E. L, EACH ACCIDCNT $ <br />77 <br />ifyeedescdbegnder <br />E.L. DISEASE =EA EMPLOY $_ <br />` <br />EL DISEASE,POLICY WMIT $ <br />Dar cdble- $500.00 <br />DESCRIPTION OF OPERATIONS/ LOCATIONSIVEHIOLESAttach ACORD 101, Addlt(onal Remarks Schedule, if More space is requireq) <br />.CERTIFICATE HOLDER � ......"_.. <br />._._.- __ <br />Aditionai Insured <br />The City of Santa Ana <br />20 CIVIC Center Plaza <br />Santa Ana< CA 82701 <br />ACORD 25 (2010105) <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 />AUTHORISED REPRESaENTATIVe <br />Tha ACORD name and loge are registered marks of <br />A NON —All rights reserved. <br />1001486 132849.8 01- 23.2013 <br />