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�1 <br />Policy Number: <br />Dale Entered: 1/8/2009 <br />ACORN CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM <br />12/ 2/2015 /2015 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the 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 ondorsement(s). <br />PRODUCER <br />VICTORIA INSURANCE AGENCY <br />Chris D. Victoria <br />talla- <br />1740 West Ka Ave #H <br />CONTACT <br />NAME: CHRIS VICTORIA <br />PNONE Ert.(714)744 -4500 FAX (714)744 -2500 <br />E-MAIL VICTORIAINSURANCE345 @GMAIL. COM <br />ADDRESS: <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />Orange, CA, 92667 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A; TRUCK INSURANCE EXCHANGE <br />21709 <br />INSURED SANTA FE BUILDING MAINTENANCE <br />INSURER B: MID — CENTURY INSURANCE COMPANY <br />21687 <br />INSURERC; <br />$ 75,000 <br />GUADALUPE MEDINA <br />I5644 PALOMINO DRIVE <br />INSURER D: <br />CHINO HILLS, CA 91709 -5510 <br />INSURER E: <br />$1,000,000 <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 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 <br />I <br />TYPE OF INSURANCE <br />ADDL <br />DIED <br />SUER <br />WVD <br />POLICY NUMBER <br />POLICY I <br />MMIDD/YYYY <br />POLICY I <br />MM /DDIYYYY <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />X <br />60366 -1 <br />3/29/2015 <br />3/29/201/6 <br />✓ <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE TO RENTED occurrence <br />$ 75,000 <br />MED EXP(Any one person) <br />$ 5,000 <br />PERSONAL B ADV INJURY <br />$1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />POLICY [::]JE� [:] LOC <br />PRODUCTS - COMP /OP AGG <br />$1,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,()00 <br />BODILY INJU RY(Per person) <br />$ <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />60486 -94 -07 <br />1/01/2015 <br />1/01/2017 <br />BODILY INJURY (Per accident) <br />$ <br />B <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY ident) AGE <br />Per accident <br />$ <br />$ <br />A <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$2,000,000 <br />AGGREGATE---- <br />EXCESS LIAR <br />CLAIMS -MADE <br />60499 -63 -93 <br />3/29/2015 <br />3/29/2016 <br />DED RETENTION$ 10,000 <br />--$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y <br />ANY PROPRIETOR /PARTNER /EXECUTIVE ❑ <br />OFFICER /MEMBER EXCLUDED? <br />(Mandatory In NHI <br />N/A <br />A0931 -60 -44 <br />2/15/2015 <br />2/15/2016 <br />I SPER OTH- <br />TATUTE ER <br />E.L. EACH. ACCIDENT <br />$2,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 2 r 000, 000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$2,000,000 <br />A <br />EMPLOYEE DISHONESTY <br />60366 -65 -69 <br />/29/2015 <br />/29/2016 <br />$100,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101 Additlonal Remarks Schedule, may be atlached if more space is requlretl <br />30 DAYS NOTICE OF CANCELLATION �XCEPT 'E'OR NON PAYMENT OF PREMIUM WHICH REMAIVS AT 10 DAYS <br />THE CITY OF SANTA ANAr ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE ADDITIONAL <br />INSURED IN RESPECT TO GENERAL LIABILITY. <br />CERTIFICATE HOLDER CANCELLATION <br />THE CITY OF SANTA ANA /fir <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />60 CIVIC CENTER PLAZA <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />P.O. BOX 1981 <br />SANTA ANA, CA 92702 v <br />O^ <br />AUTHORIZED REPRESENTATIVE <br />CHRIS VICTORIA�� <br />ACORD 25 (2014/01) <br />11988-2014 ACORD CORPORATION. All rights roserved. <br />The ACORD name and logo are registered marks of ACORD <br />Produced using Forms Boss Plus software. www. FormsBoss.com; Impressive Publishing 800- 208 -1977 <br />