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I— T
<br />A b CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYYI
<br />05/8112016
<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 AFFORDEED 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 HOLDEK
<br />IMPORTANT; If tho certificate holder Is an ADDITIONAL, INSURED, the policy(im) must be endorsed, If SUBROGATION IS WAIVED, subject to the
<br />terms and conditions of the policy, certain policies may require an endorsement. A statOMOnt on this certificate sloes not confmr rights to the
<br />certificate holder In lieu of such eadorsement(s).
<br />PRODUCER Eddie Quillares Jr. State Farm Agency
<br />415 N. Broadway
<br />Santa Ana, CA 9270
<br />NAME T EdUie uiUare Jr_
<br />PRONb j 714 61 FA c o :714.61 7158
<br />ADaRESa eddie eddi inaurance,Cam
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 0
<br />INSURER A: St& teFafn15lre and Casual_t+LCompany
<br />26143
<br />Li
<br />INSURED Santa Ana Chamber of Commerce
<br />INSURER B.State Farm General Insurarg.,g QqMpp,n.y,__.__.
<br />PREMISES N11 n urrenee}
<br />IN5URERC:
<br />MEO EXP (An one LM4on
<br />1631 W. SunfIOWerAve STE C 3 5
<br />PERSONAL R ASV INJURY
<br />$ 31004,000
<br />Santa Arta, CA 92704
<br />11 V:
<br />OENERALAGGREOATC
<br />5 6,004,000
<br />�
<br />GEN'L AGGREGATE LIMIT APPLIES PER'
<br />POLICY PRO Lac
<br />ATTN: Marty Perterson
<br />MSIJURE:
<br />ENSURER F
<br />COV15aAGES C514TIF'ICATI= NUMBEIZ75d)450 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES QF INSURANCE LISTED SEwLOW HAVE 6EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INIDiCATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIDN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUI3JECT TO ALL THE TERMS,
<br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />IN'rR
<br />TYPE OF INSURANCE
<br />0.
<br />POLICY NUMBER
<br />POLICY EI=F
<br />MMIDalYYYY
<br />xP
<br />1DQaYYY
<br />LIMITS
<br />A
<br />GENERAL LIARIUTY
<br />COMM I:RCIALGENERALUABILITY
<br />..,i CLAIMS -MADE D OCCUR
<br />Y
<br />92 -CM- 15H499 -2 G
<br />03!0112016
<br />03!0112617
<br />EACH OCCURRENCE
<br />$ a,aao,aoo
<br />�-1
<br />PREMISES N11 n urrenee}
<br />$ 340,404
<br />MEO EXP (An one LM4on
<br />5 10,000
<br />PERSONAL R ASV INJURY
<br />$ 31004,000
<br />OENERALAGGREOATC
<br />5 6,004,000
<br />�
<br />GEN'L AGGREGATE LIMIT APPLIES PER'
<br />POLICY PRO Lac
<br />PRODUCTS- COMPIORAGG
<br />8 6000,000
<br />$
<br />ALJTOM0BI E UASILTY
<br />ANYAUTO
<br />ALI, OVAtED SCHEDULED
<br />AUTOS AUTOS LN-CWIIED
<br />HIREDRUTOS gUTQS
<br />❑
<br />431 6546-COI-75
<br />60l0172011
<br />4/p912p1i
<br />CO oiNER L I I
<br />ant
<br />s
<br />I
<br />{
<br />W01LY INJURY IPer person)
<br />1,000
<br />SOOILY INJURY (Fier acs &rV)
<br />S 1,00
<br />PRTPERT DA9,7
<br />Pereccid F
<br />S 1,0000
<br />5
<br />_
<br />i1MSRLI J A L1,1
<br />EXCESS LIAR
<br />OCCUR
<br />CLAIMS MAD
<br />III
<br />E
<br />❑
<br />EACH GCCURREtdCE
<br />$
<br />AGGftEOATE
<br />�W�
<br />S
<br />DEO RE ENTIONR
<br />C
<br />WORKER$OOMPFtNSATIRN
<br />AND ENPLOYERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNERJEXECUTIVE
<br />OFFICEWFMQER EXCLUDED?
<br />IMandatory In NHI
<br />Ifyes, dest;Pbe under
<br />N A
<br />I Y
<br />JRa"E966 -6
<br />02f0112p1G
<br />I
<br />t12f0112017
<br />x TORY cSLATU_ C7TrH
<br />E.L EACH ACCIDENT
<br />S 1,000,00()
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 9,000'wo
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />ID56CRIPTION OF OPERATIONS I LOCATIONS I VEHICLRS (Atrarh ACORD 109, AtI(Wonal Remarks 50edule, IT tours spaatf Is MgUIMM
<br />V"
<br />City of Santa ADS SHOULD ANY OF THE ABOVE DESCRIBED POLITIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF:, NOTICE. WILL BE DELIVERED IN
<br />20 Civic CeEtter Plaza ACCORDANCE WITH THE POLICY PRR105IONS.
<br />Santa Ana, CA 92701
<br />AUTHO SEHTA
<br />ell
<br />m 1488 -2616 D CORPORATION. All rights reserved,
<br />ACORD 25 (20161045) The ACORD name and logo are registered marks of AC 10014BG 132944,7 03 -01 -2012
<br />
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