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Q® CERTIFICATE OF LIABILITY INSURANCE 7 <br />DATE(MWOWY -M <br />ADDL I <br />06/20/2016 <br />PRODUCER <br />STATE FARM INSURANCE - Jeff Biddle, AGENT <br />543 S GLASSELL STREET <br />THIS CERTIFIC TIE IS ISSUED AS MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ORANGE, CA 92866 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />Sandweod Ent Inc. <br />INSURERA state US= Mutual Auto Insurance Company 25178 <br />EACH OCCURRENCE 5 <br />INSURER <br />PREMISES Ea owvmw S <br />OBA Orange County Sandbagger <br />2424 N Batavia Street <br />NIURERC: <br />—" <br />Orange, Ca 92865 <br />INSURER D: <br />INSURER E: <br />MEDEXPIAM",Rnon j $ <br />nm,ee A nec <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY RBOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />SIM A <br />ADDL I <br />TYPE OF INSURANCE P <br />POLICY NUMBER D <br />ID 6FPEG 0 <br />0 RA <br />L11.9T4 <br />GENERALLIABILITY E <br />EACH OCCURRENCE 5 <br />5 <br />PREMISES Ea owvmw S <br />S <br />COMMERCIALGENERAL LIABILITY P <br />MEDEXPIAM",Rnon j $ <br />$ <br />WIIMSMADE FOCCUR M <br />PERSONAL E AOV INJURY S <br />S <br />GENERAL AGGREGATE ; <br />; <br />GBTLAOGREGATEUMfAPPJHSPER: I <br />I <br />PM S- COMPICPAGO $ <br />$ <br />A X <br />X A <br />AUTO M <br />MOBILE LIABILITY 1 <br />132 9265- D28 -75K 0 <br />04 -28 -16 0 <br />04 -2B -17 C <br />COMBINED SINGLE LIMIT <br />S 1, 000, 000 <br />X A <br />ALL OWNED AUTOS B <br />BODILY INJURY <br />$ 1, 000 <br />X H <br />HIREDAUTOS B <br />BODILY INJURY <br />(Para0dam) $ <br />$ <br />PROPERTYOAMAGE S <br />S <br />GARAOELMUILJTY A <br />AUTO ONLY- EAACCIDENT $ <br />$ <br />OTHER THAN EAACC $ <br />$ <br />ANYAUTO O <br />AUTO ONLY: <br />AGO S <br />S <br />EXCESSIUMBRELLAIJABBJTY E <br />EACH OCCURRENCE ; <br />; <br />AGGREGATE �S <br />OCCUR CLAIMS MADE A <br />; <br />DEDUCTIBLE <br />5 <br />RETENTION ; <br />EMPLOYERS' LIABILITY AND ] <br />] WOaTATU- OTH- <br />E.L. EACHACOIOENT S <br />S <br />ANY PROPRIETORLPARTNERJEXECUTIVE E <br />EL DISEASE -EA EMPLOYEE S <br />S <br />If yes, desulbe under E <br />ELOISEASE- POLICY LIMIT S <br />S <br />JOTHER <br />DESCRIPTION OF OPERATIONS? LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVIS 4 <br />Job description: All .Operations A/ <br />74 TI d <br />d 4 <br />.cnIir, lcnu> -ucn L;ANL:CLLATIUN <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRISEO POLICIES OE CANCELLED BEFORE THE ExMRATIoN <br />its elected and appointed officials, offorers, DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ]D oWSWRITTEN <br />employees and volunteers. NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BW FAILURE TO DO SO SHALL <br />Engineering Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER, ITS AGENTS OR <br />20 Civic Center Plaza REPRESENTATIVES, <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br />Jeff Biddle, AGENT <br />~ <br />T $2844 OS-1'5 -2017 vl On "B"+ra0 °O 53CUS 15all c y+- .++c,au+y w tnn um, ns uy a Ielr respective owners VAUV Ku UUKPORATION 1B ZS, 2 if'j <br />All rights reserved <br />~ <br />T $2844 OS-1'5 -2017 vl On "B"+ra0 °O 53CUS 15all c y+- .++c,au+y w tnn um, ns uy a Ielr respective owners VAUV Ku UUKPORATION 1B ZS, 2 if'j <br />All rights reserved <br />