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CERTIFICATE OF LIABILITY INSURANCE DA 09/01/2016wY) AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF I NSU RANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(;), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. � IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT SUBIR WVD NAME: Wendy Munoz(976134A) PHONE FAX 2441 N Tustin Ave Ste E (A/C, NO, EXT): 714-550-1100 (A/C, NO): 714-550-7170 E-MAIL __---_.______ Santa Ana CA 92705-1661 ADDRESS: wmunoz@farmemagent.com INSURER(S)AFFORDING COVERAGE NAIC# is 1,000,000 INSURED INSURERA: Truck Insurance Exchange 21709 INSURERS: Farmers Insurance Exchange 21652 ELIZALDE, GUILLERMO INSURERC: Mid Century Insurance Company DAMAGETO RENTED S(Ea Occurrence) 1702 N BRISTOL ST STE D INSURER D: _21687 $_ 5,000 SANTA ANA CA 92706 INSURER E: INSURER F: --- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH IS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BY TH E POLICIES DESCRIBED HEREIN IS SUBJ ECTTO ALL TH E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPEOFINSURANCE AL NSG SUBIR WVD POLICY NUMBER POLICY EFF (MM/DD/YYVY) POLICYEXP (MM/DD/YYY)Q LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE is 1,000,000 CLAIMS -MADE OCCUR u DAMAGETO RENTED S(Ea Occurrence) $ 250,000 MED EXP (Any one person) $_ 5,000 PERSONAL$ADV INJURY 1,000,000i. B Y Y 605416467 11/01/2015 11/01/2016 G EN'L GENERALAGGREGATE $ 2,000,000 AGO R EGATE LI M IT APPLI ES P ER: X POLICY I` PROJECT LOC PRODUCTS COMP/OPAGG $ 2,000_,000 $ OTHER: COMBINED SINGLE LIMIT (Eaaccident) $ AUTOMOBILE LIABILITY BODILY INJURY (Per person) ANYAUTO $ BODILY INJURY(Per accident)$ OWNEDAUTOS SCHEDULED ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOSONLY PROPERTY DAMAGE (Per accident) $ UMBRELLALIAB OCCUR EACHOCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED �,i RETENTION$ PER` STATUTE 1T OTHER $ - I$ WORKERS COMPENSATION ANDEMPLOVERi'LIABILITY : ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER N/A E.L. EACH ACCIDENT I$ -- —i E.L.DISEASE - EA EMPLOYEE EXCLUDED? (Mandatory in NH) � E. L. DISEAS LICV LIMIT _ $ Ifyes, describe under DESCRIPTION OF OPERATIONS below Remarks Schedule, maybeattached ifmorespaceis 101,Additional required) DESCRIPTION 1702 OFOPERATIONS/LOCATIONS/VEHICLESACORD N BRISTOL ST, SANTA ANA, CA 92706 G�,�i �\•\.�, '0"' -GI& CERTIFICATE HOLDER CANCELLATION f THE CITY OF SANTAANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION L 20 CIVIC CENTER PLAZA DATE THEREOF, NOTICEWILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUNRff %"E9JNTATIVC SANTA ANA -__.. CA 92701 ACORD 25 (2016/03) @1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD