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ACC)Rp® CERTIFICATE OF LIABILITY INSURANCE Onr5 11 /2 051111201717 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 Sariah Devereaux-Barrientos, Agent CONTACT NAME: Norma or Theresa uuc° NE A.�• 714 1- 280 (m No): 714 384-3892 ADDRESS: sariah.devereaux.t8lb@statefarm.com 1202 W 1st S# StafeFa►m Santa Ana, CA 92703 INSURERS AFFORDING COVERAGE NAIC 4 INSURER A : State Farm General Insurance Company5�5 INSURED CESAR VARGAS DBA MENTE INC INSURER B INSURER C : 6543 E VIA FRESCO INSURERD: ANAHEIM, CA 92807 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 NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL SUBRI POLICY NUMBER POLICDY EFF POff CDY EXP LIMITS GENERAL LIABILITY ❑! 92-EK-V825-4G I 05/16/2017 05/16/2018 EACH OCCURRENCE $ 1.000.000 rA iC COMMERCIAL GENERAL LIABILITY WWZ' 3E TO RENTED PREMISES Ea omnrance s CLAIMS4MDE DOCCUR MED EXP (Any one person) $ 5,000 PERSONAL R ADV INJURY S GENERAL AGGREGATE i 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S 2.000,000 $ X POLICY JECT PRO LOC AUTOMOBILE LIABILnY ❑ ❑ COM Ee eBccidEe�DitSINGLE LIMIT $ BODILY INJURY (Per pemn) S ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per ecddenl) $ PROPERTY DAMAGE $ HIRED AUTOS NON-OWNEO AUTOS S • UMBRELLA LIAB OCCUR j EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION WC STATU- I iOTH- AND EMPLOYERS' UABILRY ANY PROPRIETORJPARTNERJEXECU IVE Y!❑N OFFICEJMEMSER EXCLUDED? N 1 A ❑ E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEEE E.L. DISEASE - POLICY LIMIT S IS yes, describe under nFsQRIPnQN OF OPERATIONS belaw ❑ Deductible- $5.000 El PERSONAL PROPERTY $1000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional RemaiM Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA SANTA ANA , CA 92701 AUTHORIZED REPRES NTATIYE , i988-2010 O)tD COR191ATION:All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of AICORD �� 1001486 132849.8 01-23-2013