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AI`C)RCERTIFICATE OF LIABILITY INSURANCE D05/01/2018 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(€es) 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 endarsement(s). PRODUCER Sariah Devereaux-Barrientos, Agent 1202 W 1 St St 5tafe'Farm Santa Ana, CA 92703 A• CAOMACT SARIAH DEVEREAUX FAX PHaNE Ext)- 714-�a41-7280 Ao}: 714-384-3892 E MAIL ADDRESS: San ah-devereaux.t8lb statefarrn.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: State Farm General Insurance Company 25151 INSURED MENTE INC. 6543 E VIA FRESCO ANAHEIM, CA 92607 INSURERS: INSURERC: INSURER D: INSURER E: INSURER f : COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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, INSR TR TYPE OF INSURANCE AODL sUBR POLICY NUMBER POLICY EFF MM1Db POLICY EXP MM Ol LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE DOCCUR Fy ❑ 92-EK-V825-4 05116/2016 05116/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) 5 5,000 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC pftOpUCTS - COMPIOP AGG S 2,000,000 I S AUTOMOBILE LFABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS I COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY IIAMAGE Peraccktent S UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE ❑ EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS` LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICEIMEMBER EXCLUDED? (Mandatory in NH) H yes, describe under N I A WC STATU- j j OTH- 1 E-L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Irmore space is required) CERTIFICATE HOLDER CANCELLATION THE CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 AUTHORIZED REPRESE TATIVE '-------0 1988-2010 ACO CORPORA;74816 AII_right�dserved. ACORD 25 (2010f05) The ACORD name and logo are registered marks of AC 1 132849.8 01-23-2013