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A6. R CERTIFICATE OF LIABILITY INSURANCE <br />Do4127/22o s ) <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 AFFORDED 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 HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Sariah Devereaux-Barrientos, Agent <br />1202 W 1st St <br />statefarrn Santa Ana, CA 92703 <br />A <br />CONTACT <br />NAME: SARIAH DEVEREAUX <br />PHO <br />OX.No..ExO' Ac,Ho):JL4_384_3892 <br />nDDRESS Sariah.devereaux.t8lbCdstatefaml.com <br />INSURER 5 AFFOROMG COVERAGE <br />NAIL 11 <br />INSURER A: State Fann Fire and Casualty Comoan <br />25?a3 <br />WXRI! <br />INSURED MENTE INC. <br />INSURER B: <br />INSURER C: <br />6543 E VIA FRESCO <br />ANAHEIM, CA 92807 <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />T <br />TYPE OF INSURANCE <br />ADO S BR POLICY NUMBER <br />MMDDY EFF <br />MMMD UCYEXP <br />UMTre <br />GENERAL UABILJTY <br />COMMERCIAL GENERAL DABILITV <br />CLAIMS -MADE ❑OCCUR <br />❑Y iF-] <br />92-EK-V825-4 <br />0611612019 <br />05116/2020 <br />EACH OCCURRENCE <br />S 1.000,000 <br />D <br />PREMISES jE. aaarrence <br />S <br />MEDEXP(Anycneperson) <br />S 5.000 <br />PERSONAL&ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />S 2,000.000 <br />GENL AGGREGATE <br />POLICY <br />LIMIT APPLIES PER: <br />7 PRP LOC <br />PRODUCTS -COMNOP AGO <br />$ 2,000.000 <br />S <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS AUTOS <br />❑ <br />FO .CCEen SINGLE LIMIT <br />S <br />BODILY INJURY (Per Person) <br />S <br />BODILY INJURY(Per eWdent) <br />S <br />P�ROPE�R,d ^DAMAGE <br />$ <br />S <br />UMBREWk UAB <br />EXCESS UAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />$ <br />DELI I I RETENTIONS <br />$ <br />WORKERS COMPENSATION <br />ANOEMPLOYERS'DABILITY <br />ANY PROPRIETORIPARTNEWEXECUTIVE YI❑N <br />OFFICEIMEMBER EXCLUDED? <br />(Mandatary In NHl <br />dyea.d"al0eender <br />NIA <br />❑ <br />V/C STATU- OTH- <br />- MDS <br />E.L. EACH ACCIDENT <br />S <br />E.L. DISEASE -FA EMPLOYE <br />S <br />E.L. DISEASE -POUCV OMIT <br />$ <br />❑ <br />❑ <br />Dedu able: 2,00) <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attnh ACORD 101, AddiBonal Remade Sce le. H more slues is mpalred) <br />THE CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD/ 10014'Bel32849.8 01-23-2013 <br />