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CERTIFICATE OF LIABILITY INSURANCE °A04125/201�w" <br />THIS CERTIFICATE 15 ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY <br />AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE ACONTRACT BETWEEN THE ISSUING INSURER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTAW,, IfthecertlRcate holder is an ADDITIONAL INSURED, the policy(lea) must haveADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subled to Use terms and <br />conditions of the polity, Certain polictesmay require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements). <br />............... ..... ..... .............. . .... ......_ ...._-.. __.. _... ......__—_.-. _.___—_ _. _.__.-._..... <br />PRODUCER CONTACT <br />NAME: Wendy Munoz <br />' Wendy MUnOZ(976134A) 'PHONE FAX <br />2441 N Tustin Ave Ste E (A/C, NO, EXT): 714-550-1100 (A/C, No): 714-550.7170 <br />.�5-MAIL <br />Santa Ana CA 02705-1061 ADDRESS: WmUTIOZ )farmersagent corn <br />INSURER(5)AFFORDING COVERAGE NAICN <br />INSURED-INSURERA: Truck Insurance Exchange 21709 <br />.... ....__.... <br />INSURER& Farmerslnsurance Exchange 21652 <br />ELIZALDE, GUILLERMO --- --- ---- --- ---- <br />IDEA: SUPER ANTOJITOS EXPRESS INSURERc Mid Century Insurance Company 21687 <br />1702 N BRISTOL ST STE D INSURERD <br />--- _..... ....... ._ ...._. ___ . -. <br />SANTA ANA CA 92706 INSURERE '.. <br />INSURERF: .._..-.___. <br />_.__,.. ......__.._.. __....._.__ . .. _. _. .._ ..._..._-_..--- _—_...._ <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />._.. _ ..._._.._._ _._.——..._— HE_I .___.E .__.O IN <br />TO <br />NCE <br />THIS I EMENT. TERM <br />CONDITICIESOFINSURATRACTOR BELOWHAVE BEEN IESUEDTOTHEIO WHIC NAME ABOVE FOR MAYKIISSUCY E OR INOICATA THEINSURANC AFFORDED <br />REQUIREMENT. TERM OREIN5ITBJECT ION ANY WNTRACTOR OTHERDOCUMENTC NDITIOSPECTTCHPOITHIS CERTIFICATE SHOWN MAY1SSUEDEN REDUCETAIN,THEINSURANCEAFFORD@BY THE <br />POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXGLUSIONSAND CONDITIONSOF SUCH POLICIES. LIMITS SHO'NNMAVHAVEBEEN REDUCE.. BY PAID CLAIMS. <br />INSR Type OF INSURANCE AOOTL SUER POLICYNUMBER POLICY SEE POLICY EXP OMITS <br />LTR INS° WVD (MM/DD/)rYYY) (MM/OD/YYYY) <br />Z/I COMMERCWL GENERAL UARUTY EACHOCCURRENCE $ 1,000,000. <br />I I.,.__7 <br />CLAIMS-MAOE X j OCCUR DAMAGETORENTED $ - <br />PREMISE5(EaOccurrence) 250.000 <br />~- MED EXP(Anyone person) $ 5 000 <br />A __ Y Y 605416467 11/01/2016 ` 11101/2017 PERSONAL&ACV INJURY $ 1,000,000 <br />_._._._......,. <br />GEN'L AGGREGATE LIMIT APPLI ES PER: GENERAL AGGREGATE $ 2000000 <br />, <br />,I <br />POLICY PROJECT L �; LOC PRODUCTS COMP/OP AGO $ 2,000,000 <br />OTHER: 'q <br />AUTOMOBILELNLBILITY <br />COMBINEDSINGLEUMIT <br />$ " <br />(Ea accident) <br />ANYAOTO <br />,...,....__. .. ... <br />BODILY INJURY(nerperson) <br />._...._..__J. <br />E <br />4 OWNEDAUTOS SCHEDULED <br />T <br />ONLY AUTOS <br />'.' BODILY INJURV(Per accident)$ <br />'HIREDAUTOS NON -OWNED <br />'- <br />,Ay, ��•° <br />PROPERTY DAMAGE <br />$ -, <br />ONLY 1 AUTOSONLYU <br />.. <br />(Peraccident) <br />..... ..,. <br />.. <br />UMBRELLA LIAB OCCUR <br />EXCESS LIAR CLAIMS MADE <br />EACHOCCURRENCE <br />S <br />AGGREGATE <br />_ <br />$ <br />_ .._DED RETENTION$ ..._.. <br />...' <br />�� ,✓•�e ,YAfir. <br />..... ____ <br />—. -. <br />AND EM SCO RS'LUM ILIT <br />',. AND EMPLDYERS'LIABILITY <br />- <br />PER <br />STATUTE OTHER <br />$ <br />ANY PROPRIETOR/PARTNER/ YIN <br />�(•. <br />P 11 <br />EL EACH ACCIDENT <br />$ <br />EXECUTIVE OFFICER/MEMBER N/A <br />-"" <br />- <br />EXCLUDEDI(Manditory in NH) ; <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />DESCRIPTION Of <br />�_......-..._-.:... _.._. <br />._._........._. <br />OPERATIONS <br />OPERATIONS below <br />below/ <br />E.L DISEASE -POLICY LIMIT <br />S <br />DESCRIPTION OF (ACORD IDI, Additional Remarks Schedule, maybeattachad Ifmpreapace lsreRuimd) <br />1702 IN BRISTOL ST,TISANTA ANANCA 92706 <br />CERTIFICATE HOLDER <br />CANCELLATION <br />THE CITY OF SANTA ANA. <br />. ..__.._� .____... _._ .... _.. _.... .. <br />SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION <br />20 CIVIC CENTER PLAZA <br />DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICYPROVISIONS, <br />A11�������ESENTATiVE <br />........ _—..._........ .__SANTAANA .... _.. . <br />_CA -92701 <br />ACORD 25 (2016/03) 01988.2015 ACORD CORPORATION. All Rights Reserved <br />31-1759 11.15 The ACORD name and logo are registered marks of ACORD <br />