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AC RO V - °"T1 1..,..- CERTIFICATE OF LIABILITY INSURANCE 1/0/20'"""' 11; 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 INSURE R(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 NAME: QUYEN HOANG PARKSIDE INSURANCE SERVICES,-- 16511 Brookhurst St Fountain Valley CA 92708 INSURED - -- - ELIZALDE, GUILLERMO DBA: SUPER ANTOJITOS EXPRESS 1702 N BRISTOL ST STE D SANTA ANA CA 92706 PHONE FAX (A/C, NO, EXT): 714-705-9453 (A/C, NO): 714-839-7381 E-MAIL ADDRESS: parksideins@gmail.com INSURER(S)AFFORDING COVERAGE INSURERA: EMPLOYERS PREFERRED INSURANCE CO INSURERB: INSURER C: INSURER D: INSURERS INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH E INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB] ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD Vivo(MM/DD/YVYV) (MM/DD/VYYV) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGETO RENTED $ PREMISES (Ea Occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS - COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY \e6 COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY (Per person) $ OWNEDAUTOS SCHEDULED.(t, �e,�e V� G e �` V - ONLY AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED PROPERTY DAMAGES ONLY AUTOSONLY lC^1 (Peraccident) ��; /^ �iJ $ UMBRELLA LIAB OCCUR Q EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION ��-- - - ^ -.-PER �— OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L. EACH ACCIDENT $ 1,000,0001 EXECUTIVE OFFICER/MEMBER N/A EIG229134900 11/01/2017 11/01/2018 A EXCLUDED? (Mandatory in NFN _Y ELDISEASE EAEMPLOYEE. $ 1,000,0001 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASEPOLICYLIMIT $ 1,000,0001 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder, its officers, agents and employees are named as Additional Insured. Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the additional interest named below, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. 10 day notice of cancellation for nonpayment. CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATT: PRCSA DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA M-23 AL(4.R5WgNTATIVE __.--- _ SANTAANA -.--- -.._- --- 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