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A� O® CERTIFICATE OF LIABILITY INSURANCE DATE,MM/BD,YYYY) <br />5/- 17 <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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the 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 CONTACT Dori Jared-Ferranto <br />NAME: <br />Assistance Insurance Agency P`AHONtEa, Exq; (714)245-2777. PAS NeI o1a)2as-27ee..._ <br />215 N Second Ave. EMAIL d aredB assistanceins. com <br />ADDRESS; 7 _ <br />Suite D INSURERLS1 AFFORDING COVERAGE NAIC4 <br />Upland CA 917E6 INSURERA State Compensation Insurance Fund <br />INSURED INSURER B : <br />_......._ .............. __-_. _-_... _.... ............ <br />Manuel Hnante, DDA: Stage Plus, Inc. INSURER <br />.......... _._ _._- <br />... . _... .. <br />2330 S. Susan St. INSURERD: <br />INSURER E: <br />Santa Ana CA 92704 1INSURER F: <br />COVFRAr:FS CERTIFI(`.ATENHMRERtl7-18 WC 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 <br />REDUCED BY PAID CLAIMS. <br />ASR AODL SUER - - <br />LTR TYPE OFINSURANCE 0 vD POLICY NUMBER <br />- POLICY EFF - POLICY EXP - <br />IMMIDDIYVYYJ UMMIODMYYLIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />DAMAGEr"o RENTED .. $._ __.. <br />CLAIMS MADE OCCUR <br />_ PREMISES Ea occurrence) <br />MED EXP (Any ono parson) $ <br />PERSONAL&ADV INJURY $ <br />GE_NLAGGREGATE UMITAPPLIES PER <br />GENERAL AGGREGATE $ <br />POLICY PRO <br />JECT LOC <br />-. <br />PROOUCTSCOMP/UP AGO 8 <br />OTHER: <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT 8 <br />(Ea accidan9 <br />ANY AUTO <br />BODILY INJURY(Per person) $ <br />ALL OS -----SCHEDULED <br />BODILY INJURY (Peraccitlen) $ <br />_ <br />WNED <br />e ac denDAMAGE $ <br />HRTEDSAU rOS ANON UTO <br />_(PROPERTY <br />UMBRELLA LIAR OCCUR <br />EACI'I OCCURRENCE $ <br />EXCESS LIAS CLAIMS -MADE <br />AGGREGATE 8 <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />YPER ` STATUTE ERH <br />AND EMPLOYERS' LIABILITY YIN <br />— .-- -- -- -- <br />ANYPROPRIETORPARTNER/EXECUTIVE <br />)^ EL EACH ACCIDENT $ 1,000,000 <br />OFFICERIMEMBER EXCLUDEDI NIA�� <br />A (Mandatory In NH) 1T86318-17 <br />"" -' <br />217 5/1/2018 LDISEASE EA EMPLOYEE$ 1 Do 0, 000 <br />If yyes, descnbe under <br />As.OF OPERATIONS below <br />EL. DISEASE -POLICY LIMIT 5 1,000,000 <br />n <br />e , <br />DESCRIPTION OF OPERATIONS /LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schadule,'V <br />v e�lP\ space Is required) <br />The City of Santa Ana, its officers, employees, ag�ng <br />uftt� s and representatives <br />Proof of Insurance <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 />Jared-Ferrant0/STEP <br />n 1OHR_9D1d AC(IRn <br />r,nhte <br />ACORD 2512014/01) The ACORD name and logo are registered marks of ACORD <br />INS025 nnte0n <br />