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1001486 132849.14 04-13-2022 INSR LTR TYPE OF INSURANCE ADD INSD SUB WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC OTHER: EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence)$ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident)$ BODILY INJURY (Per person)$ BODILY INJURY (Per accident)$ PROPERTY DAMAGE (Per accident)$ $ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CANCELLATION E-MAIL ADDRESS: CONTACT NAME: PHONE (A/C, No, Ext): FAX (A/C, No): INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : PRODUCER INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. 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. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD AUTHORIZED REPRESENTATIVE B Y Y 92-CX-M179-0 02/26/2025 02/26/2026 2,000,000 2,000,000 5,000 2,000,000 4,000,000 2,000,000 A Y Y 723 6569-A05-75 640 3716-B28-75 564 7151-A16-75 01/05/2025 02/28/2025 01/16/2025 07/05/2025 08/28/2025 07/16/2025 1,000,000 B Y 92-TA-P867-0 02/28/2025 02/28/2026 1,000,000 1,000,000 1,000,000 alexandra@royjefferson.net Alexandra 714-283-5336 714-283-5941 State Farm Mutual Automobile Insurance Company 25178 State Farm General Insurance Company 25151 ROY JEFFERSON, AGENT 115 S CHAPARRAL COURT, SUITE 250 ANAHEIM HILLS, CA 92808 AIMTD LLC 751 WEIR CANYON RD STE 157-158 ANAHEIM, CA 92808 01/16/2025 City of Pleasanton 200 Old Bernal Ave Pleasanton CA 94566 30 DAY NOTICE OF CANCELLATION, EXCEPT FOR 10 DAYS NON PAYMENT OF PREMIUM WILL BE PROVIDED Additional Insured: City of Pleasanton, 200 Old Bernal Ave,Pleasanton CA 94566 Completed by an authorized State Farm representative. If signature is required, please contact a State Farm agent. Docusign Envelope ID: DB1047F1-C907-4C36-BCCB-D3C5B1A78E77