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DATE
<br />CERTIFICATE OF LIABILITY INSURANCE 7/3/2018
<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 pollcyQes) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />_—___—... _..................
<br />....__._____._....._--
<br />PRODUCER Contact Name: LarryCossio
<br />Cossio Insurance Agency Phone (864)688-0121 IF.. ---
<br />PO Box 5987
<br />(AIC No, Extj__
<br />-------
<br />Greenville, SC 29606 �s e 130
<br />N-G018-
<br />E MaU:
<br />tammy�cossclnsurance_com
<br />(864) 688-0121
<br />INSURER(S) AFFORDING COVERAGE NAIC
<br />INSURED
<br />,, INSURER A:
<br />NATIONWIDE MUTUAL INS CO 23787
<br />All'Star Event Rentals, Inc.
<br />INSURER B.
<br />Berkley Life &Health Insurance Company 64890
<br />23986 Aliso Creek Road Ste Al2#441
<br />Laguna Niguel, CA 92677
<br />_....-._._.- .... .....___________
<br />INSURER C:
<br />- - -______..__...__._—........____ _
<br />INSURER D
<br />INSURER E
<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 CONTRACTOR 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 TYPE OF POLICY iADDL',SUBR POLICYNUMBER POLICY EFF POLICY EXP LIMITS
<br />LTR INSR j WVD (MMIDDIYY) (MMIDDIYY)
<br />X COMMERCIAL GENERAL LIABILITY
<br />^I 1 CLAIMS MADE 'i' OCCUR
<br />F
<br />A �7] 1 X
<br />GEN'LAGGREGATE LIMITAPPLIES PER
<br />X POLICY _',PROJECT nLOO
<br />=I OTHER:
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />ALL OWNED
<br />SCHEDULED
<br />—' AUTOS
<br />AUTOS
<br />J ''. HIRED AUTOS
<br />NON -OWNED
<br />❑rAUTOS
<br />_
<br />II
<br />J
<br />UMBRELLA LIAB i^ OCCUR
<br />EXCESS LIAB '�: CLAIMS -MADE
<br />'IJ DEO ] RETENTION$
<br />WORKERS COMPENSATION'
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N
<br />OFFICER/MEMBER EXCLUDEB? IN/A
<br />(Mandatory in NH)
<br />If yes, describe under 1
<br />DESCRIPTION OF OPERATIONS below
<br />. General Agg (Other than Products-C
<br />$5,000,000
<br />Each Occurrence
<br />$1,000,000
<br />Products and Completed Operations
<br />$1,000,000
<br />Personal and Advertising Injury
<br />$1,000,000
<br />FWC0000028614200 V25/2018
<br />1/25/2019 Legal Liability to Participants
<br />$1,000,000
<br />Professional Liability (for Event Plan
<br />$1,000,000
<br />I Damages to Premises Rented to You
<br />$300,000
<br />Participant Accitlent- Excess Medics
<br />$10,000
<br />Deductible
<br />$0
<br />COMBINED SINGLE LIMIT
<br />'', $
<br />j (Ea accident)
<br />�I.
<br />BODILY INJURY (Per Person)
<br />BODILY INJURY (Per accident)
<br />I',I $
<br />j PROPERTY DAMAGE
<br />(Peraccldent)
<br />I.
<br />Q1V\G
<br />V�
<br />PER ''.OF
<br />,STATUTE '.ER
<br />Accident Medical Deductible $100
<br />Benefit Period 52 weeks
<br />g Accident Medical PAIL012COR182502 1 1/25/2018 I 1/25/2019 Benefit Maximum $5000001
<br />Applies During - per Levered Accident
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Applies fDeath more spacesr Dismemberment Benefits only
<br />required)1
<br />Party Equipment Rentals Operations located at 23986 Also Creek Rd Ste Alt#441 Laguna Niguel, CA 92677. Certificate Holder is listed as additional insured per form CG2026,
<br />The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured
<br />Amusement devices on file with the company for special events) dated 7/4/2018 to 7/4/2018 located at 3000 W. Edinger Avenue, Santa Ana, CA 92704.Coverage Is excluded for
<br />Trackless Train, Surges Trampolines, Mechanical Bulls, Mechanical Surfboards, Carnival Games, Photobooths
<br />CERTIFICATE HOLDER:
<br />City of Santa Ana Its Officers, Employees, Agents,
<br />Volunteers and Representatives
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />CANCELLATION
<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. -\ n
<br />:AUTHORIZED REPRESENTATIVE
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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