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AIl Rom® CERTIFICATE OF LIABILITY INSURANCE Yyyy DAT12/3no18 l 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions of 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: Brian Roberts Blue Lion Insurance, LLC PHONE 800-665-5154 888-221-9537 AIC, No, Ext : (AIC, No): ADDRESS: titian@bluelioninsurance.com 10224 Airport Way, Ste C INSURER(S) AFFORDING COVERAGE NAICH Snohomish WA 98296 INSURERA: Mesa Underwriters Specialty INSURED INSURER B: Darrell Wagner dba Professional Entertainment INSURER C: PO BOX 78593 INSURER D: INSURER E : Seattle WA 98178 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, LTR TYPE OF INSURANCE INSD NND POLICY NUMBER (MMIDDIYYYY) MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 2,000,000 PREMISES (Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL &ACV INJURY $ 1,000,000 A Y Y ND0002007002854 12/05/2018 12/05/2019 GEN'LAGGREGATE x LIMITAPPLIES PER. POLICY ❑JECT LOG GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY (Ea accident $ BODILY INJURY (Par person) $ ANY AUTO OWNED AUTOS ONLY AUTOS SCHEDULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY P BODILY INJURY(Peraccident) 5 (Peracciden0 $ i $ UMBRELLA LIAR Lj OCCUR EACH OCCURRENCE $ EXCESS LIAB I I CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE FFICERIMEMBER EXCLUDED? NIA STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE1 $ Mandatory In NH) f yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below Y Y DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder, its officers, agents, and employees are named as additional insured in' m1 lto General Liability per attached CG2015 11/88. R0' \G-ti(�( 10-day notice of cancellation for nonpayment. -11- CERTIFICATE HOLDER CANCELLATION -,, r,1 1N r - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. ACM: PRCSA AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza M-23 OrLab ROorf5 Santa Ana, CA 92701 © 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD