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DATE (MMIDDIYYYY) <br />�cQ�o CERTIFICATE OF LIABILITY INSURANCE 5/16/2019 <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 policy(ies) 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 />PRODUCER <br />Specialty Insurance Agency <br />Performers of the U.S. <br />P.O. Box 24 <br />CONTACT Stephanie Weiss <br />N&Mt, <br />PHONE 715-246-8908 FAX 715-246-4257 <br />IALG. N9..F.xt): <br />ADDRESS ceft@specialtylnsuranceagerlcy.com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />New Richmond, WI 54017 <br />INSURER A: Evanston Insurance Company <br />35378 <br />_ <br />INSURED Franklin Delano Haynes <br />INSURERS: <br />INSURER C <br />dba Franklin Haynes Marionettes <br />1234 Muirfield Road <br />Riverside, CA 92506 <br />itusuRERn: <br />INSURERE: <br />INSURER <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 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 REDUCED BY PAID CLAIMS. <br />INSR <br />TRam <br />TYPE OF INSURANCE <br />ADDL <br />SUBIR <br />3mn <br />POLICYHu BER <br />POLTCYEFF <br />POLICY EXP <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE ix� OCCUR <br />TO FfffffffD_ <br />PREASES(Ea o [el e <br />$ 300,000 <br />MED EXP (Any oneperson) <br />$ 5,000 <br />PERSONAL& ADV INJURY <br />$ 1,000,000 <br />A <br />X <br />X <br />2CN0165-7335 <br />04/18/2019 <br />04/17/2020 <br />t3Etl'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS -COMP/OPAGG <br />$ 2,000,000 <br />X POLICY PRO ❑ LOC <br />JECT <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />(Ea pc4 en ll SINGLE LIMIT <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />$ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />$ <br />• <br />E <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />_ <br />DIED I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETORIPARTNERIEXECUTIVE Y� <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />OFFICERIMEMBEREXCLUDED? <br />(Mandatory In NH) <br />N / A <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />A <br />BUSINESS PERSONAL PROPERTY - <br />INLAND MARINE <br />I AGGREGATE <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: <br />Franklin Delano Haynes dba Franklin Haynes Marionettes <br />Additional Insured: The City of Santa Ana, its officers, agents and employees as additional insured <br />Email: mloera@santa-ana.org Attn: Michelle Loera <br />Event Date: July 15, 2019 <br />REVIEWED & APPROVED <br />CLItIIFIC;AII: HULUtR i \ I.HIVI.CLLPIIIUIY <br />City of Santa Ana J 1 9 901A <br />26 Civic Center Plaza 1 L 7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Santa Ana, CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />A FIA M. LAMBERT <br />AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD CORPORATIUIV. Ali rignts reservea. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />