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CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDD/YYY11 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.12019 IS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />REPRESENTATIVE O <br />BELOW. THIS CERTIFICATE INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESER PRODUCEE R, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certigcate holder is en ADDITIONAL INSURED, the policy{les) 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 this certificate does not Confer rights to the certificate holder in ill nr III...w....__.__.._, require an endorsement. A statement on <br />PRODUCER <br />East Main Street Insurance Services, Inc. <br />Will Maddux <br />PO Box 1298 <br />Grass Valley <br />INSURED <br />M.A.G.I.C. INC. <br />James Stapleton clo Anita Harvey <br />700. W. 3RD ST <br />THIS IS TO CERTIFY THAT THE POLICIEI <br />INDICATED. NOTWITHSTANDING ANY R: <br />CERTIFICATE MAY BE ISSUED OR MAY <br />EXCLUSIONS AND CONDITIONS OF SUCH <br />CA 95945 <br />CA <br />Insurance <br />35378 <br />NT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT OLICY WHICH PERIODWHICHTHE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />CLAIMS -MADE X OCCUR i EACH OCCURRENCE g 1, <br />737ANVI <br />Host Liquor Liability PREMISES (Eacmurrerm) g V <br />A Retail Liquor Liability Y Y 3DS5466-M2704118 MED ExP (An ore pemon) s 5, <br />09/28/2Q19 Q9/29/2019 PERSONAL& ADV INJURY It 1, <br />OEN'L AGGREGATE LIMIT APPLIES PER 12:01 AM 12:01 AM t <br />IJl POLICY 0 �a r LOC I GENERALrgGGgEOpTE - s 2,i <br />OTHER: l PRODUCTS-COMP/OPAGG It I,I <br />AUTOMOBILE LIABILITY j j Deductible 's 1,1 <br />I M INEO SIN LE LIMIT <br />MY ALTO I fEa eccitla0I 8— <br />OWNED SCHEDULED BODILY INJURY (Per pareon) I $ <br />AUTOS ONLY AUTOS �`�----r—. <br />1 HIRED NON-0WNED BODILY INJURY(Peracddant), $ <br />_ AUTOS ONLY AUTOS ONLY 1 ?ROPEROAMAGES— <br />UMBRELLAUAB .00CUR is <br />EXCESS LIAR EACH OCCURRENCE <br />„J�l CLAIMS•MADE� - S <br />_ <br />DED ! 1 RETENTIONS AGGREGATE <br />WORKERS COMPENSATION -g <br />AND EMPLOYERS' DABILITV Y/N .'' PER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE `. �aTATUTE IOTH— <br />OFflCE�In NH EXCLUDED9 �N/A STATUTE <br />ACCIDENT _ g <br />(Mande �{�_ <br />Ir ySCRIP ION,radar E.L. DISEASE -EA EMPLOYEEIfs <br />DESCRIPTION OF OPERATIONS below ' <br />i I <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remark. Schedule, may be."rhed It more Space is required) <br />Iertificate holder listed below is named as additional insured per attached MEGL 2217 01 19, <br />ltiendance: 200, Event Type: Block Party. <br />Vaiver of Subrogation applies per attached CG 24 04 05 09. <br />'dmary/Non-Contributory wording applies per attached CG 20 0104 13. <br />:ity of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written Contract, agreement, or <br />lemorandum of understanding <br />REVIEWED & APPROVED <br />City of Santa Ana `W <br />Risk Management <br />20 Civic Center Plaza, 4th floor <br />Santa Ana <br />19 2019 <br />M. LAMBERT <br />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 />ACORD 25 2016/03 G r aoo-�M 1a AL"LiKu wHPURATION. All rights reserved. <br />) The ACORD name and logo are registered marks of ACORD <br />