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GREELLC-03
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />MONIES
<br />DATE (MMIDDIYYYY)
<br />W29/2020
<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 endomemen s .
<br />PRODUCER
<br />C NTACT
<br />PZrN,Ext: 303 987-3373 1 IV,Ne:303 969-9120
<br />DCI(Lakewood)
<br />1074 South Alklre Street
<br />Lakewood, CO 80228
<br />Ai%%ss. john.ossian@dcinsurers.com
<br />IN RE AFFORDINGI COVERAGE
<br />INSURER A: The Hartford
<br />29424
<br />INSURED /
<br />INSURIERS,PinnacollAssurance
<br />41190
<br />INSURER :
<br />GmenPlay LLC /
<br />IN RER 0:
<br />1021 E. South Boulder Road Suite N
<br />Louisville, CO 80027
<br />INSUER E
<br />INSURRER F :
<br />COVERAGES CFRTIFICATF NIIMRFR• RFVISION NIIMRER-
<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 />TYPE OF INSURANCE
<br />DDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMff3
<br />A
<br />X
<br />COMMERCIAL GENERAL LIA I
<br />CIAIMS-MADE OCCUR
<br />X
<br />X
<br />34SBAIR6876
<br />511/2020
<br />✓
<br />5111202,
<br />EACH OCCURRENCE
<br />2,000,000
<br />DAMAGE TO RENTED
<br />1�000,000
<br />n
<br />10,000
<br />INJURY
<br />2,000,000
<br />AGGR TE LIMIT ",S PER
<br />POLICY�JELPT LJ LOC
<br />OTHEI
<br />4,000,000
<br />PRODUCTS - COMPIOP AGG
<br />S 4,000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY /
<br />AY AUTO✓
<br />OWNED AITUSOSD AUTOSONLY �
<br />HIW ONLY N%tM
<br />X
<br />X
<br />34UEGJJ1390
<br />5/112020
<br />✓
<br />5/11202
<br />COMBINEFsacc,doD SINGLE LIMB
<br />1,000,006
<br />X
<br />BODILYI RY (Per
<br />--
<br />BODILY INJURY a
<br />RAGE
<br />A
<br />X
<br />UMBRELLALIAe
<br />EXCESS Lus
<br />X
<br />OwCCUR
<br />cMSMADE
<br />X
<br />34SBAIR6876
<br />511/2020
<br />5111120211
<br />EACH OCCURRENCE
<br />1,000,000
<br />AGGREGATE
<br />DED X RETENTIONS 10,000
<br />Gen Aggregate
<br />11000,000
<br />B
<br />WORKERS COMPENSATIONPER
<br />AND EMPLOYERS' LIABILITY �IYYYY ��/�ttt11111I
<br />ANY PROPRTTORIPARTNEREXECUTIVE u
<br />Wp ICEW,MBER EXCLUDED? u
<br />(rar,aal«yIn NH)
<br />rc ,aeavee ender
<br />D RIPTI Nu' PERATIONS below
<br />NIA
<br />X
<br />19301
<br />51112020
<br />511/2021
<br />OTH-
<br />ATUIT
<br />E.L. EACH ACCIDENT
<br />11000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />_
<br />..DI POLICY UNIT
<br />1,000,000
<br />A Business Owners Poll
<br />A Business Auto
<br />34SBAIR6876
<br />34UECJJ1390
<br />51112020
<br />5/112020
<br />51112021
<br />54/2021
<br />Ded 500
<br />comp 500 S toll. 500
<br />36,700
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES ACORD101, Additional Remarks Schedule, may be attached K more space is required)
<br />City of Santa Ana, California and its officers, oAcals, employees and agents are named as additional Insure o General liability (SS00080405)on Primary
<br />and non-contributory basis (SS00080405) and commercial auto (HA99160312)4q� 1by written contract. Waiver of subrogation
<br />on the General liability(SS00080405), commercial auto (HA99160312), and woro 'OIie ,�N 6Wuimd by written contract. 30 day ✓
<br />cancellation notice applies (IH03130611). excess policy to follow form. By Ri ANAfi M(I 0--t EN�UIIII�I
<br />2020
<br />City of Santa Ana, CA
<br />Risk Management Division
<br />20 Civic Center Plaza 4th Floor
<br />Santa Ana, 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 WRH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />&.-'o
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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