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Francine R. Villareal Digitally signed by Francine R.Villareal
<br />Date: 2021.06.2217.35.10-07'00'
<br />BACKDAN-01 TPRETO
<br />d►c , CERTIFICATE OF LIABILITY INSURANCE
<br />��
<br />DATE(MM/D2YYYY)
<br />6/3/2021
<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 />CONTACT
<br />NAME:
<br />PHONE
<br />(A/C, No, Ext): (410) 685-4625 (A/c, No):(410) 685-3071
<br />Maury, Donnelly & Parr
<br />24 Commerce St.
<br />Baltimore, MD 21202
<br />E-MAIL
<br />DD RIESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Great American Insurance Cornan #
<br />16691
<br />INSURED
<br />INSURER B :
<br />INSURER C7
<br />Backhaus Dance
<br />INSURER D 7
<br />PO Box 5890
<br />Orange, CA 92863
<br />INSURER E
<br />INSURER F :
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />GLP3961460
<br />6/3/2021
<br />6/3/2022
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 20,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />X
<br />POLICY jE LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COBINED SINGLE LIMIT
<br />Ea Maccident
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />ccident
<br />Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />X
<br />UMB3961461
<br />6/3/2021
<br />6/3/2022
<br />AGGREGATE
<br />$ 4,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />STATUTE ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$
<br />OF EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N / A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />A
<br />Abuse & Molestation
<br />X
<br />GLP3961460
<br />6/3/2021
<br />6/3/2022
<br />Each Abuse
<br />1,000,000
<br />A
<br />Abuse & Molestation
<br />X
<br />GLP3961460
<br />6/3/2021
<br />6/3/2022
<br />Aggregate Limit
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers are additional insured. Coverage is primary and
<br />non-contributory. 30 day prior written notice of cancellation is in favor of the City of Santa Ana, Risk Management, its officers, employees, agents,
<br />representatives, and volunteers. The $4,000,000 Umbrella Liability policy goes overtop of the $1,000,000 each abuse limit, bringing the total abuse &
<br />molestation per occurrence limit to $5,000,000.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />Y
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />RisieMallagementDiviaian
<br />,�oRaN�
<br />REVIEWED & APPROVED BY.-
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<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD
<br />Risk Management Analyst
<br />
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