DARRELL WAGNER DBA PROFESSIONAL ENTERTAINMENT (2)

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Francine R. Mgaanrd9Md byFranene R. Villareal Villareal oate2021.1102 627:28 URaa A� D® CERTIFICATE OF LIABILITY INSURANCE OATH/81202A1YYY) 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 policy(ies) must have ADDITIONAL INSURED provisions or 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: Bt1an Roberts Blue Lion Insurance, LLC PHONE 800-665-5154 888-221-9537 A/C No a : (A/C, No poDRESs: brian@bluelioninsurance.com 10224 Airport Way, Ste C INSURER(S) AFFORDING COVERAGE NAIL# Snohomish WA 98296 INSURERA: Mesa Underwriters Specialty INSURED INSURER 5: Darrell Wagner dba Professional Entertainment INSURER C : PO BOX 78593 INSURER D : INSURER E : Seattle WA 98178 1 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- THIS IS TO CERTIFY THATTHE 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 WVD POLICY NUMBER (MMIDOIYYYY) (MMMD/YYYY) LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y Y N90046001004491 07/30/2021 07/30/2022 EACH OCCURRENCE $ 1,000,000 PREMISES(E. occurrence) $ 100,000 MED EXP (Any ene person) $ 5,000 PERSONAL SADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PET 7 LOG OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS -COMPIOP AGO $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UUMUINtUblNULLUM11 (Ea accident) $ BODILY INJURY (Par person) $ BOOILV INJURY (Per accident) $ (Perocciden0 $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMSMADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ ORKERS COMPENSATION ND EMPLOYERS' LIABILITY YIN NY PROPRIETORIPARTNER/EXECUTIVE❑ DFFICERIMEMBER EXCLUDED? IMandatoryln NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA - STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 151, Additional Remarks Schedule, may be attached If more space Is required) The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Vendor including materials, parts, or equipment furnished in connection with such work or operations. City of Santa Ana Risk Management Division 20 Civic Center Plaza CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Brian RoWts 161:85'zIS I4_116161 H Q ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WskManiganatt DIMEan r+'s �x'°� Rew AE#EQ&APPRIDBY: '' fat na:r r Q, V t/w uC ' Risk Management Analyst 01