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Digitally signed by Francine K
<br />Francine R. Villareal Wheal
<br />BACKDAN-01 Date: zon.tzia io:ze:ot TPRETO
<br />' CERTIFICATE OF LIABILITY INSURANCE
<br />DAT
<br />III
<br />61312021
<br />613/2
<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 endorsements).
<br />PRODUCER
<br />NQ CT
<br />l&Parr
<br />24 Commerce St.
<br />PHONEe, Eat): (410) 685.4625 AID, No):(410)685-3071
<br />Mal
<br />Baltimore, MD 21202
<br />pf$AIL
<br />ESS
<br />INSURERS AFFORDING COVERAGE
<br />NAIC N
<br />INSURERA:Great American Insurance Company#
<br />16691
<br />INSURED
<br />INSURER 5,
<br />INSURER C :
<br />Backhaus Dance
<br />PO BOX 5890
<br />Orange, CA 92863
<br />INSURER D
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER' REVISION NUMBER
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />L T.
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />p
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILIN
<br />CLAIMS -MADE [X] OCCUR
<br />X
<br />GLP3961460
<br />6/312021
<br />6/312022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RMISES (EaENTED
<br />$ 1,000,000
<br />MED EXP (Any one rsm
<br />$ 20, 000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JELPT LOC
<br />GENERA -AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />XI
<br />I
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />8
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />Ea acadtlen SINGLE LIMIT
<br />$
<br />BODILY INJURY Per persom
<br />$
<br />ANY AUTO
<br />LE
<br />OWNED SAUTOSCHEDULED
<br />AUTOS ONLY SCHEDULED
<br />AUTOS ONLY AUTNOOS ONLYOa
<br />BODILY INJURY Peraccldent
<br />$
<br />ERdYt IMAGE
<br />$
<br />A
<br />X
<br />LIAS
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />M
<br />OCCUR
<br />OCCUR
<br />CLAIMS -MADE
<br />X
<br />UMB3961461
<br />613/2021
<br />613/2022
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />DED I X I RETENTION$ 10,000
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PRRO@PRIETOE�RR@IPARTNEPoEXECUTIVE ❑
<br />jMa tCErNlMWR EXCLUDED9
<br />If yes, ddescribeO
<br />NIA
<br />PER OTH-
<br />U E E
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYE
<br />S
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />D
<br />DESCOF RIPTION OF OPERATIONS below
<br />A
<br />Abuse &Molestation
<br />X
<br />GLP3961460
<br />6/312021
<br />613/2022
<br />Each Abuse
<br />1,000,000
<br />A
<br />Abuse & Molestation
<br />X
<br />GLP3961460
<br />613/2021
<br />61312022
<br />Aggregate Limit
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required1
<br />The City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers are addl�lonal 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE Risk MCRallY.t11CatD[WaWt
<br />REVIEWED&APPROVBJ BY:
<br />ACORD 25 (2016/03) ©1988-2015 ACORD Cls 'j F^"`"'G"^` z va"d
<br />The ACORD name and logo are registered marks of ACORD Risk Nlanagemem Analyst
<br />
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