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CERTIFICATE OF LI B <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CI <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, th <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the plal <br />this certificate does not confer rights to the certificate holder in lieu of such <br />PRODUCER <br />NA <br />Blue Lion Insurance, LLC PAR <br />10224 Airport Way, Ste C AD <br />Snohomish WA 98296 IN: <br />Darrell Wagger dba Professional Entertainment <br />PO BOX 78593 <br />INSURAIIcjigitally si MMIDD/ <br />1/8/2021 <br />IGHTS U 'O f TE HOLDER. THIS <br />E HE COV .F'k9E AFFORDED BY THE POLICIES <br />BETWEEN TI E ISAGIR111il'i AUTHORIZED <br />an <br />Brix, R- uerts <br />800-665-5t54 <br />INSURERS) AFFORDING <br />Mesa Underwriters Specialq <br />I Seattle WA 98178INSURER F: <br />COVERAGFS CFOTICIPATIM Mnaacco. __..._._......- <br />on <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 SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />MD <br />POLICY NUMBER <br />(FULIC <br />(MMIDDIYYVY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />EACH OCCURRENCE <br />$ 11000,000 <br />PREMISES Ea occurrence) <br />$ 100,000 <br />MED EXP(Any one person) <br />$ 5,000 <br />A <br />Y <br />Y <br />MP0046001004491 <br />07/30/2021 <br />07/30/2022 <br />PERSONAL S ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO <br />JECT �LOC <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />PRODUCTS-COMPIOPAGG <br />$ 1,000,000 <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />Ea'RLEnJUl) <br />$ <br />BODILY INRY (Per person) <br />$ <br />BODILY INJURY (PeraccitlenQ <br />$ <br />P.,accideni <br />$ <br />UMBRELLA LIAR <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEp <br />I I RETENTION$ <br />$ <br />CREEPS COMPENSATION <br />AND EMPLOYERRIPARILITY YIN <br />ANY PROPRIETOR/ EXCLUDED? <br />EXCLUDE09 ❑ <br />NIA <br />_ <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />MandatoryIn NH) <br />(f yes, d ory In and <br />If yes, describe under <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />DESCRIPTION OF OPERATIONS below <br />EX DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD iOl, Additional Remarks Schedule, may be allached If more space is required) <br />The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on <br />the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Vendor <br />including materials, parts, or equipment furnished in connection with such work or operations. <br />City of Santa Ana Risk Management Division <br />20 Civic Center Plaza <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 WITH THE POLICY PROVISIONS. <br />Grt.ar. Roberts <br />© 1988-2015 ACOR <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />e- <br />RiskM-WmodDMln ? <br />RVEWED 6 APPRa Y <br />A,fi Auvo�. <br />link ManagpuI <br />