|
Digitally signed by Tod Pierson
<br />Tori Pierson Date: 2022.0907 15:22-15
<br />-0Too'
<br />BACKDAN-01
<br />TPRE
<br />DAT514/2 OIYIYY)
<br />514/2022
<br />CERTIFICATE OF LIABILITY INSURANCE
<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 />CONTACT
<br />AME
<br />Maury, Donnell & Parr
<br />24 Commerce St.
<br />PHONE FAX
<br />Ac, No, Ext: (410) 685-4625 A/C, No :(410) 6853071
<br />Baltimore, MD 21202
<br />E-MAIL
<br />INSURE S AFFORDING COVERAGE
<br />NACIf
<br />INSURER A: Great American Insurance Company#
<br />16691
<br />INSURED
<br />INSURERS:
<br />INSURER C:
<br />Backhau5 Dance
<br />INSURER D :
<br />PO Box 5890
<br />Orange, CA 92863
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NIIMRFR- PEWSUNU MUMBER-
<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 />ADDLSUBR
<br />POLICY NUMBER
<br />POLICYEFF
<br />POLICYEXPJaR.
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMSWADE ❑X OCCUR
<br />X
<br />GLP3961460
<br />6/312022
<br />613/2023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occumencial
<br />NED EXP (Any one person
<br />$ 700000
<br />20,000
<br />PERSONAL& ADV INJURY
<br />11000,000
<br />GENIE
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JECPT LOG
<br />OTHER:
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS - COMP/OP AGO
<br />2,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOSS
<br />AUTOS ONLY AUTOS ONL�
<br />COMBINED SINGLE LIMIT
<br />$
<br />BODILY INJURY Perperson)$
<br />BODILY INJURY Per accitlenl
<br />$
<br />f e�aaciEen[ AMAGE
<br />$
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMSWADE
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />DED RETENTIONS
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERTLIABILITY YIN
<br />ANY PROPRIETOWARTNERiEXECUTIVE ❑
<br />OF FICEVEBER EXCLUDED?
<br />antlato'y In NH)
<br />Hyes, descdbe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />PER OTH-
<br />STATUTEER
<br />E.L. EACH ACCIDENT
<br />EL. DISEASE- EA EMPLOYE
<br />E.L. DISEASE. POLICY LIMIT
<br />A
<br />A
<br />Abuse & Molestation
<br />Abuse & Molestation
<br />X
<br />X
<br />GLP3961460
<br />GLP3961460
<br />61312022
<br />613/2022
<br />6/312023
<br />6/3/2023
<br />Each Abuse
<br />Aggregate Limit
<br />1,000,000
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be anached If more space Is required
<br />The City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers are addi tonal 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.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702
<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 PROM^'^-'^
<br />Rhlr Ma naganmt Di,..s: m
<br />JTTHO�R�IZEEDD REPRESENTATIVE o ReinEwFD6�A.Cl+:
<br />`-'� / �RskMaugenaf,tav,rzlN,l
<br />ACORD 25 (2016/03) ©1988.2015 ACORD CC V N
<br />The ACORD name and logo are registered marks of ACORD
<br />
|