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-- CERTIFICATE OF LIABILITY INS A"MfS F by MW2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CE ICATE HOLDER . HkS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLP ;IEJAcevedo BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISS G S R U r D REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. Date. 2. 022.06.1 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONA I E provisions or oe endol1��s�d If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemen'.. P statern entldi+:1 0.51 -07 00 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Contact Name: Todd Tyler Cossio Insurance Agency Phone (864)688-0121 Fax PO Box 5987 (A/C, No, Ext): (A/C, No): E-Mail: tammy@cossioinsurance.com Greenville, SC 29606 (864) 688-0121 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Nationwide Mutual Insurance Company 23787 Ultimate Attractions Ilc 2700 Angelo Dr. INSURER B: Berkley Life & Health Insurance Company 64890 INSURER C: Cerritos, CA 90703 INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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. INSR TYPE OF POLICY ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YY) (MM/DD/YY) X COMMERCIAL GENERAL LIABILITY General Agg (Other than Products-C $2,000,000 ❑ ❑ CLAIMS MADE 0 OCCUR Each Occurrence $2,000,000 Products and Completed Operations $2,000,000 ❑ Personal and Advertising Injury $2,000,000 ❑ A X X FWC000003192523100 8/27/2021 8/27/2022 Legal Liability to Participants $2,000,000 Professional Liability (for Event Plann $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY ❑PROJECT ❑LOC Damages to Premises Rented to You $300,000 Participant Accident -Excess Medica $10,000 ❑ OTHER: Deductible $0 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑ ANY AUTO (Ea accident) BODILY INJURY (Per Person) $ ❑ALL OWNED ❑ SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ ❑ HIRED AUTOS NON -OWNED ❑ AUTOS PROPERTY DAMAGE $ ❑ ❑ (Per accident) ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE ❑ DED ❑ RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) ❑ If yes, describe under DESCRIPTION OF OPERATIONS below Total Benefit Maximum for all Accident M $25,000 Class 1 Principal Sum $25,000 B Accident Medical PAI L012010778502 8/27/2021 8/27/2022 Benefit Maximum $500,000 Accident Medical Deductible $100 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Party Equipment Rentals Operations located at 737 S State College BLVD Unit 94 Fullerton, CA 92831. Certificate Holder is listed as additional insured per form CG2011 when required by written contract. The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. Amusement devices on file with the company for special event(s) dated 6/8/2022 to 6/8/2022 located at 20 Civic Center Plaza, Santa Ana, CA 92701.Waiver of Subrogation included when required by written contract. CERTIFICATE HOLDER: CANCELLATION City Of Santa Ana, Its Officers, Agents, And Employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, CA 92702 ACCORDANCE WITH THE POLICY PROVISIONS.,, ACORD 25 (2016/03) AUTHORIZED REPRESENTATIVE RisMougemerd kDRR810R � e ° REVIEWED & APPROVED BY: