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Samantha Digitally signed by <br />Samantha M <br />Ae"R& CERTIFICATE OF LIABILITY INSUR 7VC t Latebert , .07DATE(MM12022m <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 'IFIFICA E 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 endorsement(s). <br />PRODUCER <br />CONTACT Will Maddux <br />NAME: <br />PHGNE , (530) 477-6521 A No <br />East Main Street Insurance Services, Inc. <br />E-MAIL info lheeventhel er.com <br />ADDRESS: @ P <br />Will Maddux <br />INSURERS AFFORDING COVERAGE <br />NNC # <br />PO BOX 1298 <br />INSURER A: Evanston Insurance Company <br />35378 <br />Grass Valley CA 95945 <br />INSURED <br />INSURER a : <br />INSURER C: <br />Qing Wei <br />INSURER D : <br />Austin Quach <br />INSURER E: <br />15911 ROCHESTER ST <br />1 INSURER F: <br />Westminster CA 92683 <br />CUVERAGE5 CEH IIFICATE 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 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 />x COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FKOCCUR <br />Host Liquor Liability <br />A I I Retail Liquor Liability <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />POLICY PRO- <br />JECT LOC <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBBELLALIAB OCCUR <br />EXCESS LIAR r,eiue <br />EMPLOYERS' LIABILITY Y/N <br />jROPRIETORIPARTNERIEXECUTIVE ❑ <br />,ERIMEMBEREXCLUDED9 <br />Y I N 13DS5473-M2748331 09210/ 02 10 /18/ AM <br />02 <br />2:01 <br />Deductible $ 1 <br />COMBINEDSINGLE LIMIT $ <br />Ea amident <br />BODILY INJURY (Perperson) $ <br />BODILY INJURY(Peraoddent) $ <br />PROPERTYDAMAGE $ <br />Per accident <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule,may be attached if more space is required) <br />;ertificate holder listed below is named as additional insured per attached MEGL 2217 01 19. <br />attendance: 40, Event Type: Event Vendor. <br />-vent Location: Santa Ana Public Library, Newhope Branch, 122 N Newhope St, Santa Ana, CA 92703 <br />City of Santa Ana is listed as additional insured and will be mailed written notice of cancellation <br />SHOULD ANY OF THE ABOVE DESCF <br />THE EXPIRATION DATE THEREO <br />ACCORDANCE WITH THE POLICY PR <br />City of Santa Ana <br />Risk Management Division AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br />e REvtEWED&APPRcvmBr <br />JM/v�tNPA [suh4rnM1 <br />® Risk Management Supervisor <br />Of <br />i4w/' /Gr/140 <br />@ 1988-2015 ACI <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />All rights reserved. <br />