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THEJAYP-01
<br />PREVOMA
<br />AFRO CERTIFICATE OF LIABILITY INSURANCE
<br />DAM
<br />3121120242112024
<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 conditio of the policy, c ain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certifica e h D e
<br />yy D C
<br />811 Media Va. Acevedo
<br />Toledo, OH 43604
<br />Date: 20
<br />Co ACr Dee ile
<br />NA
<br />wco,NN, EaI:(419) 724-3434 arc, No:
<br />E-MAIL D e ' le yl .c0m
<br />FF INGCOVERAGE
<br />NAICr
<br />INSURER A•Philadelphia Indemnity Ins Co
<br />18058
<br />cpvpdo _ I 1
<br />_
<br />INSURED
<br />INSURERS: Hartford CasualtyInsurance Co
<br />29424
<br />The Jay Particle, LLC dba Mad Science of West Orange
<br />County
<br />INSURER C:
<br />3501 W. Moore Ave., Suite J
<br />INSURER D:
<br />INSURER E:
<br />Santa Ana, CA 92704
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER- RF:VIAInM NI IMRRR-
<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 DOCUMENTWITH RESPECTTO 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 LTR
<br />TYPE OF INSURANCE
<br />ADDLINSD
<br />S SR
<br />POLICY NUMBER
<br />POLICYEFF MMflDDrYYYTl
<br />POLICY EXP
<br />LIMITS
<br />A
<br />TCOMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />X
<br />PHPK2645846
<br />1/2712024
<br />1127/202$
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGE TO RENTED
<br />$ 300000
<br />MED EXP (Any one arson
<br />g 15,000
<br />PERSONAL &ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY EK jEa � LOC
<br />X AmmelMolestation $1 MIU$2MIL
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />PRODUCTS-COMP/OPAGG
<br />41000,000
<br />g
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDSINGLE LIMIT
<br />IF. ocid..fiANY
<br />$ 1,000,000
<br />BODILY INJURY Paraarson
<br />Ix
<br />AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTNNO..ppSWN
<br />PHPK2645846
<br />1/27/2024
<br />1/27/2025
<br />BODILY INJURY Per accident
<br />$
<br />POPcECTY AMAGE
<br />$
<br />AIIT OS ONLY X A�TOS ONLID
<br />A
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />AGGREGATE
<br />1,000,000
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />PHUB897330
<br />112712024
<br />1/2712025
<br />DELI I X I RETENTION$ 10,000
<br />$
<br />*
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑
<br />OFFICER/MEEMr EXCLUDED?
<br />(Me, .91yin NI)
<br />If yes. describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />5WECAV7H87
<br />112712024
<br />11271202$
<br />X PER OTH-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />EL.DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Property -Commercial
<br />PHPK2645846
<br />1/27/2024
<br />1/2712025
<br />BPP/DED $1,000
<br />20,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES IACORD 101, Additional Remarks Schedule, may be attached if mare s ace is required)
<br />City of Santa Ana its officers, agents and employees are included as an Additional Insured for Genera Liability, on a Primary and Non -Contributory basis,
<br />when required by written agreement, subject to policy provisions. Automobile: The Jay Particle, LLC dba Mad Science of West Orange County does not own
<br />any vehicles to insured that would require this type of policy. Hired & Non -Owned Auto is provided on the General Liability. A Waiver of Subrogation applies
<br />on the General Liability and Workers Compensation policy in favor of the Additional Insured.
<br />SHOULD ANY OF THE ABOVE DESCF
<br />CityTHE EXPIRATION DATE THERE(
<br />of Santa Ana
<br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PR
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />rlw '!V-J—
<br />ACORD 25 (2016103) ©1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />REVIEWED 6 APPRW®BY:
<br />Rbk Management Spenalist
<br />
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