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r'1 <br /> ACORd CERTIFICATE OF LIABILITY INSURANCE DATE(MNllDD/YYYY) <br /> �,- sn21202s <br /> THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERSNO RIGHTSUPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTENDOR ALTER THE COVERAGEAFFORDEDBY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCEDOESNOT CONSTITUTE A CONTRACT BETWEENTHE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVEOR PRODUCERAND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSUREDprovisions or be endorsed. <br /> If SUBROGATIONIS 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 CONTACT B.W.Baker Insurance Inc. <br /> NAME: <br /> B.W.Baker Insurance Inc. n/c No Ext: 310 437-5092 (FA ) 310 457-6225 <br /> Lic#OB49439 E-MAIL ADDRESS: commercialcare@bwbaker.com <br /> 29169 Heathercliff#208 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Malibu CA 90265 INSURERA: Progressive Insurance Company <br /> INSURED <br /> INSURER B <br /> Ultimate Entertainment LLC INSURER C: <br /> 12104 Park St INSURER D: <br /> Cerritos,CA 90703 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER: <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 ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD POLICYNUMBER MMIDD/YYYY MM/DD/YYYY LIMITS <br /> COMMERCIALGENERALLIABIUTY EACH OCCURRENCE $ <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Anyoneperson) $ <br /> PERSONALBADV INJURY $ <br /> GEN'LAGGREGATELIMITAPPLIESPER'. GENERALAGGREGATE $ <br /> ECT POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ <br /> HOTHER'. $ <br /> AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ 1000000 <br /> Ea accident <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> A OWNED SCHEDULED X X 997206500 5/9/2025 11/9/2025 BODILY INJURY(Per accident) $ <br /> AUTOSONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOSONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION $ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABIUTY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatoryin NH) E.L.DISEASE-EAEMPLOYEE $ <br /> If yes,describeunder <br /> DESCRIPTIONOF OPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional RemarksSchedule,maybe attached if more spaceis required) <br /> 30 day notice of cancellation/10 day notice for non payment <br /> Certificate holder is listed as additional insured including Cityof Santa Ana,its City Council,officers,officials,employees,agents and volunteers <br /> Digitally signed <br /> TU TYd n by uy Nguyenn AP ROVED <br /> Ng <br /> Nguyen Date:2025.05.13 <br /> 07s2:49-07'00' By Tu Tran Nguyen at 7.32 am,May 13,2025 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Cityof Santa Ana THE EXPI RATION DATETHEREOF,NOTICE WILL BE DELIVERED IN <br /> Attention:Parks,Recreation,and Community Services Agency ACCORDANCEWITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza, M-23 <br /> Santa Ana,CA 92701 <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />