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____......IN THEJAYP-01 PREVOMA
<br /> A�ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> 5/15/2024
<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 ri hts to the certificate holder in lieu of sur n an ement s
<br /> PRODUCER `ONT• ' I � I I y signed by
<br /> Hylant-Toledo IH2N x
<br /> 811 Madison Ave. No,Ext):( )724-1990 INC,No):
<br /> Toledo,OH 43604 ngie
<br /> AAI .Cindy.Bleir Hy nt.com
<br /> An � SI, orRedo NAIL#
<br /> INSU.=RA:Philgielphia Indemnity Ins Co 18058
<br /> INSURED �NSUR caau 01241 • n 29424
<br /> The Acle
<br /> LLC dba Mad Science of West ange L�VJLCoun
<br /> 3501r ve. INSURER D: 7 ^Jl 7SantA 4eve _ INSURE F •4/ •O✓ _O / 'oo'
<br /> COVERAGES CERTIFICATE 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 CONTRACTOR 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD IMM/DD/YYYYI IMM/DD/YYYYI
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000
<br /> CLAIMS-MADE n OCCUR X X PHPK2645846 1/27/2024 1/27/2025 DAMAGESO a occu Dnce) $ 300,000
<br /> MED EXP(Any one person) S 15,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000
<br /> POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> X Abuse/Molestation$1 MIU$2MIL
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> (Ea accident) $
<br /> - ANY AUTO PHPK2645846 1/27/2024 1/27/2025 BODILY INJURY(Per person) $
<br /> OWNED -SCHEDULED -
<br /> _ AUTOS ONLY AUTOS BODILY INJURY(Per accident), $
<br /> X AUTOS ONLY X NON-OWNED
<br /> ONLYY PROPERTY
<br /> accidentDAMAGE $
<br /> S
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE PHUB897330 1/27/2024 1/27/2025 AGGREGATE $ 1,000,000
<br /> DED X RETENTIONS 10,000
<br /> $
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STAIIJTF ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X 45WECAV7H87 1/27/2024 1/27/2025 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
<br /> A Property-Commercial PHPK2645846 1/27/2024 1/27/2025 BPP/DED$1,000 20,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana its officers,agents and employees are included as an Additional Insured for General 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 /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREO\ f
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PR(
<br /> 20 Civic Center Plaza o„.9L,4".,. RialcManagetnvttDfvisian
<br /> Santa Ana,CA 92701 c.'';ty� ��'+ REVIEWED&APPROVmBY: •
<br /> AUTHORIZED REPRESENTATIVE I (I-AGW`Ot.O
<br /> r.„. 4.4. 7 7/ �' Risk Management^ ` Specialist
<br /> I
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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