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/ <br />A� " CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DDYYY) <br />IY <br />03/05/2025 <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 rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT NAME: — <br />Safebuilt Insurance Services LLC <br />HONN , Ext : 760-599-7242 FAX No : 866-467-6701 <br />E-MAIL <br />1811 ASTON AVE SUITE 200 <br />ADDRESS: — <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />CARLSBAD, CA 92008 <br />INSURERA: Employers Preferred Insurance Company <br />10346 <br />INSURED <br />INSURER B : — <br />— <br />ULTIMATE ENTERTAINMENT LLC <br />INSURERC: — <br />— <br />INSURER D : — <br />— <br />12104 PARK ST <br />INSURER E : — <br />— <br />CERRITOS, CA 90703-1842 <br />INSURER F : — <br />— <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 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDIYYYY <br />POLICY EXP <br />MM/DDIYYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />— <br />DAMAGE TO RENTED <br />❑ CLAIMS -MADE ❑ OCCUR <br />PREMISES Ea occurrence <br />— <br />MED EXP (Any one person) <br />- <br />— <br />— <br />PERSONAL & ADV INJURY <br />— <br />- <br />— <br />— <br />— <br />— <br />— <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />— <br />POLICY PRO LOC <br />JECT <br />PRODUCTS - COMP/OP AGG <br />— <br />OTHER: — <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />— <br />BODILY INJURY (Per person) <br />- <br />ANY AUTO <br />- <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />— <br />— <br />— <br />— <br />— <br />BODILY INJURY (Per accident) <br />— <br />PROPERTY DAMAGE <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />Per accident <br />— <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />- <br />AGGREGATE <br />— <br />- <br />EXCESS LIAB <br />CLAIMS -MADE <br />— <br />— <br />— <br />— <br />— <br />DED RETENTION — <br />— <br />— <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N <br />OFFICER/MEMBEREXCLUDED? I Y I <br />(Mandatory in NH) <br />N/A <br />Y <br />EIG561248700 <br />06/05/2024 <br />06/05/2025 <br />PER OTH- <br />STATUTE ER <br />— <br />E.L. EACH ACCIDENT <br />$1,000,000.00 <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000.00 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />D <br />E.L. DISEASE- POLICY LIMIT <br />$1,000,000.00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />The following are excluded from coverage: STEVEN NERO <br />Inflatable game rental for event "Dia de los ninos / Dia de los libros" locate at "26 Civic Center Plaza Santa Ana, CA 92701" <br />Waiver of Subrogation applies on worker's compensation policy per written contract. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />ATTN: Michelle Loera <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />EMAIL: mloera@santa-ana.org <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />26 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <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 />