BREATH OF FIRE LATINA THEATER ENSEMBLE (2)

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AUSTCRE-01 TPRE CERTIFICATE OF LIABILITY INSURANCE DATDlYYYY) a/17,<1712202, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER NA TEACT Maury,Donnell &Parr,Inc. PHONE FAx 24 Commerce Sit. ArC,No,Ext):(410)685-4625 Afc,1,10(410)685-3071 Baltimore,MD 21202 INSURERS AFFORDING COVERAGE NAIC N INSURERA:TCI State Insurance Company of Minnesota INSURED INSURER B: Austin Creative Alliance INSURER C: 81 San Marcos Street Suite C1 INSURER D: Austin,TX 78702 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILT R TYPE OF INSURANCE IN pL 3U D POLICY NUMBER POLICY EFF POLICY DI EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED _PBEMISES Ea occu re $ M~D EXP(Any oneperson) _ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY yp, LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aocide i ANY AUTO BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOpSyy BODILY INJURY Per accident AUTOS ONLY AUO70S ONeY Per acci lent)DAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB— H CLAIMS-MADE AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOREPARTNERIEXECLETIVE YIN X WCA7500257-1$ 1I20I2025 1/20/2026 1,OOD,000 04FFICEWE�MM MBER EXGLUDED7 NIA E.L.EACH ACCIDENT _ (Mandainry�n NH) E.L.DISEASE-EA EMPLCYE 1°000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Waiver of subrogation applies. Re: Paymaster Client: Breath of Fire Latina Theater Ensemble. Austin Creative Alliance is covering entirety of their payroll. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attention: Executive Director, Community Development Agency — 20 Civic Center Plaza,M-25 AUTHORIZED REPRESENTATIVE Santa Ana,CA 92701 r ACORD 25(2018103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD