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DATE(MMIDDIYYYY) <br /> A`C)R" CERTIFICATE OF LIABILITY INSURANCE <br /> 01/20/2426 <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 CONTACT NAME: Caroline Arthur <br /> Safebuilt Insurance Services LLC PHONE <br /> No,Ex1: 760-599-7242 FAX No): 866-467-6701 <br /> E-MAIL a.comIscmth line.arur <br /> 1811 ASTON AVE SUITE 200 ADDRESS: caro @ 9 <br /> CARLSBAD,CA 92008 INSURERS AFFORDING COVERAGE NAIL# <br /> INSURER A: Employers Preferred Insurance Company 10346 <br /> INSURED INSURER B: — — <br /> ULTIMATE ENTERTAINMENT LLC INSURER C: — — <br /> 12104 PARK ST INSURERD: — <br /> CERRITOS,CA 90703-1842 INSURER E: — <br /> INSURER F: — — <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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR POLICYNUMBER MMIDDIYYYY MMlDDlYYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE <br /> ❑ CLAIMS-MADE ❑ OCCUR DAMAGE TO RENTED — <br /> PREMISES Ea occurrence <br /> MED EXP(Any one person) — <br /> PERSONAL SAOV INJURY <br /> GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE — <br /> POLICY F7 PRO- ❑ LOG PRODUCTS-COMP)OP AGG — <br /> JECT <br /> OTHER — I I I— <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT — <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person)— OWNED OWNE❑ SCHEDULED — — — — BODILY INJURY(Per accident) <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident — <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE — — — — — AGGREGATE — <br /> DED I RETENTION — — <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY STATUTE H TUTE ER " <br /> ANY PRO PRIETOFUPARTN ERIEXECUTIVE YIN E.L.EACH ACCIDENT $1,040,000.00 <br /> A OFFICERIMEMBEREXCLUDED? ❑Y NIA Y EIG561248701 06/0512025 06/05/2026 <br /> (Mandatary In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000.00 <br /> It yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000.00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> The following are excluded from coverage:STEVEN NERO <br /> Event:Dia de Los Ninos 1 Dia de Los Libros <br /> Event Location:26 Civic Center Plaza Santa Ana,CA 92701 <br /> Waiver of subrogation applies on worker's compensation policy per written contract. APPROVED <br /> By Tu Tran Nguyen at 10:50 am,Feb 19,2028 <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana <br /> ATTN:Michelle Loera SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> EMAIL:mloera@santa-ana.org THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 26 Civic Center Plaza <br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE <br /> K. <br /> @ 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />