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ACORD CERTIFICATE OF LIABILITY INSURANCE TM DATE IMM 10 -18 --201201 YYI 3 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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 endorsement(s). PRODUCER CONTACT NAME: 67626 / Kelly Williams Insurance Agency Inc PHONE FAX 4400 East Pacific Highway (A /C No, Ext): (A /C No): E -MAIL Long Beach, CA 90804 LIMITS ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: MARKEL INSURANCE COMPANY INSURER B: Weber School of Dance Inc. DBA INSURER C: Webby Dance Company P.O. Box 3161 Long Beach, CA 90803 INSURER D: INSURER E: $ 1,000,000 INSURER F: TOO-,GOO 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. INSH ADDL SUER POLICY SEE POLICY EXP LIER TYPE OF INSURANCE INSR WVD POLICY NUMBER MM /DD /YYYY IMMIDDIYYYYI LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAG PREMISES IEa occurrence) TOO-,GOO ❑ ❑ CLAIMS -MADE ® OCCUR ❑ 3602HF292125 -7 10 -14 -2013 10 -14 -2014 MED EXP (Any one person) s 5,000 PERSONAL & ADV INJURY g 1,000,000 ❑ GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER RO- ❑ POLICY ❑ JECT ❑ LOC PRODUCTS - COMP /OP AGO 5 1,000,000 5 AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ❑ COMBINED SINGLE LIMIT E. accident) s BODILY INJURY (Per person) S ❑ ALL OWNED ❑ SCHEDULED AUTOS NON -OWNED ❑ HIRED AUTOS ❑ AUTOS BODILY INJURY (Per accident) s PROPERTY DAMAGE (Per accident) $ s ❑ ❑ UMBRELLA LIAB ❑ OCCUR ❑ ❑. EACH OCCURRENCE $ EXCESS LIAB ❑ CLAIMS MADE AGGREGATE a ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION WC OER AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE 1:1 OFFICER /MEMBER EXCLUDED? ❑ N/A ❑ TORY LIMITS ER LIMIT E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPEflAT10NSILOCATION$ /VEHICLES IA1Iecb ACORD 101, Additional Remarks Schedule, If more apace Is required) VED/ .r Lv O TO- H<`i' Additional insured as respects to the Webby Dance classes conducted by the named gppRO' insured at 1825 W. Civic Center Dr., Santa Ana, CA 92701. LISA E STORCK / Stant CIty Attorney Z CERTIFICATE HOLDER CANCELLATION - I City of Santa Ana, it's officers, agents and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION C/O Parks, Recreation and Community Services Agency DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY 1925 W. CIVIC Center PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE SGA Bruce A. Kay 10 (c) 1988 -2010 AM11 TCORPORATION rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD P 4)