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DD1YYYYJ <br />E (MMd <br />ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br />IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREDS), AUTHORIZEE <br />PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />�IORTAII If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />ms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not conifer rights to the <br />PRODUCER CONTACT NAME: Mass Merchandising <br />K&K Insurance Group, Inc. PHONE (Aac, No. EX[): 1-800-328-2317 Fax (A1C, No): 1-260-459-5502 <br />1712 Magnavox Way <br />Fort Wayne IN 46804 E-MAIL ADDRESS: Info@eventunsurance-kk.Com <br />INSURED 2000361738 CP# 602 INSURER(S) AFFORDING COVERAGE NAIC # <br />Felice Ilkcagla I a INSURERA: Nationwide Mutual Insurance Company 23787 <br />3436 Taurus Lane ^ M_, r INSURER 8: <br />Santa Ana, CA 92704 INSURER C: <br />Member of the Sports, Leisure & Entertainment. RPG unlsuRER D: <br />COVERAGES CERTIFICATE NUMBER* 2WO2310270 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 INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MMIDDIYY <br />POLICY I <br />_rMMlOD1YY <br />LIMITS <br />A <br />X <br />COMMERCIAL ,GENERAL LIABILITY <br />X <br />6BRPGO000005730600 <br />01/14/16 <br />01114/17 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE I X IOCCUR <br />V_J <br />12:01 AM <br />12:01 AM <br />DAMAGE TO RENTED <br />PREMISES Es occurrence) <br />$300,000 <br />MFD FXP (Any one person) <br />$5,000 <br />PERSONAL & ADV INJURY <br />$1'....,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE <br />$5,000,000 <br />POLICY �RRGJECT �LOC <br />OTI1'...ER <br />PRODUCTS-COMPYOPAGG <br />$1,000,000 <br />PROFESSIONAL LIABILI"Y <br />$1,000,000 <br />LEGAL LIABTOPARTICIPANTS <br />$1,000,000 <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea Accident <br />ANY AUTO <br />BODILY INJURY (Per person) <br />ALL OWNED AUTOS SCHEDULED <br />BODILY INJURY (Per accident) <br />NON-O <br />HIRED AUTOS NON -OWNED <br />HAUTOS <br />X Not provided while in Hawaii <br />a <br />NSA <br />PROPERTY DAMAGE <br />Per aVCidenG <br />UMBRELLA <br />CCUR <br />EXCESS L ABAB HCLAIMS-MADE <br />DED RETENTION <br />may, <br />p �,�"�S'� <br />tV <br />�° <br />i,Y <br />9 <br />EACH OCCURRENCE <br />AGGREGATE <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />'` <br />/^"h <br />OTHER <br />ANY PROPRIETORlPARftTNER! <br />FXCCLULDIEVDE�gFFICERrMEMSER <br />(Mandatory In NH) <br />NIA <br />'�'•mI <br />ENT <br />A EMPLOYEE <br />FDISEASE <br />GLIOY LIMIT <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS <br />below <br />'MEDICAL. PA°rMENTS FOR PARTICIPANTS <br />PRIMARYMEDICAL <br />EXCESS MEDICAL <br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Instructor of: Craft Making, Instrumental Music <br />The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. <br />L;LKIIF'IGAIF HOLDER CANCELLATION <br />City of Santa Ana it's Officers, Agents, Employees, and Volunteers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. <br />Owner/Manager/Lessor of Premises AUTHORIZED REPRESENTATIVE <br />Coverage is only extended to U.S. events and activities. <br />" NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. <br />ACORD 2:5 (2014101) @ 1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />