THE WOODEN FLOOR FOR YOUTH MOVEMENT - 2015

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ACC)J?EIr CERTIFICATE OF LIABILITY INSURANCE 8/DATE(M 5DYYYY) 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 Frank Crystal & Co of CA, Inc. dba Crystal & Company Ins Srvc #OB64537 575 Market St - 13 FL NAME, Ricardo Ramos PHONE . 310- 981 -0816 FAX .8O0- 383 -1852 IA 10-98 -081 EMAIL Ric rdo.Ramos@crystalco.com c stalco.com Ban Francisco CA 94105 INSURERS AFFORDING COVERAGE NAIC q INSURER A:Philadelphia Indemnity Insurance Co 18058 INSURED W 00 DFL INSURER B 2/1/2015 The Wooden Floor 1810 North Main St. INSURER C: $1,000,000 INSURER D. DAM RENTED PREMISES RE, currence Santa Ana CA 92706 INSURER E: MED EXP(Any one person) $5,000 INSURER F COVERAGES CFRTIFICATF NIIMRFR• 1694005375 ucvtmnu unaao vo. 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, INSR LTR TYPE OF INSURANCE IN BD W. POLICY NU M BER POLICY EFF MMIDDIYYYY PO MMI LICY -'CY EXP YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r—xl OCCUR PHPK1289624 2/1/2015 211/2016 EACH OCCURRENCE $1,000,000 DAM RENTED PREMISES RE, currence $100,000 MED EXP(Any one person) $5,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY ❑ PRO- ECT F-1 OC GENERALAGGREGATE $2,000,000 PRODUCTS - COMP /OP AGO $2,000,000 OTHER: $ AUTOMOBILE LIABILITY 2MBINED LE accident $ ANY AUTO BODILY INJURY (P., person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMA E Peraccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS�MADE DED RETENTION$ $ WORKERS COMPENSATION YIN PER ER S ATUTE ER EL EACH ACCIDENT $ ANY ANY PROPRIETORIPARTNERIEXECUTIVE ❑NIA OFFICERIMEMBER EXCLUDEDP E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of Santa Ana is named as Additional Insured with respect to the General Liability coverage provided per the attached form PI- GLD -HS 1011 on a Primary and Non - contributory basis. Endorsements are to follow. 16C� The City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 019RR -gel4 ACnRn r]nRP0PATInN AD rL,Mf� ---H ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD