MARIACHI MALIBU, A DIVISION OF PARTY TIME ENTERTAINMENT 1 - 2015

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ACCWH'I' CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD YYW) ll.� 1 12/2/2015 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(les) 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 PRODUCER INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS NAME�yI Stephanie Weiss ILTR' TYPE OF INSURANCE Specialty Insurance Agency -- POLICVEFF POLICY NUMBER MMIDDIYYYY _ PHONEFAX__ --- - LIMITS Performers of the U.S. _(AIC No Exn. 715-246-8908 -. _- AIc No: _6-4257 71524 P.O. Box 24 $ 1,000,000 AIL ADDRESS: - _ certs@spe_cialty_ins_uranceagency.com _ New Richmond, WI 54017 .._. -- _ - --� CLAIMS MADE X OCCUR INSU_RER)S)AFFORDING COVERAGE _ NAICM MED EXP (Any one person) INSURERA: Evanston Insurance Company 35378 INSURED Gary A. Egnatz X INSURER B: 2CN0129-4367 04/25/20151 04/25/2016 dba Gary Valentine, Party Time Entertainment _ GENERAL AGGREGATE _- _ $ 2,000,000 911 Lincoln Blvd. # 3 INSURER c: — - - ----- ---- Santa Monica, CA 90403 INSURER D: _- INSURER E: X POLICYFI PES -- LOC INSURER F: $ COVERAGES CERTIFICATE NUMBER: AUTOMOBILE 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. -' ILTR' TYPE OF INSURANCE IIADDLNSR SUBR �!INS WVp -- POLICVEFF POLICY NUMBER MMIDDIYYYY POLICYEXP MMIDDMIYY --- - LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 SIX COMMERCIAL GENE PAL LIABILITY ! _ DAMAGE TO RENTED - PREMISEB (Ea occurrence) $ 300,000 CLAIMS MADE X OCCUR MED EXP (Any one person) _ $ 5,000 $ 1,000,000 A X X 2CN0129-4367 04/25/20151 04/25/2016 PERSONAL_& ADV INJURY _ GENERAL AGGREGATE _- _ $ 2,000,000 IPRODUCTS- COMP/OP AG_G $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: X POLICYFI PES -- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT , (Ea accitlentZ $ _ BODILY INJURV(Per person) $ "I ANY AUTO, -- ALL OWNED SCHEDULED AUTOS AUTOS !, BODILY INJURY (Peraccltlenq $ NON -OWNED HIREDAUTOS AUTOS ! PROPERTY DAMAGE Per eccldent $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ - _ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION$ $ Irk WORKERS COMPENSATION AND EMPLOYERS' LIABILITY p�C/ / TORY STATU OT YIN ANVETOR/ Pi pV�" S f EL EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑NIA EXCLUDE09 i�V ,/ $ -- E.L.DISEASE EA EMPLOYEE ryinN (MantlatorylnNH) C' $ byes ,describe under "DESCRIPTIRIPTIONOFOPERATIONS below ! E.L. DISEASE -POLICY LIMIT $ A BUSINESS PERSONAL PROPERTY - I'� .. ��N, rX d \" AGGREGATE ..INLAND MARINE �I $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: Gary A. Egnatz dba Gary Valentine, Party Time Entertainment Additional Insured: The City of. Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701; its officers, employees, agents and representatives are named as additional insured's with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. - Cancellation is as stated in the Policy. Fax: 714-540-1085 Email: rhernandez5@santa-ana.org Attn: Purchasing Department V GR I ul lM I C Il V' .,CR I.rHIVIiCLLH I IUIV City of Santa Ana 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana, CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (S) lSt5ii-20U AOUKU OUKVUKA I IUN. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD