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CERTIFICATE OF LIABILITY INSURANCE I
<br />DATE(MMIDDIYYYY)
<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 poiicy(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 Bolton & Company CONTACT
<br />3475 E. Foothill Blvd., Suite 100 PHONE FAX
<br />Pasadena, CA 91107 -(AL. No Exii - (626) 799 (AIC No): (626) 583-211.7
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE _ _ NAIC4
<br />mww.boltonco.com 0008309 INSURER A: Samsung Fire & Marine Insurance Co. 38300
<br />INSURED INSURERB: New York Marine And General Insurance Co 16608
<br />CWF, Inc.
<br />DBA: Al Party Rentals INSURERC:
<br />251 E. Front Street INSURERD: _
<br />Covina CA 91723
<br />K1011-0—
<br />CnVFRASFS CERTIFICATE NIIMRFR• 9091079R RFVI.SIr1N1 NIIMRFR•
<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 />ILTRI TYPE OF INSURANCE AOpL8l18R POLICYEFF POLICY EXP
<br />LTR POLICYNUMBER MMIDDP/VYY MMIDDIV/YY LIMITS
<br />B V
<br />COMMERCIAL GENERAL LIABILITY ✓
<br />PK201600007271
<br />2/1/2016
<br />2/1/2017
<br />EACH OCCURRENCE
<br />"
<br />CLAIMS -MADE r✓ ] OCCUR
<br />-
<br />_ _$_ _1,000,000
<br />_
<br />JAMA E TO RENTED
<br />PREMISES Ea occurconce) ��, $ 500,000
<br />MED EXP (Any one person) $ 10,000
<br />PERSON_AL&ADV INJURY $ 1,000,000
<br />LIMIT APPLIES PER:
<br />GEN'LAGGREGATE
<br />GENERAL AGGREGATE $ 2,000,000
<br />POLICY✓� JECOT LOC I
<br />PRODUCTS-COMPIOPAGG $ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />1 AUTOMOBILE
<br />LIABILITY
<br />CPPOO6511201
<br />2/1/2016
<br />2/1/2017
<br />CEOMaBINdEeDSINGLE LIMIT nt)$
<br />1,000,000
<br />BODILY INJURY (Par person)
<br />$
<br />1 ✓
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />✓
<br />HIRED NON -OWNED
<br />AUTOS ONLY ✓ AUTOS ONLY
<br />PROPERTY DAMAGE
<br />(Per accident
<br />$
<br />$
<br />B
<br />r/
<br />UMBRELLA LIAR ,/ OCCUR
<br />UM201600003772
<br />2/1/2016
<br />2/1/2017 EACH OCCURRENCE $ 5,000,000
<br />EXCESS LIPS_ CLAIMS -MADE
<br />AGGREGATE $ 5,000,000
<br />OED ✓IRETENTIGN$10,D00
<br />1
<br />1
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANVPROPRIETORIPARTNERIEXECUTIVE VIN
<br />OFFICERIMEMBER EXCLUDED? ❑Y
<br />NIA
<br />WC2015000009970
<br />11/1/2015
<br />111/1/2016 ,� PER STATUTE ER
<br />--
<br />EL. EACH ACCIDENT
<br />--------
<br />$ 1,000,000
<br />$
<br />(Mandatory lnNH)
<br />E.L. DISEASE - EA EMPLOVE
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />IEL DISEASE - POLICY LIMIT
<br />_ _1,000,000
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) r�
<br />,,te�tt
<br />The certificate holder is included as an additional insured, but only as respects to claims arising out of the negligence of mhedd (�/
<br />Insured. <12 \1\ d"
<br />GL Primary & Nan -Contributory per form CG2026 attached.
<br />Additional Insured: The City of Santa Ana, it's officers, employees, agents, and representatives J
<br />CERTIFICATE HOLDER CANCFI I ATIr1N J .nK
<br />Cit of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Finance &Managgement Services Agency
<br />na e 9 y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PO Box 1988
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702
<br />Jessica Poretta
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />29519956 1 CWFINCA-01 115-16 WC 16-37 G1,,Pz0P,EL EQIP Master Certificate I Alisa Lopez 1 4/19/2016 3:53:44 PM (PDT) I Page 1 of 2
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