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COVERAGES CERTIFICATE NUMBER: 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 <br />acoRH IIICERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) <br />�� NMKEL" 4/5/2016 <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Specialty Insurance Agency <br />Performers of the U.S. <br />P.O. Box 24 <br />NANTACT Stephanie Weiss <br />_ <br />PHONE 715-246-8908 A^�Na, 715-246-4257 <br />EMAIL carts@specialtyinsuranceagency.com <br />New Richmond, WI 54017 <br />INSURER(S) AFFORDING COVERAGE NAIC9 <br />INSURER A: Evanston Insurance Company 35378 <br />INSURED Franklin Delano Haynes <br />dba Franklin Haynes Marionettes <br />1234 Muirfield Road <br />INSURERS: <br />INSURER C <br />INSURER D: <br />Riverside, CA 92506 <br />INSURER E: <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADEOCCUR <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 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 <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 />IINNSR <br />TYPE OF INSURANCE <br />AOOLSUEIR <br />POLICY NUMBER <br />POLICY EFF <br />ga <br />POUCYEXP <br />MWODNM) <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE s 1,000,000 <br />PREMISES Ea ac rrance $ 300,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADEOCCUR <br />MED EXP(Any one person) $ 5,000 <br />PERSONALS ADV INJURY $ 1,000,000 <br />A <br />X <br />X <br />2CN0140.7335 <br />04/14/2016 <br />04/13/2017 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES P ER: <br />PRODUCTS-COMPIOPAGG $ 2,000,000 <br />X POLICY F7 PRO- LOC <br />$ <br />AUTOMOBILE <br />LIABILITY <br />REOMVctlIN <br />,VhSINGLE LIMIT $ <br />BODILY WJURY(Petpereom) $ <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />90DILY INJURY Perattident $ <br />( ) <br />HIRED AUTOS AUTOSMED <br />(P&amidwal MAGE $ <br />$ <br />LAIIAB <br />OCCUR <br />eveVzy. <br />OCCURRENCE <br />GGREGAS <br />EXCESS LIAR <br />CLAIMS-MDE <br />DEO I i RETENTIONS <br />$ <br />WORKERS COMPENSATION <br />"� <br />WCSTATU- OTH- <br />ANDEMPLOYERS'LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE YfN <br />OFFICERIMEMBER EXCLUDED? <br />N/A <br />�; <br />..—% <br />YLIMER <br />EL EACH ACCIDENT S <br />F DISEASE -FA EMPLOYE $ <br />(Mandatory In NH) <br />�!_ <br />If yas, describe under <br />DE SCRIPTION OF OPERATIONS ba:mv <br />EASE.POLICYLIMR S <br />BUSINESS PERSONAL PROPERTY- <br />NG MARINE <br />Monique ]RIN-JeSiales <br />SiP /Yout S <br />pYg® <br />7 <br />AGGREGATEP$ <br />DESCRIPTION OF OPERATIONS r LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: <br />Franklin Delano Haynes dba Franklin Haynes Marionettes <br />Additional Insured: City of Santa Ana, its officers, agents, and employees <br />Email: MRosales@santa-ana.org Attn: Monique Rosales <br />City Of Santa Ana Public Library <br />26 Civio Center Plza <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL 8E DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Ai-' (thew,.:. (.(.).l ira. <br />riahts reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />