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DARRWAG-01 BROBERTS <br />ACOR®' CERTIFICATE OF LIABILITY INSURANCE <br />OAT Y) <br />TYPE OF INSURANCE <br />6 <br />6/2312/23/201016 <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 policy(los) 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 endorsements). <br />PRODUCER CONTACT Brian Roberts <br />Blue Lion Brokersac°NN Ea: (425) 968-2236 FAX No: (818) 827.3380 <br />4208 198th St. SW Suite 208 EMAIL <br />Lynnwood, WA 98036 AODREss: brian@bluellonbrokers.com <br />INSURERS AFFORDING COVERAGE NAIL# <br />INSURERA: Mesa underwriters Specialty <br />INSURED INSURER B: <br />Darrell Wagner lithe Professional Entertainment INSURER C: <br />P.O. Box 78593 INSURER D: <br />Seattle, WA 98178 INSURER E: <br />INSURER F: <br />COVERAGES - CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS 15 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />Nee <br />LTR <br />TYPE OF INSURANCE <br />0 <br />NSO <br />B <br />MD <br />POLICY NUMBER <br />POLCY EFF <br />MMIODPlYYY <br />POLICY E%P <br />MWODNYVY <br />LIMITS <br />A <br />X <br />I COMMERCIALGENERALLIARILITY <br />CLAIMS -MADE 1XI OCCUR <br />X <br />MP0002007000168 <br />12/0512015 <br />12105/2016 <br />EACH OCCURRENCE $ 1,000,000 <br />PREMISES Eaaccurrence $ 100,000 <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL B ADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO ❑ <br />ECT LOC <br />OTHER: <br />GENERAL AGGREGATE $ 2,000,000 <br />PRODUCTS -CONFIDE AGO 5 2,600,000 <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALLOWNED SCHEDULEO <br />AUTOS AUTOS <br />HIREDAUTOS NOAUTO OWNED <br />- <br />LIMIT $ <br />INJURY (Per person) $ <br />URY (Per acoidan0 $ <br />KBINEDSINGLE <br />Per DAMAGE $ <br />UMBRELLA LIAB OCCUR <br />E%OESS LIAB CLAIMS -MADE <br />DED RETENTION$ <br />t�RRENCE <br />-,1e" <br />V`�VVYY <br />$ <br />E $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />ry In NH) CLUDE09 ❑ <br />(Mandatory <br />ntler <br />If yes under <br />D <br />DESCRIPTION un OPERATIONS below <br />NIA <br />r �+.\ <br />yy VVe�I <br />��G <br />PER <br />STATUTE ER <br />EL EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYE $ <br />E.L. DISEASE- POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ADDED 101, Additional Remarks Schedule, may be attacked if more space is required) <br />Certificate Holder, Its officers, agents, and employees are named as Additional Insured in regards to General Liability per attached CG 2015 11188 <br />10 -day notice of cancellation for nonpayment. <br />City of Santa Ana <br />Attn: PRCSA <br />20 Civic Center Plaza M-23 <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. - <br />(91988-ZU14 AUUKU UUKPUKA I IVN. All rlgnts reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />