BROSKI, ROBERT - 2016 - Laserfiche WebLink

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AC�K�w CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVYY) 6/28/2016 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 certificate holder In Ilou of such endorsement(s). PRODUCER CONTACT Allison Steeves Shoff Darby Companies 488 Main Avenue PAHSNE Ltidb(203)445-2123 AXIA/C0:(203)445-2139 aOO..88 ateeves@sho££darby. COAL 3rd Floor 1Vorwalk CT 06881 INSURERS AFFORDING COVERAGE HAKE INSURERA Nationwide Mutual Insurance Co INSURED A Member of the SLE RPG INSURER B: WildWestPerformers.com, DBA: The R9enactors INSURER C: 32405 Orange Blossom Dr INSURER D: INSURER E: GENERAL AOGREGATE $ 5,000,000 Winchester CA 92596 INSURER F: COVERAGES CERTIFICATE NUMBER:CL164419007 RFVIRNIN NIIMFIPR. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE 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 DESGRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRNSR ryPE OF INSURANCE OLS OF POLICY NU E POLICY POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIM3 MAGE �OCGUR RP059048 RPG59048 9/1/2016 4/1/2019 4/1/2019 4/1/2018 EACH OCCURRENCE $ 2,000,000 DA—MAGET 30D,000 accunence $ MEDEXP(Anyone arson) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY [:]jECT ❑LOG OTHER: GENERAL AOGREGATE $ 5,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Employee Senarite $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS OYJNEO HIRED AU TOS N1'_' AUTOS COMBINED SINGLE LIMIT $ Ea accident _ BODILY INJURY (Pro proem $ BODILY INJURY Per aecldonl S ( ) PROPERTY DAMAGE $ Poraccidenl UMBRELLA LIA@ EXCESS LIAB pCGUR CIAIMSMAOE Elie �•r `'3 1 EACH OCCURRENCE $ AGGREGATE $ OED RETENTIONS..0000 $ WORKERS COMPENSATION AND EMPLOYERS'UABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMSER EXCLUDED? ❑NIA (Mammamy in NH) If yes, cmer i e under.n DESCRIPTION OF OPERATIONS below ""ffpy 4r'�\y:�I�L1�L 'vv 7^ "' nn`1r� V��'` us 8b PER OTH- GTA'rUTL---- E. L. EACH ACCIDENT $ E. L. DISEASE -EA EMPLOYE $ E.L DISEASE - POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe allachoO irmore roams is required) Robert Broaki Aka 'Abraham Lincoln'- is included under the above policy effective 4/14/16 to 4/14/17. Proof of Insurance. The City of Santa Ana Parks, Recreation & Community Services Agency 20 Civic Center Plaza M-23 Santa Ana, CA 92702 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 p Allison Steeve B/ALLI G,�' All riahts ACORD 25 (2014101) Tho ACORD name and logo are registered marks of ACORD INS0251Mt,1011