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AC'" CERTIFICATE CERTIFICATE 4F LIABILITY INSURANCE DATE(MMlDDRYYYY) <br />0311012017 <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 BELOW, <br />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(fes) must have ADDITIONAL INSUREDprovisions 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 <br />K&K Insurance Group, Inc. <br />1712 Magnavox Way <br />Fort Wayne IN 46804 <br />CONTACT NAME:: Mans Merchandising <br />arc No Ext : 1-800-328-2317 (A/C, No): 1-260-459-5502 <br />E-MAIL <br />ADDRESS: infoCa)evenlinsurance-kk.com <br />PRODUCER <br />CUSTOMER ID: <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED 2000E48858 CP# 1581 <br />Kevin Christian Noonchester <br />DBA: NOTEWORTHY PUPPETS INC <br />438 S LINCOLN PLr..w, III <br />MONROVIA, CA 91016 " <br />A Member of the Sports, Leisure & Entertainment RPG <br />INSURER A: Natlonwide Mutual Insurance Company 23787 <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURE=R E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER:.. 2000294117 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 INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT'IF'ICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />Vivo <br />POLICY NUMBER <br />POLICY EFF <br />MM2P)YYY <br />POLICY EXP <br />MM/DMYYYY <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />X <br />68R.PGO000005895300 <br />04/16/17 <br />04/16118 <br />EACH OCCURRENCE $2,000,.000. <br />CLAIMS -MADE FX OCCUR <br />12:01 AM <br />12.01 AM <br />P�EMISESCEacaFiD _...... <br />T $300,000 <br />mance <br />MED EXP (Any one. persnn) $.5,000 <br />PERSONAL X ADV INJURY Excluded <br />GENERAL AGGREGATE $5,000,000 <br />GEN'L AGGREGATE. LIMIT APPLIES PER: <br />POLICY 0 PROJECT ❑ LOC <br />PRODUCTS -COMPIOP AGG $2,000,000... <br />PROFESSIONAL LIABILITY <br />OTHER: <br />LEGAL LIAB TO PARTICIPANTS $2,000,000 <br />AUTOMOBILE <br />LIABILITY <br />I L CIM17 (Ea <br />accident) <br />BODILY IN...-......._. <br />JURY' (Per person) <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLYAUTOS <br />.. <br />BODILY' INJURY (Per aecidentl <br />HIRED NON -OWNED <br />AUTOS ONLY H AUTOS ONLY <br />�», <br />I <br />PROPERTY DAMAGE <br />Per ac=cident <br />X <br />Not provided while in Hawaii <br />UMBE OCCUR <br />LIAR <br />EXCESS LIAR H CLAIMS-MADE� <br />DED RETENTION <br />.,.i, r <br />�- <br />,�r.,..:,.-s'°�� <br />eWORKERS <br />EACH OCCURRENCE <br />AGGREGATE <br />NY EMPLOPROPHIYERS' LIABILIT <br />N/A <br />. <br />_ <br />V'R� 'qj <br />PER STATUTE OTHER <br />ACMPENSATION <br />F Y J N <br />EXECUTIVEOFFICERfMEMBER <br />EXCLUDED? (Mandatory In NH) <br />�, <br />�\ �4 <br />+./? <br />E, L, EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE <br />I yes, deyCflhe under <br />eio�ol"i <br />" <br />DESCRIPTION OF OPERATIONS below <br />k <br />F.L. DISEASE -POLICY LIMIT <br />A <br />MEDICAL PAYMENTS FOR PARTICIPANTS <br />6BRPG0000005895300 <br />04f16/1.7 <br />12:01 AM <br />04116/18 <br />12:01 AM <br />PRIMARY MEDICAL $5,000 <br />EXCESS MEDICAL <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />Performing as Puppeteer <br />Event Date: 07/25/2017 — 07/30/2017 <br />City Of Long Beach, Its officials, employees and agents are added as an additional insured, but only for liability caused, in whole or in part, by the acts or <br />omissions of the named insured. <br />CERTIFICATE HOLDER CANCELLATION <br />City Of Long Beach <br />333 West Ocean Boulevard <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH <br />Long Beach, CA 90802 <br />THE POLICY PROVISIONS. <br />Owner/Manager/Lessor of Premises <br />AUTHORIZED REPRESENTATIVE <br />O 1988-2015 ACORD CORPORATION. All rights reserved'. <br />Coverage is only extended to U.S. events and activities. <br />,. NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />