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ccaRta® CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMMIOD YVYY) <br />O6/21/201fi <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poll%les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the pol cy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such andorsement(s). <br />PRODUCER <br />CONTACTNAME: Mass Merchandlsln <br />._....._..-,_. <br />K&K insurance Group, Inc. <br />1712 Magnavox Way <br />Fort Wayne IN 46804 <br />IIE <br />ac No (,Ti_800-328-2317 n No: 1-260.459.5502 <br />EMAIL -"' ----- '- <br />ADORP31 info@eventinsurance-kk.com <br />PRODUCER <br />CUSTOMER to: <br />X <br />INSURERS AFFORDING COVERAGE NAIC N <br />INSURED 2000648658 CP#68 <br />INSURERA: Nationwide Mutual Insurance Company 23787 <br />Kevin Christian Noonchaster <br />INSURER e: -- <br />DBA: Noteworthy Puppets Inc. <br />INSURER c: <br />438 S Lincoln PlaceINSURER <br />Monrovia, CA 91016 <br />A Member of the Sports, Leisure & Entertainment RPG <br />_ <br />D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 2000255578 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 CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO 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 />WVO <br />POUCYNUMSER <br />POUCYEFF <br />MMIDD <br />POLICY EV <br />MMIDDIY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />DLAIMS.MADE � OCCUR <br />X <br />68RPGO000005895300 <br />04/16/16 <br />12:01 AM <br />04/16/17 <br />12:01 AM <br />EACHOCCURRENCE $2,000,000 <br />[)AMA E TO RENTED — <br />PREMISES Ea Occurrence $33 00,000 <br />MED EXP Any oneperson) $5,000 <br />PERSONAL& ADV INJURY Excluded <br />GEN'L AGGREGATE LIMIT APPLIES PER; <br />GENERAL AGGREGATE $5,000,000 <br />POLICY n PROJECT ❑ LOC <br />PRODUCTS-COMP/OPAGG $2,000,000 <br />PROFESSIONAL LIABILITY <br />OTHER, <br />LEGAL UAB TO PARTICIPANTS $2,000,000 <br />AUTOMOBILE <br />I <br />LIABILITY <br />ANYAUTO <br />OWNED SCHE[)ULEO <br />AUTOS ONLY AUT <br />a <br />�) <br />0c'a61 <br />ffm a <br />a dent <br />BODILY INJURY IPerperaen) <br />BODILY INJURY (Peraccident} <br />HIRED NON -OWNED <br />HIRED ONLY AUTOS ONLY <br />t y <br />`'^-•--._.....- a <br />-- — <br />PROPERTYDA OE <br />Peraccidenl <br />X <br />Not provided while In Hawaii <br />UMBRELLA <br />LWSOCCUR <br />EXCESS UAB OUR.MADE <br />EACHOCCURRENCE <br />Monique <br />`` <br />Rog <br />IBS <br />AGGREGATE <br />OED RETENTION <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />NFA <br />T UU <br />L1 I QrtVI <br />V IllPER <br />STATUTE OTHER <br />ANY PROPRIETORIPARTNEIL YIN <br />EXECUTIVE OFFICEMMEMSER 77 <br />EXCLUDED? lMendatory In Ne <br />EL. EACH ACCIDENT <br />E.L. DISEASE -EA EMPLOYEE <br />eyes, 3"me under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />A <br />MEDICAL PAYMENTS FOR PARTICIPANTS <br />6BRPG000M895300 <br />04/16/16 <br />12:01 AM <br />04/16/17 <br />12:01 AM <br />PRIMARY MEDICAL $5,000 <br />EXCESS MEDICAL <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VSHI XSS (ACORD 101, Additional Remarks Sohodula, may be attached If more space is required) <br />Performing as Puppeteer <br />City of Santa Ana, its officers, employees, agents and volunteers are added as an additional Insured, but only for liability caused, in whole or in part, by the acts <br />or omissions of the named insured. <br />This certificate voids and replaces certificate #2000246038 -Effective: 6/10/20164/16/2017 <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana, Its officers, employees, agents and volunteers <br />20 Civic Center Plaza <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH <br />Santa Ana, CA 92702 <br />THE POLICY PROVISIONS. <br />Owner/Manager/Lessor of Premises <br />— <br />AUTHORIZED REPRESENTATIVE <br />low / <br />©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 (2018/03) The ACORD name and logo are registered marks of ACORD <br />