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<br />Date 10126120 1 S 1'.29.58 PIV Pace.1 of 3
<br />HAPPEVE-01 KE I LAND
<br />CERTIFICATE OF LIABILITY INSURANCE [ DATE (MMIOD(YYYY)
<br />1012612015
<br />THIS CERTIFICATE 15 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 />. ...... ....... . -- - — - --- - ----- -- --------------- ... .. . ...... . .. . ..... .. ...... ................. . ... . .......... .
<br />IMPORTANT: If the eerlifiaate holder Is an ADDITIONAL INSURED, the policyles) must be endorsed, If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may rectuh e an andomernent. A statement on this Certificate does not Center rights to the
<br />PRODUCER License If 0383047 NAME,
<br />"C,
<br />Onstad's Insurance Agency PHONE ....... ...... . .. .....................
<br />3130 Crow Canyon PI, Ste 250 LAX, Np, EaNI (9?�) $66-1444
<br />Sari Ranion, CA 94583 ADDRESS! info@onstads.ci
<br />NAIC 0
<br />,— --- I ---- ------- ---------------------------------- - - - ------------------------- IN,$,U R, E
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<br />A_-A----t-a--i- n-Specialty...I.n..-.s...u...r..a...r.. .c. -. e.. . - C.
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<br />INSURED SURERastslaCornmensation Insurance Fun
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<br />Happily Ever Laughter, LLC ISUER
<br />501 Cedar St Suites C & D INsunER
<br />D.
<br />Santa Cruz, CA 95060 ---c
<br />I INSURER F
<br />OVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />TiF T1 -- - OF -- us�i F it4v-L -F Tssa -niE -VF TME POLICY WEI21U0
<br />THIS IS '10 CER N TRA -HIF POLICIES - mul�mcF ---6 IeFtcni - BEEN -oT6 TINISUREDNAMETI
<br />INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT IDWHICH THIS
<br />CERTIFICATE MAY DE ISSUED OR MAY PERTAIN, II INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHETERMIS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />LTR_TYPE OF INSURANCE" POLCYNUMSER D;YVYY) LIMITS
<br />. . ..... ...... (MMAIDIYYYY) . .......
<br />X COMMERCIAL --- --- GENERA-L-LIA-11-11-1-TY -- ----- ---- - EACH OCCURRENOL
<br />I"
<br />CIAIMS-MADE. x OCCUR X CIP178478002 10/0112015 10101/2016 DAMAGE
<br />MLD FXP (Ally 011f) p.mMR
<br />- - - - ------ I -- -- -- --
<br />PERSONAL A ADV INJURY
<br />... . ...... - ----
<br />GELIL AGGREGATE LIMP APPLIES PER GENERAL AGGHL GA I E $
<br />xj POLICY JPE"P, EILOC PROUKIS COMPIOPAGG S
<br />- - ----- - -------------- - ---- ....... .............. ... . . - - - ------- ... ... ... ......... ..
<br />COMFIINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY
<br />ANY AD 10BODILY INJURY IF,,
<br />ALL 0 1 1 �qCITIDULFD 00 1 BO LY INJI
<br />AUTOS
<br />UOES
<br />NON-OWNLD
<br />HIREDAUTOS AUrOS ( ROPER UE $
<br />P.,
<br />- ---------- i ------
<br />UMBRELLA LIAR OCCUR
<br />EXCESS EIAB CLAIMS MADE, AGGREGATE
<br />DFO FrFal ecse?
<br />e�N (N"c" PER
<br />WORKERS COMPENSATION
<br />AND EMPLOYEkS'LIABILI PY YIN E4PH
<br />ANY 'ROPRILICRIPAR I NER LXECUr VL 911234722016 10/0112015 1010112016 1., 1, EACH, S
<br />Of F Cl-ROVEMBERLXCLUDED?
<br />M..da1Q'Ym Nm F L DISEASE
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES LACORD 101, Additional Remarks Schedule, may be attached it more space is roPirrvd)
<br />rhe City of Bentz Ana, Its officers, agents, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability
<br />rising out of the rental of the facility, work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in
<br />:onnrecfion with such work or operations.
<br />The City of Santa Ana, its officers, agents, employees, and
<br />volunteers
<br />20 Civic Center Plaza
<br />Santa Ana, CA 02701
<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 PROVISION$,
<br />AUTHORIZED REPRESENTATIVE
<br />
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