EMERALD ISLE ENTERTAINMENT - 2016

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]`*. s €a CERTIFICATE OF LIABILITY INSURANCE �' OAT07/18/OIVYYV) 07/18/2016 THIS CERTIFICATE IS ISSUED ASA 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(ies) 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 lieu of such endomement(s). PRODUCER CONTACT NAME; do maylatl PHONExt) (239) 244-9777 plc No : (860) 627-8695 Northeast Insurance Center ppp IE ricm@neinscenteccom P O Box 151868 INSURERS AFFORDING COVERAGE NAIC q Cape Coral, FL 33915 INSURER A : United States Fire Insurance Co. 21113 Phone (239) 244-9777 Fax (860) 627-8695 INSURED INSURERS: INSURERC: EMERALD ISLE ENTERTAINMENT, INC DBA THE BUBBLE ROLLERS and INSURER D: MED EXP (Any one person $ 5,000.00 980 North Main Street NSU RER E : orange CA 92867 INSURER F: COVERAGES CERTIFICATE NUMBER: USP204598 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR SR IWO POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS -MADE O OCCUR DAMAGE TO TED PREMISES Eaoacurrence $ 300,000.00 MED EXP (Any one person $ 5,000.00 ❑ A Y SRPGP-101-0715 03/02/2016 03/02/2017 ❑ PERSONAL a ADV INJURY s 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY [:]JEST 1:1 LOC PRODUCTS - COMPIOP AGO $ 2,000,000.00 ❑ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT EMB BODILY INJURY (Per person) $ ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS I_J AUTOS BODILY INJURY (Per accident) $ ❑HIRED AUTOS NON -OWNED ❑ AUTOS PROPERTY DAMAGE $ Per accident $ ❑ L ❑�-� UMBRELLA LIAR [:]OCCUR EACH OCCURRENCE $ 2,000 000.00 A LJ EXCESS LIAR ❑ CLAIMS -MADE USX102014 03/08/2016 03/08/2017 AGGREGATE $ 2,000,000.00 ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ❑SPER TATUT ❑ Om - D E.L. EACHACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIV[� OFFICER/MEMBER EXCLUDED? a NIA E. L. DISEASEEAEMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Accident AH-GA26932-002/US480123 03/02/2016 03/02/2017 max medical benefit per claim $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is regolred) MOBILE BUBBLE ROLLERS, mobile laser tag, inflatables, synthic ice rink, mobile indoor airsoft range, ZORB BALLS, SUMO SUITS, Bumper suits, paddle Rollers, inflatable obstacle course/slide, mobile bungee, and photo booth, rental tables chairs and ancillary equipment. Certificate holder (property owner) is listed as additional insured in regards to general liability within respects to the named insureds operation. d�� Date of event: 08/20/2016 1e Location of event:20 Civic Center Plaza M 23, Santa Ans, California 92701 Poe y �J The City of Santa Ana Attn:PRCSA 20 Civic Center Plaza M 23 Santa Ana, California 92701 ACORD 25 (2014/01) OF SHOULD ANY OF THE ABOVE THE EXPIRATION DATE THEIR ACCORDANCE WITH THE POI AUTHORIZED REPRESENTATIVE IN BEFORE ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD