AUNTIE ROXIE'S LIFE OF THE PARTY - 2016

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ADATE a® CERTIFICATE OF LIABILITY INSURANCE 1 6/16/2016 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 lieu of such endorsement(s). PRODUCER CONTACT Elizabeth Flinders NAME; -.--_..— -.— _.---_ Flinders/D®Palma Insurance Agency License #0447329MAIL PHONE (818) 893-8600 WE Nol: (838)596-9841 T _A8.93ES.a-liz@flinderains.00m INSURERS AFFORDING COVERAGE NAIC N P.O. Box 510 _ INSURER A Northfield, Insurance Company_ 27987 Burbank CA 91503 INSURED INSURER B: PERSONAL& ADV INJURY $ 1,000,000 INSURERC; GENERAL AGGREGATE $ 2,000,000 David Skala INSURER D: dba: Auntie ROXie'S Life of the Party INSURER E: 6762 Alexandria Drive 1 (SURER F: �y By- {ted Huntungton Beach CA 92647 COVERAGES CERTIFICATE NUMBER: Master Cert 2016-2017 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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.__ Iaw LTTR TYPE OF INSURANCEI= SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE WVD P CV NUMBER POLICYYY POLICY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR _ X WS264221 03/05/2016 03/05/2017 EACHOCCURRENCF $ 1,000,000 VAMAUt IV KtN I tU 2UMI-aff't-twoccurre ce $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY❑ PECT RO- r7 LOC J OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS COMP/OP AGO $ 1,000,000 S AUTOMOBILE ,.. LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS ANON UTOSOWNED AUTOS RL'6'1 /'ewe Reviewed V �! V V i -d �y By- {ted COMBINED SINGLE LIMIT S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE $ Par aacidantl $ UMBRELLA UAB EXCESS UAB OCCUR/�� CLAIMS -MADE p / EACH OCCURRENCE $ AGGREGATE 3 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OANY FFICERRMEIMeER EXCLUDED? r'� (Mandatory in NH) L-.� It yes, describe under DESCRIPTION OF OPERATIONS below NIA NIA �+ s7 PEROR jt/+�{� 9 �j tt/ unique Rosales SAPLIY®uth �s e� �y�+ �y r� (� a XIV -.-..-.. E.L. EACH ACCIDENT $ E.L. DISEASE, EA EMPLOYE $ EL DISEASE - POLICV LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD Wt, Additional Remarks Schedule, may be a aclood it mom space is raquired) The City of Santa Ana, its officers, agents and employees are named as additional insureds on the General Liability policy as per written contract, primary wording applies. Endorsements attached. 10 day notice of cancellation for non payment of premium. CERTIFICATE HOLDER CANCELLATION mrosales@santa-ana.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Aria Public Library Attention: Purchasing Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 E Flinders/LAF��.''-`�) ACORD 26 (2014/01) INS025 M14011 O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD