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Acc rzo ■ms CERTIFICATE OF LIABILITY INSURANCE DATE(MOCOMYYI
<br />1.. MARKEL' 7/2 112 01 6
<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
<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 />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONT NAME ° Stephanie Weiss
<br />Specialty Insurance Agency PHONc- — - - FAX - -- -
<br />Performers of the U.S. _(AIC,Na, EXIH 715.246-8008 _ _ INC Nap 715-246-4257
<br />E•MAI — _
<br />P.O. Box 24 goagl€ss:. certs@specieltyinsuranceagency.Com _
<br />New Richmond, WI 54017 INSURERS) AFFORDING COVERAGE NAIC0
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSft AbDO'SUBR__ _- --- - POLIC EPF POLIQY EXPO-- -�— --_--- - -- - -- --
<br />LTR TYPEOFINSURANCE 'WV POLICYNUMBER M Y M IDOfIYVY LIMITS
<br />GENERAL LIABILITY EACHOCCURRENCE S 1_000,000
<br />- _ DAMAGETORENTED _
<br />X COMMERCIAL GENERAL LIABILITY I 300,000
<br />-. _ _PREM�aES (Ea acurtenca) I S _ _
<br />_ CLAIMS•MAUE IX OCCUR ,MED EXP (Any ane pass.) 5 _ 5,000_
<br />A X X 2CN0140-7942 05/05/2016 05/04/2017 pERsomALaAOVINJURY s _ _ 1,000,000
<br />_ GENERALAGGREGATE 5 2,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER: P, ROOUCTS COMPIOPAGG.S 2000,000
<br />X POLICY ...._. P O. LOC S _
<br />AUTOMOBILE LIABILITY
<br />ANYAUTO BODILY INJURY (Per Person) 6
<br />ALL OANED SCHEDULED BODILY INJURY (Per accidem) S
<br />_AUTOS --- AUTOS
<br />'PROPERTY OAMAOE
<br />HIREDAUTOS AUTOS tPetawldent) _ S
<br />_S
<br />UMBRELLA LINE OCCUR V EACH OCCURRENCE 5 _
<br />EXCESS LIAR _ CLAIMS -MADE ,Av AGGREGATE 5
<br />DED RETENTIONS 5
<br />WORKERS COMPENSATION NC STATU OTH.
<br />AND EMPLOYERS' LIABILITY YIN j'�� ,,('��TORY LIMITS ER.
<br />ANY PROPRIETOMPARTNERIEXECU LIVE•' \` EL EACH ACCIDENT 5
<br />OFFICERIMEMSER EXCLUDED? ❑.N/A M1` — - --- ---
<br />(MandatoryinNH) t'a Ga�.y� E.L.DISEASE-EA EMPLOYEE a _
<br />It'sa, descries Wider
<br />DESCRIPTION OF OPERATIONS helm J E.L. DISEASE -POLICY LIMIT 5
<br />A BUSINESS PERSONAL PROPERTY- AGGREGATE g
<br />INLAND MARINE
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANech ACORD 101, AddlUonel Remarks Schedule, N more apace is required)
<br />PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.:
<br />Toryann Kolstedt dba Best Bubble Parties, Best Bubble Learning
<br />Additional Insured: City of Santa Ana Public Library, The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701; Its officers, employees, agents and
<br />representatives are named as additional insured's with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of
<br />the named Insured. Cancellation is as stated in the Policy.
<br />Email: souevas@santa-ana.org Attn: Silvia Cuevas
<br />raa:�uyw.Tl�y:ranalar anray�n�rra,
<br />City of Santa Ana Public Library
<br />26 Civic Center Plaza
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Santa Ana, CA 92701
<br />WSURERA: Evanston Insurance Company 35378
<br />INSURED Toryann Kolstedt
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />INSURER B:
<br />dba Best Bubble Parties, Best Bubble Learning
<br />AUTHORIZED REPRESENTATIVE
<br />---- -----_-- -- _---
<br />c/o Best Bubble Parties PO Box 7091
<br />INSURER c:
<br />Van Nuys, CA 91409
<br />INSURERD:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:
<br />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
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSft AbDO'SUBR__ _- --- - POLIC EPF POLIQY EXPO-- -�— --_--- - -- - -- --
<br />LTR TYPEOFINSURANCE 'WV POLICYNUMBER M Y M IDOfIYVY LIMITS
<br />GENERAL LIABILITY EACHOCCURRENCE S 1_000,000
<br />- _ DAMAGETORENTED _
<br />X COMMERCIAL GENERAL LIABILITY I 300,000
<br />-. _ _PREM�aES (Ea acurtenca) I S _ _
<br />_ CLAIMS•MAUE IX OCCUR ,MED EXP (Any ane pass.) 5 _ 5,000_
<br />A X X 2CN0140-7942 05/05/2016 05/04/2017 pERsomALaAOVINJURY s _ _ 1,000,000
<br />_ GENERALAGGREGATE 5 2,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER: P, ROOUCTS COMPIOPAGG.S 2000,000
<br />X POLICY ...._. P O. LOC S _
<br />AUTOMOBILE LIABILITY
<br />ANYAUTO BODILY INJURY (Per Person) 6
<br />ALL OANED SCHEDULED BODILY INJURY (Per accidem) S
<br />_AUTOS --- AUTOS
<br />'PROPERTY OAMAOE
<br />HIREDAUTOS AUTOS tPetawldent) _ S
<br />_S
<br />UMBRELLA LINE OCCUR V EACH OCCURRENCE 5 _
<br />EXCESS LIAR _ CLAIMS -MADE ,Av AGGREGATE 5
<br />DED RETENTIONS 5
<br />WORKERS COMPENSATION NC STATU OTH.
<br />AND EMPLOYERS' LIABILITY YIN j'�� ,,('��TORY LIMITS ER.
<br />ANY PROPRIETOMPARTNERIEXECU LIVE•' \` EL EACH ACCIDENT 5
<br />OFFICERIMEMSER EXCLUDED? ❑.N/A M1` — - --- ---
<br />(MandatoryinNH) t'a Ga�.y� E.L.DISEASE-EA EMPLOYEE a _
<br />It'sa, descries Wider
<br />DESCRIPTION OF OPERATIONS helm J E.L. DISEASE -POLICY LIMIT 5
<br />A BUSINESS PERSONAL PROPERTY- AGGREGATE g
<br />INLAND MARINE
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANech ACORD 101, AddlUonel Remarks Schedule, N more apace is required)
<br />PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.:
<br />Toryann Kolstedt dba Best Bubble Parties, Best Bubble Learning
<br />Additional Insured: City of Santa Ana Public Library, The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701; Its officers, employees, agents and
<br />representatives are named as additional insured's with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of
<br />the named Insured. Cancellation is as stated in the Policy.
<br />Email: souevas@santa-ana.org Attn: Silvia Cuevas
<br />raa:�uyw.Tl�y:ranalar anray�n�rra,
<br />City of Santa Ana Public Library
<br />26 Civic Center Plaza
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Santa Ana, CA 92701
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />�U.�L�TG+YI-�•W.4Jl1O/
<br />O 1988.2010 ACORD CORPORATION. All rights reserved.
<br />A CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
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