LOS ANGELES FIESTA MARIACHI - 2016

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DARRWAG-01 BROBERTS 4coRcy' CERTIFICATE OF LIABILITY INSURANCE DATE 61/231223/201166 Y) 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 Blue Lion Brokers 4208 198th St. SW Suite 206 Lynnwood, WA 98036 CONTACT NAME: Brian Roberts PHON o E (d26) 968.2236 FAX Nul: (818) 827.3380 EMAIL ADDRESS: brian@bluelionbrokers.com INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Mesa Underwriters Specialty INSURED Darrell Wagner dba Professional Entertainment P.O. Box 78593 Seattle, WA 98178 INSURER 8: INSURERC: _ INSURER D: INSURER E INSURER F :: COVERAGES - CERTIFICATE NUMBER: 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. NOTMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY. THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE D INSD Me POLICY NUMBER POLICY EFF MMIOOIYYYY POLICY EMP MMIDDPrYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ® OCCUR X MP0002007000168 1210512015 12105/2016 PREMISES Eacccunenca $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL A ADV INJURY $ 1,000,000 GEN'L AGGREGATE U MIT APPLI ES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 X POLICY E PRO- ❑ LOC JECT $ OTHER: AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO - BODILY INJURY (Per accitlent) $ ALL OWNED SCHEDULED---- AUTOS AUTOS NON -OWNED HIRED AUTOS -- PROPERTY ; DAMAGE $ 8 UMBRELLA LIAROCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICERIMEMBEREXCLUDED7ECUTIVE Y� (Mandatory in NH)� If yes, describe antler DESCRIPTION OF OPERATIONS below NIA n ( . .i�,� t� - STATUTE OERH E.L. EACH ACCIDENT $ EJ_ DISEASE-EAEMPLOYE $ E.L DISEASE - POLICY LIMIT 1 $ �y DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlo Remarks SO qdp y beaeach.d if more space is required) Certificate Holder, its officers, agents, and employees are named as Additional Insured in regards to General Liability per attached CG 2015 11188 10 -day notice of cancellation for nonpayment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Santa Ana City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: PRCSA 20 Civic Center Plaza M-23 AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD