Laserfiche WebLink
DARRWAG-01 BRt78ERTS <br />ACORO� <br />CERTIFICATE OF LIABILITY INSURANCE <br />E IMMlD D1YYYY) <br />aDATE <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 pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsements . <br />.PRODUCER <br />NO T CT Brian Roberts <br />Blue Lion Brokers <br />4208198th St. SW Suite 206 <br />Lynnwood, WA 98036 <br />(PA NE., Ext): (425) 968-2236 I'AArc, Nn :(818) 827-3380 <br />RMbss, briars blueiionbrokers.com <br />INSURERISI AFFORDING COVERAGE <br />NAIC # <br />INSURER A! Mesa Underwriters Specialty <br />INSURED <br />INSURER a; <br />INSURER C ; <br />Darrell Wagner dba Professional Entertainment <br />INSURER D ; <br />P.O. Box 78593 <br />Seattle, WA 98178 <br />INSURER E ; <br />INSURER F ; <br />nnVFRAPFC r_I=PTIFiCATR NIIMRFR• RPVL4I()N NIIMRER. <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />INSR <br />TO <br />TYPE OF INSURANCE <br />ADD-INSp <br />SUBp <br />POLICY NUMBER <br />POLICY EFP <br />POL.ICY EXPI <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE )( OCCUR <br />X <br />MP0002007001476 <br />1210512016 <br />12 O612017 <br />EACH OCCURRENCE <br />2,0001000 <br />DAMAGE rO RFNTED <br />REMESES =aoccunwee <br />10D,D00 <br />VIED EXP (Any one erson <br />$ 6,000 <br />GEN'L <br />X <br />PERSONAL &ADV INJURY <br />'I1000'000 <br />AGGREGATE LIMITAPPLIES PER <br />POLICY❑ Toa LOG <br />OTHER: <br />GENERALAGGREGATE <br />2,000,000 <br />PRODUCTS - CCMPIOPAGG <br />2,000,000 <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOSoS®� <br />ALTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />$ <br />aODfLYINJURY Per arson <br />$ <br />BODILY INJURY Peraccldenl <br />Pe�accigent AMAGE <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMSMADE <br />s+f1 <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />PEP RP'7PNTICN $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y l N <br />AANFICEOMR IET RIPFJARTNERlp CECUTIVE ❑ <br />(Mandatory in NEH) <br />If yyos, describe under <br />❑ESCRIPTION OF OPERATIONS below <br />N A <br />- <br />SER OTH- <br />F.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE. -EA FMPLOYE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />1 $ <br />A <br />Abuse $ Molestation <br />MP0002007001476 <br />1210512016 <br />12/05/2017 <br />100,000 <br />300,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is re uired) <br />Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as add�tlonal insured(s); (b) be primary with respect to <br />insurance or self -Insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. <br />10-day notice of cancellation for nonpayment. <br />City of Santa Ana <br />Attn: PRCSA <br />20 Civic Center Plaza M-23 <br />Santa Ana, CA 92701 <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 PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016103) O 1988-2016 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />