PROFESSIONAL ENTERTAINMENT - 2017

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�•" ^� DARRWAG-01 BRGBERTS �C'oRom CERTIFICATE OF LIABILITY INSURANCE DATE 03/2812017YI 4312$12017 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(ies) must have ADDITIONAL INSURED provisions or 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 Brian Roberts NAME: Blue Lion Brokers PHONE 4208 198th St. SW Suite 206 FAX IA1c, No, Exq: (425j 988-2236 (A1c, Nol,(818) 827-3380 E-MAIL Lynnwood, WA 98036 ADD.-brian bluelionbrokers.com E _..., .INSURERS} AFFORDING COVERAGE _ NAIC ft INSURI Mesa Underwriters 5pecialt� INSURED INSURER B : Darrell Wagner dba Professional Entertainment INSURER C : P.O. Box 78593 INSURER D : Seattle, WA 98178 IN5U RER E INSURER F r`n%1FI7Af-9=C rr-0TI9:IrATFZ Kn IMRGQ- A11111Ac2co. 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, INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP ' LIMITS LTR INSR WVD DDPMY A X COMMERCIAL GENERAL LIABILITY i CLAIMS4ADE X OCCUR X, MP0002007001476 12/05/2016 1210612017 EACH OCCURRENCE DAMAGE TO RENTED PRE Ea occUfrence) : $ 2,000,000 100,400 $ MED EXP (Any oae-I ..... _ $ 5,000 $ 1,400,000 _PERSONAL &ADVINJURY _ GEN'LAGGREGATE LIMIT APPLIES PER X POLICY Pn LOG GENERALAGGREGATE PRODUCTS-COMPlDPAGG $ 2,000,000 $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT _(Ea accident) $ BODILY INJURY(Per person BODILY INJURY Per accident ANY AUTO OWNED SCHEDULED AURRT��OppS ONLY ASUTOpSyy� $ - -- $ PPe�acciden �AMAGE $ AUTOS ONLY AU OS 6NLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y 1 N I PER 1OTH- _ _J STATUE I I FIR ANY PROPRIETORIPARTNERIEXECUTIVE EXCLUDED? NIA E.L. EACH ACCIDENT — $ E,L, DISEASE- EA EMPLOYE (�pFECERR'MEMBER iAandatory m NH} If yes, describe under $ _ _ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Abuse Sr Molestation MP0002007001476 12105/20161! 12/0512017 100,000 300,000 DESCRIPTION OF OPERATIONS f LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. 10-day notice of cancellation for nonpayment. 9rc17T1CIrrATC Lint nCo r`Akle c1 I ATU-M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana y Attn: PRCSA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza M-23 AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD