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A'IC R & CERTIFICATE ®F LIABILITY INSURANCE DATE(MMfDDIYYYYj <br />03/23/2017 <br />PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br />East Main Street Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Will Maddux HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />PO Box 1298 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Grass Valley, CA 95945 <br />Phone: (530) 477-6521 Email: info@theeventhelper.com INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Essex Insurance Company 39020 <br />Mobile Game Theatre LLC INSURER B: <br />Michael Haithcock -- <br />7315 Sitio Castano INSURER C: <br />Carlsbad, CA 92009 INSURER D: <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />_POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRADDT <br />LTR.INSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MMIDDIYY <br />POLICY EXPIRATION <br />BATE MMII DIYY <br />_ <br />LIMITS <br />GENERAL <br />LIABILITY <br />EACH OCCURRENCE INCLUDES <br />BODILY INURY& PROPERTY DAMAGE <br />$ 1,000,000 <br />A <br />Y <br />ii <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE [ OCCUR <br />3DS5450-M 1830244 <br />05/29/2016 <br />05/29/2017 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL&ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />Host Liquor Liability <br />"""'''"""GGEEN'LAGGREGATELIMITAPPLIESPER: <br />POLICY LJ PRD- <br />JECT LOC <br />PRODUCTS - COMPIOPAGG <br />$ 1,000,D00 <br />DEDUCTIBLE <br />$ 1,000 <br />Retail Liquor Liability <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY I NJ URY <br />(Per person) <br />$ <br />ALL OVMV ED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per accident) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />� <br />DAMAGE <br />(Per <br />(per accident) <br />i $ <br />Pill <br />GARAGE <br />LIABILITY �Cp <br />AUTO ONLY - EA ACCIDENT <br />5 <br />OTHERTHAN EA AGO <br />AUTO ONLY: AGG <br />$ <br />$ <br />ANY AUTO <br />`\ <br />EXCESSIUM13RELLA LIABILITY <br />,�_ h� 1� <br />EACH OCCURRENCE <br />$ <br />OCCUR n CLAIMS MADE�d1b <br />' <br />AGGREGATE <br />$ <br />$ <br />DEDUCTIBLE <br />$ <br />�I RETENTION $ <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY <br />WC STATU- I I OTH- <br />` TORY LIMITS ER <br />-_" <br />- — ""-- .- <br />ELEACH ACCIDENT <br />ANY PROPR <br />$--- <br />-EACH <br />E.L. DISEASE - EA EMPLOYE <br />OFFICERIMFMBFR FXCLUDED4 <br />$ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />SPECIAL PROVISIONS below <br />OTHER <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ! EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS <br />Certificate holder listed below is named as additional insured per attached CG 20 26 07 04. <br />Attendance: 1000, Event Type: Vendor at Event. <br />t' -film] a 011\ t �1111 i lq III ■J-4 •f1i0 IN R A III I IQ0 <br />City of Santa Ana, It's officers, agents <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />and employees. Purchasing Dept <br />20 Civic Center Plaza <br />DATE THEREOF, THE ISSUING INSURER WILL EPHK-MA1d4MAIL 30 DAYS WRITTEN <br />Santa Arra, CA 92701 <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 9 T ;"" "^^ T^ ^^ ^^ ^ "' ' <br />AUTHORIZED REPRESENTATIVE �� <br />A%,VKLO 40 t[UU"LIUaj (V AGUKU L UKPUKA I IUN IH?JIf <br />