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<br />CERTIFICATE ®F LIABILITY INSURANCE
<br />DATE /2017 ryrrr)
<br />F a412012D17
<br />-
<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 1NSURER(5j, AUTHORIZED
<br />REPRESENTATIVE, OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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
<br />Marsh Risk & Insurance Services
<br />CA License #0437153
<br />777 South Figueroa Street
<br />Los Angeles, CA 90017
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />rArc. No. ExU: [AIC No):
<br />_
<br />EMAIL
<br />ADDRESS:
<br />GLO3714.03
<br />Attn: LosAngeles,CertRequest@marsh.com IF: 212-948-0535
<br />INSURERS) AFFORDING COVERAGE
<br />NAIc #
<br />INSURER A: Atlantic Specialty Ins Co
<br />27154
<br />581977--EX-16-17 _
<br />INSURED
<br />KWIZ-FM La Ranchera 96.7
<br />INSURER 8: National Union Fire insurance Co.
<br />INSURER C: Insurance Company of the State of Pennsylvania
<br />MED EXP (Any one person) $ 5,000
<br />1845 Empire Ave
<br />INSURER D : NIA
<br />N/A
<br />Burbank, CA 91504
<br />INSURER E
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: LOS -002063627.04 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 />!NSR LTR TYPE OF INSURANCE
<br />iI
<br />UBRi
<br />POLICY NUMBER
<br />EFF
<br />MMfDDIYYYY
<br />MPOLICY
<br />M! DfYYYLICY Y
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />X
<br />GLO3714.03
<br />11!0112016
<br />1110112017
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE L1 J OCCUR
<br />DAMAGE TO RE TED
<br />PREMISES Ea occurrence $ 1 000,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGRFGATE_ $ 2,000,000
<br />POLICY JERCOT- M LOC
<br />PRODUCTS - COMPlOP AGG $ 2,000,000
<br />I$
<br />OTHER:
<br />B AUTOMOBILE
<br />LIABILITY
<br />AL 2305067
<br />11/011201
<br />1110112017
<br />COMBINED SINGLE LIMIT r $1,000,000
<br />Ee accident
<br />X
<br />I _ANY
<br />AUTO
<br />ALL AUTOSED AUTCSUL£D
<br />NON-OWNED��
<br />HIRED AUTOS AUTOS
<br />� ® +�
<br />'�3,�"�
<br />�,
<br />_ _ _ _
<br />BODILY INJURY Per person) i
<br />( P ) $
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />(Per accident)
<br />Is
<br />UMBRELLA LIAB
<br />OCCUR
<br />1 EACH OCCURRENCE $
<br />EXCESS LAB _
<br />CLAIMS -MADE
<br />��`�
<br />I, AGGREGATE $
<br />DED •, RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />�AND EMPLOYERS' LIABILITY
<br />C 'ANY PROPRIETOWPARTNERrEXECUTIVe Y
<br />;OPHCERIMEMBER EXCLUDED?FT]
<br />(Mandatory In I
<br />NIA
<br />X
<br />142200
<br />14220041
<br />03/0412017
<br />03/0412017
<br />0310412018
<br />0310412018
<br />X I PER OTH-
<br />STATUTE ER
<br />-_
<br />E.L., EACH ACCIDENT $ 1,COD,00D
<br />T-_
<br />E,L. DISEASE - EA $ 1,000,000
<br />If yes, describe under
<br />ID ESCRIPTION OF OPERATIONS below
<br />I
<br />_EMPLOYEE
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,OOD
<br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Remarks schedule, maybe attached If more space Is required)
<br />Re, KWIZ-FM onsite appearance, Event City of Santa Ana Cinco de Mayo Festival, Date: 516117 -517117 and Event: Dia del Nino, Date 4129!17, Location: Santa Ana Public Library 26 Civic Center Plaza, Santa Ana,
<br />CA 92701
<br />The City of Santa Ana, its officers, employees, agents, and representatives are included as additional insured (except workers' componsation) where required by written contract. The general liability is primary and
<br />non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions. Waiver of subrogation is applicable where required by
<br />written contract and subject to policy terms and conditions.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Attn: PRCSA
<br />20 Civic Center Plaza - M-23
<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 />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh Risk & Insurance Services
<br />Angel Hovseplan
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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