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ACC)R6r CERTIFICATE ®F LIABILITY INSURANCE <br />FDATE(MMIDDIYYYY) <br />111.1 <br />05/02/2017 <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 BELOW. <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE <br />OR PRODUCER AND THE CERTIFICATE HOLDER. <br />IMP RTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT NAME: Mass Merchandising Underwriting <br />K&K Insurance - Expedited by-R,F,I,S <br />203 N Brea Blvd. #110 <br />Brea CA 92921 <br />AX <br />(arc No Ext): 714-869-1509 A1C, No): 714-364-8563 <br />-MAIL <br />ADDRESS: FontanaInsUranceService5@Gmaii.com <br />CUSTOMER ID: <br />A <br />INSURERIS) AFFORDING COVERAGE NAIC p <br />X <br />INSURED <br />INSURER A: Nationwide Mutual Insurance Company 23787 <br />OC MUSIC LEAGUE <br />INSURER B: <br />204 E 4TH ST. <br />SANTA ANA, CA 92701 <br />INSURERC: <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: W01022676 REVISION NUMRFR: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICYPOLICY <br />MMIDDYYYY <br />EXP <br />MMlDD <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />MADE OCCUR <br />X <br />BBRPG0000006071000 <br />05/06/2017 <br />12:01 AM EDT <br />05/08/2017 <br />12:01 AM <br />EACH OCCURRENCE $1,000,000 <br />PDAMAGE TO REMISES (EaOccurrence)$1,000,000 <br />MED EXP (Any one person) Excluded <br />PERSONAL $ ADV INJURY Excluded <br />GENERAL AGGREGATE $5,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ PRO- ❑ LOC <br />JECT <br />PRODUCTS - COMPlOP AGO $1,000,000 <br />�" <br />y-� <br />PROFESSIONAL LIABILITY <br />OTHER: <br />4� <br />LEGAL LIAB TO PARTICIPANTS $1,000,000 <br />AUTOMOBILE <br />ANY AUTO <br />OWNEDAUTOS AUTOSSCHEDULED <br />LIABILITYYQ�V <br />ONLY <br />NCI NO <br />AUTOS ONLY AUTOS ONLY <br />NOT PROVIDED WHILE IN HAWAII <br />`��8 <br />� <br />(!` <br />BIKED SINGLE LIMIT <br />Ea accident <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />PROPERDAMAGE <br />Per accident <br />UMBRELLA LUIB OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAB CLAIMS -MADE <br />AGGREGATE <br />DED RETENTION <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />N/A <br />PER OTHER <br />STATUTE LJ <br />ANY PROPRIETORIPARTNER/ YIN <br />E.L. EACH ACCIDENT <br />EXECUTIVE DFFICERlMEMBER ❑ <br />EXCLUDED? (Mandatory In NH) <br />E.L. DISEASE -EA EMPLOYEE <br />E.L. DISEASE -POLICY LIMIT <br />If yes, describe under DESCRIPTION <br />OF OPERATIONS below <br />A <br />MEDICAL PAYMENTS FOR PARTICIPANTS <br />6BRPG0000006071000 <br />0510612017 <br />12:01 AM EDT <br />05/08/2017 <br />12:01 AM <br />PRIMARY MEDICAL $5,000 <br />EXCESS MEDICAL <br />DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) <br />Type of Group: Musicians, singers or vocalists; Music Genre: Ethniclworld, Folic, Pop/soft rock; Type of Venue: Outdoor venues <br />Event: CINCO DE MAYO CELEBRATION; Event Dates: 5/6/2017 to 517/2017; Event Location: CITY OF SANTA ANA <br />The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. <br />CERTIFICATE HOLDER CANCELLATION <br />CITY OF SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 CIVIC CENTER PLAZA <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />SANTA ANA, CA 92701 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />(Event Organizer) <br />/�� y <br />Iflc e vi AnLz <br />Coverage is only extended to U.S. events and activities. <br />** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas <br />ACORD 25 (2016103) ©1988-2015 ACORO CORPORATION. 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