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AC® CERTIFICATE OF LIABILITY INSURANCE <br />._.......... 0 5 <br />�ATE[10212017MM100mYY, <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGH75 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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT! If the cartlfleate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsemant(sl. <br />PRODUCER Eddie Quivares Jr. <br />State Farm Agency <br />415 N. Broadway <br />S <br />Santa Ana, CA 92701 <br />INSURED Yenny Bernal DBA Uplifting Soul Art Events <br />1052 VV Pine St <br />Santa Ana, CA, 92703 <br />COVERAGES CERTIFICATE NUMBER; 75-0450 REVISION NUMBER: <br />" ,' �. NFT MAI Inc POLICIES OF 1NSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. No TVVIT148TANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />ILTR <br />TYPE OF INSURANCE <br />DL <br />S <br />POLICY NUMVeR <br />POLICYDlYYYY <br />PMf13DiYYYyI Y EXP <br />LIMITS <br />A <br />GENERAL LIABILITY <br />Y <br />❑ <br />92 -EX -K512-8 <br />081116)2017 <br />05/08/2015 <br />EACH OCCURRENCE S 1,000,000 <br />PREMISES Ea ocaurrance 5 34(),000 <br />i� COMMEF20IALGENERAL LIABILITY <br />CLAIMS -MADE Fx7 OCCUR <br />MED EXP (Arty oreperson) S 5,000 <br />PERSONAL$ ADV INJURY $ 1,000,000 <br />- <br />GENERAL AGGREGATE 5 2,000,000 <br />GFN'LAGGREGATELIMIECTTAPPUESPER: <br />POLICY PCU- LOC <br />PRODUCTS - COMP/OPApCt $ 2,000,000 <br />8 <br />AUTOMOBILE <br />LIABILITY <br />�O atlBDISINGLE LIMIT $ <br />ANY AUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />HIIRRDAUT05 NON -OWNED <br />AUTOS <br />ry�(Per <br />'`� ° <br />BODILY INJURY (Perporson) $ <br />$ODILYINJURY (Perac6dent) $ <br />PROPERTY DAMAGE <br />accidant) $ <br />$ <br />UMBRELLA LIAM <br />EXCESS LIAR <br />R <br />ODOUR <br />CUtIMS•MADE <br />,�`IA <br />J <br />/ _ `�, <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />1)ED RETENTIONS 10.000 <br />$ <br />(� <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORlPARTNEWEXECurivE <br />OFFICE/MEMRFR FXCLU1:1DEO9 <br />NIA <br />❑ <br />°�+.,��' <br />°y\� <br />��� <br />IMC 9TATU- OTHE- <br />T <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYE $ <br />[Mandatory in NHI <br />If yns, desi:00 Lndav <br />E.L. DISEASE -POLICY LIMIT $ <br />$ <br />OESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Ir more space la raqulrsd) <br />Cinco De Mayo Celebration in Downtown Santa Ana. Uplifting Soul Art Event will he at the Yost Plaza/Spurgeon Promenade, <br />THE CITY OF SANTA ANA, IT'S OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVE ARE NAMED AS ADDITIONAL INSURED IN REGARDS TO <br />GENFRAL LIABILITY PER ATTACHED EXHIBIT B ADDITIONAL INSURED FORM. <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />$ANTA ANA, CA 92701 <br />SQNIA BATRES <br />ACORD 25 (20101051 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANGELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE= WITH THE POLICY PROVISIONS. <br />AUTHORIZED <br />a 1988- ACORD CORPORATION, All rights reserved, <br />The ACORD name and logo are regia marks &ACORD 1001486 152843.7 03-01-2012 <br />