BROSKI, ROBERT 2 - 2017 - Laserfiche WebLink

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q` oito® CERTIFICATE OF LIABILITY INSURANCE IT9 HW29D1171 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 ADOITIONAL INSURED, the Doijcy(ies) must be endorsed. if SUBROGATION IS WANED, 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 coNrncr,Allison Steeves Shoff Darby Companies wq PHONP EV. (203) 445-2123 WC NPI: (203)445-2137 488 Main AvenueDAD NESE, steevesesho£€derby. corn 3rd Floor WSURER(S) AFFORDING COVERAOE _ NNC N_-__.. Norwalk CT 06851 INSURERA:Nationwide Mutual Insurance Cc r ___.. _ INSURED A rneIDl3er -o£ the SLE RPG INsulxPne: _ WildWestPerforiners.Com, DBA: The Reenactors INSURER C: 32408 Orange Blossom Dr DISURER D: INSURER E: _. _.-___._..— _ _ _.— .�_ Winchester CA 92596 INSURER F: rnVFRAr.FR CERTIFICATE NUMRFR-CL175527108 REVISION NUMBER: THIS I$ 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. ._._._........ ADDL'SOSR' POLICY EPF POLICY EIlP--._.- �..-. .__�—_..._._....._ LTR TYPEOF UI$URANCE POLICY NUMBER 11010 Y MMIDOIYYYY LMR$ X COMMERCIAL GENERAL MABWtt ! j -_EACH OCCURRENCE I$ 21000_,000 A CLAIMSMADE ' X OCCUR DAMAGE TO RENTED 1 PRE Is lEa occnrence�_E 300, 000 _ X RPG6071a 4/1/2017 . ._ ( 4/1/2019 MEDEXP(Am/.ono,N,$) 's 51000 .PERSONAL&ADV INJURY S 2 000,000 _ _._ _.. .___ _. -_._ GENLAGOREGATE UNTAPPLIES PER: GENERAL AGGRECATE X POLICY I. JECOT LOC !' PRODUCTS, COMPIOP AGG S 2,000,00 0 (OTHER. S AOTOMO6ILE LmBIIITY eawgeQntSINQUE IMI E - 1(Ee - My AUTO I BODILY INJURY (Po pmsm) E OWNED f SCHEDULED AUTOS BOOILYINNRY(Peram4^m) $ ._ NON-0WNEO ! PROPERTY DAMAGE ...� HIREDAUTOS AUTOS I $ UMBRELLA DAB OCCUR -,1 •\ V Vi e lI/( EACH OCCURRENCE 1$ --.. EXCESS IJAa CWMS.AMOE �e� AGGREGATE E 1 _ DEO I I RETENTON S ! b !WORI(ER$ C ERV ILI A IQNlUT ANOEMPLOYER$'LmBILRY �I `J -7777-7 OTH- _ $TATyT�.... E0. Y!N 'ANY PRCPRIETORIPARTNERIFJlECt1TIVE . � EL. EACH ACCIDENTOFFICEWMEMBER \{NandaWry EXCLUDED? IN/AI <(r.5 N NH)EL DISEASE EA EMPLOYEE $Ify a, daecrib¢ ON.,DESCRIPTION OF OPERATIONS pebwEl DISEASE POLICY LIMIT , § DESCRIPTION OF QPERADQNS I LQCAPON$ I VEHICLES (ACDRD 141. AddWonal RemalFp Stpadule, may p¢ etlatMdll mpo spate (¢ I¢quiredj The City of Santa Ana Parks, Recreation b Community Services Agency is included under the above policy as additonal insured with regards to Robert Broski Aka `Abraham Lineoln" participation as a reenactor effective 4/14/17 to 4/14/18. Proof Of Insurance. The City of Santa Ana Parks, Recreation & Services Agency 20 Civic Center Plaza M-23 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. icon SLeeves/FILLY ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS0251(2U1401)