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ACORO® CERTIFICATE OF LIABILITY INSURANCE �►'� DATE,MMIDDIYYVY) 12/7/2017 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 ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, 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 CONTACT NAME: Brian Roberts Blue Lion Insurance, LLC PHONE 800-665-5154 888-221-9537 AIC, No, Ext : 10224 Airport Way, Ste C g'C SS: Brian©bluelionbrokers.com INSURERS) AFFORDING COVERAGE NAIC p Snohomish WA 98296 INSURERA: Mesa Underwriters Specialty INSURED INSURER B Darrell Wagner dba Professional Entertainment INSURERC: PO BOX 78593 INSURER D : INSURER E : Seattle WA 98178 INSURER F : COVERAGES CERTIFICATE NUMBER: RPWRION NUMRFP- THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE INSD MD POLICY NUMBER (MMIDDrNYY) (MMIDDIVYVY) LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR EACHOCCURRENCE Is 2,000,000 PREMISES (Ee occurrence) 1 $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 A Y Y MP0002007001476 12/05/2017 12/03/2018 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY F—]JECT �LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO s 2,000,000 $ OTHER AUTOMOBILE LIABILITY (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY Per accitleni ( ) $ (Per eccidenq $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CIAIMS-MADE OED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below Abuse and Molestation Y Y MP0002007001476 12/05/2017 12/05/2018 Occurence Aggregate 100,000 300,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary with respect to insurance or self-insurance programs maintained by the city; and (c) contain standard separation of insureds provisions. 6101 ° 10-dav notice of cancellation for nonnavment.�e��iQ l City of Santa Ana Attn: PRCSA 20 Civic Center Plaza M-23 Santa Ana, CA 92701 SHOULD ANY OF THE ACCORDANCE TE W TATE ABOVE POLI�CYF&E, Eff E VERED INCANCELLED BEFORE Q ITHORIZED REPRESENTATIVE 13ri&- Ralyer'f5 ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD