PROFESSIONAL ENTERTAINMENT (2) - Laserfiche WebLink

Home Browse Search

ACi `� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1 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(ies) 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 endomement(s). PRODUCER Blue Lion Insurance, LLC 10224 Airport Way, Ste C Snohomish WA 98296 NAME: Brian Roberts P ONE gQ0.665-5154 AIC No Ext: (AIC, No): 888-221-9537 ADDRESS: brian@binelionbrokers.com INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Mesa Underwriters Specialty INSURED Darrell Wagner dba Professional Entertainment - - PO BOX 78593 Seattle WA 98179 INSURERS: INSURERC: - -- -- -- -- -- -- INSURER D : INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. TNSF LTR TYPE OF INSURANCE Aunt INED MIVD POLICY NUMBER LIC (MMIDDIYYYY) (POLICY YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 2,000,000 DAMAGE TO REIT — PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one parson) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 A Y Y MP0002007001476 12/05/2017 12/05/2018 GEN'L x AGGREGATE LIMIT APPLIES PER POLICY ❑ PRO- ❑ JECT LOC GENERAL AGGREGATE 5 2,000,000 PRODUCTS - COMPIOP AGO $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY UUMBINLU 6INULE Lilyl I$ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per.oddent ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY (Per accident) $ S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB CLAIMS -MADE DED I RETENTIONS $ PORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN NY PROPRIETOR PARTNERIEXECUTIVE ❑ FFICEFUMEMBER EXCLUDED? NIA STATUTE E—FER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, adsorbs under EI 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) Certificate holder, its officers, agents, and employees are named as additional insured in rego General Liability per attached CG2015 11/88. .\L�,�0'� 10-day notice of cancellation for nonpayment. °O�4�. City of Santa Ana Aun: PRCSA 20 Civic Center Plaza M-23 Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE GrLxa RvExzrfs rnRPnPATInd All anhf—nc...... ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD