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HomeMy WebLinkAboutEMERALD ISLE ENTERTAINMENT, INC. DBA THE BUBBLE ROLLERS 1 -2015City of Santa A, i Clerk of the COON AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with -- COTC Office Use only f N-2015-169 -A �_ `c "I, ,/,/�� No. was completed on ) f jq jGCj5 and final payment has been made. (List all amendments. Use space below if needed.) Department: r t Q3A Phone/Ext.: Signature: i Date: q�1al�ota Revised 10-31-12 INSURANCE ON FILE. CORK MAY PROCEED � �NtOUNTIL INSURANCE EXPIRES �y1. CLERK OF CCIL AMUSEMENTDEVICE PROVIDER AGREEMENT DATF p q Zp15 THIS AGREEMENT is made and entered into this 8th day of September, 2015, by and A between Emerald Isle Entertainment, Inc. dba The Bubble Rollers (`"Provider") and the City of d Santa Ana, a charter city and municipal corporation organized and existing under the u Constitution and laws of the State of California ("City ). a � RECITALS A. The City desires to retain a specialized amusement device provider to supply a "bubble roller" water ball attraction for the City's Fiestas Patrias event to be held on September 12 and 13, 2015, in Downtown Santa Ana ("Event")i B. Provider represents that Provider is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in its field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Provider shall furnish a complete bubble roller water ball attraction for the Event, including without limitation, security and trained operators, as more specifically described on Exhibit A. City shall provide access to water and electricity and a suitable area for the attraction and storage. City grants Provider the right to enter its property for the purpose of delivery, set- up, and pick-up. The attraction shall be set-up and ready for operation by noon on September 12 and shall be disassembled and removed immediately at the conclusion of the Event, 2. COMPENSATION The cost to participate in the attraction shall be established by mutual agreement of the parties and paid by attendees to the Event. Provider shall pay to the City 7.5% of the gross proceeds collected by Provider during the Event. Such compensation shall be due to the City within 10 days following conclusion of the Event. Individual participation in the attraction shall be subject to Provider's rules and regulations. Total revenue to Provider under this Agreement shall not exceed $25,000. 3. TERM This term of this Agreement shall commence on September 12, 2015 and end on September 14, 2015, unless terminated earlier in accordance with Section 11 below. 4. INDEPENDENT CONTRACTOR Provider shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Provider shall maintain commercial general liability insurance which -shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Provider's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence and $2,000,000 in the aggregate, including coverage of sexual misconduct. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self- insurance programs maintained by the City; and (c) contain standard separation of insured's provisions. b. Worker's Compensation Insurance. In accordance with the provisions of California state law, Provider, if Provider has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work wider this Agreement, Provider agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. c. The following requirements apply to the insurance to be provided by Provider pursuant to this section: (i) Provider shalt maintain all insurance required above in full force and effect for the entire period covered by this Agreement. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City. (ii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. d. If Provider fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Provider's right to be paid for its time and materials expended prior to notification of termination. Provider waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Provider agrees to and shall defend, indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the direct or indirect operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement. The Provider further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party asserting personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arising by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFLICT OF INTEREST Provider covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 8. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax (714) 647-6956 With copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 26 Civic Center Plaza (M-75) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: Emerald Isle Entertainment, Inc. 1402 Cloyden Rooad Santa Ana, CA 92705 Attn: Graham Hayden A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 9. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider, The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 10. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. 11. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. 12. RECORDS Provider shall keep records and invoices in connection with the work to be performed under this Agreement. Provider shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to City under this Agreement. Provider shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to City under this Agreement. 13. NONDISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, II termination or other employment related activities or in connection with any activities under this Agreement. 14. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 15. LICENSES Provider shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa. Ana and all other governmental agencies. 16. SEVERABI]LITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the parties hereunder. 17. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 18. AUTHORITY The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said parties and that be so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Maria D. Huizar Clerk of the Council CITY OF SANTA ANA David Cavazos City Manager signatures continue on following page APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney Johiot Funk Assistant City Attorney RECOMMENDED FOR APPROVAL: GERARDO MOUET Executive Director of Parks, Recreation grid Community Services Agency PROVIDER: EMERALD ISLE ENTERTAINMENT, INC. dba THE BUBBLE ROLLERS • � i EXHIBIT A August 260 2015 Attn: Rodolfo Hernandez, City Of Santa Arta Re: Fiesta Partrias Event on Sept 12"113" 2015 Our proposal is detailed below. It is based on operation for approx. 8-10 hours on Saturday September 12'" 2015 and approx. 8-9hrs on Sunday Sept-13'" 2015 for Fiesta Partrias in Downtown Santa Ana. We will set up on Saturday Sept 12'" 2015 between 6am - 1 lam with completion on Saturday Sept 12'h 2015 before the event and be ready to Roll at 12pm. Our proposal includes Bubble Roller'"" Staff member(s) to setup and run the attraction including transportation of staff and equipment to/from venue. We will need access to electric power (at least 2 X 110v 20A outlets) before/during and after the vent. We will also need access to water within 100ft of setup via a fire hydrant. We can supply equipment but need permission and access to the Hydrant. The water will be drained to the common area after the event on Sunday night. We provide insurance with an additional Insured endorsement but any additional insurance requirements, waivers of subrogation, etc. or additional limits required above our policy limits ($1million):by the City will result in extra charges. We can include an additional insured certificate at no extra charge, Proposal: Set up and fully operate Bubble Roller`"" attraction is suitable area by kids zone for entire duration of the event. Includes our inflatable Pool, Bubble RollerT" Bubbles and all necessary equipment for operating the attraction. The area must be flat/level and in the vicinity that we discussed and at least 30ft x 50ft in size. Weight limit for Bubble Roller is approx. 170lbs but this may be amended by our crew depending on circumstances. Bubble Rollers to provide security. City Of Santa Ana to provide space for storing Trailer. The Bubble Roller-rm will pay to The City of Santa Ana 7.5% of gross proceeds collected during the event within 7 days of event ending due to providing our own security and purchasing a primary/non-contributory endorsement for our liability insurance. Includes — 3-4 professional staff members to setup and manage the attraction. They will wear Bubble Rollers attire. • Transit of equipment and Staff to location Full Insurance but any increases in limits or special endorsements will result in extra charge. Not Included in above: Access to Water and electricity as mentioned above - o'n . h1C4RCY CERTIFICATE OF LIABILITY INSURANCE �'"��� DATE(MMIDOIYVVV) 09/02/2015 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME Northeast Insurance Center P O Box 151868 PHONE 1: (239) 244-9777 a/c No : (860) 627-8695 DAIL ricm@neinscentercom INSURERS AFFORDING COVERAGE NAIC N Cape Coral, FL 33915 INSURER A: UNITED STATES FIRE INSURANCE CO 21113 Phone (239) 244-9777 Fax (860) 627-8695 INSURED INSURER B: INSURERC: EMERALD ISLE ENTERTAINMENT, INC DBA THE BUBBLE ROLLERS and INSURER D: 1402 CLOYDEN ROAD R E: NSURER: SANTA ANA CA 92705 _SUREF COVERAGES CERTIFICATE NUMBER: USP173967 REVISION NUMBER: THIS IS 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 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, ILSRTYPE OF ADDLSUBR INSR WVD POLICY NUMBER POLICY SEE MMIDDIYYYY POLICY EXP MMIDDIYYYV LIMITS _ d COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE Eeoocurrence $ 300,000.00 CLAIMS -MADE V OCCUR MED EXP(Any one person $ 5,000.00 A SRPGP-101-0414 03/02/2015 03/02/2016 — PERSONAL &ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- -_ POLICY — JECT — LOC GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS -COMPIOPAGG $ 2,000,000.00 $ OTHER AUTOMOBILE LIABILITY COMBINED SING LE LIMIT Ea accident S BODILY INJURY (Per person) $ ANY AUTO — ALL OWNED -- SCHEDULED AUTOS AUTOS — BODILY INJURY (Per accident $ _ HIRED AUTOS - NON -OWNED — AUTOS PROPERTY DAMAGE Per accident) $ UMBRELLA LIAB OCCUR — EXCESS LIAB J. CLAIMS -MADE ,fr��``e •' \201 `I EACH OCCURRENCE $ AGGREGATE $ _ DIED — RETENTION $ $ Z WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y/N ANY OFFICER/MEMBER EXCLUDED? OFFICER/MEMBER (MandR/MEory BERNH) E RTNER/EXECUTIV If yes, describe under DESCRIPTION OF OPERATIONS below NIA v1a �,\ hI /+ G `I e,rjas rry — PER — OTH- — STATUTE —ER E.L. E.L. DSEASECEDA EMPLOYE $ E. L. DISEASE -POLICY LIMIT $ A DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD tat, Additional Remarks Schedule, If more space is required) MOBILE BUBBLE ROLLERS, ZORB BALLS, SUMO SUITS, infiatables, mobile laser tag, mobile indoor airsoft range Certificate holder (landlord), it officers, employees, agents and representative are listed as additional insured in regards to general liability, within respects to the named insured operation. Insurance is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: PRCSA ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza M 23 AUTHORIZED REPRESENTATIVE Santa Ana, California 92701--- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) OF The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Policy Number: SRPG-101-0415/USP173967 Insured : Emerald Isle Entertainment Inc dba The Bubble Rollers and Task Laser Force This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ns The City of Santa Ana, its officers Attn: PRCSA 20 Civic Center Plaza M 23 Santa Ana, CA 92701 SCHEDULE employees, agents, and representatives Section RI - WHO IS AN INSURED is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions of the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. GSP�I P� CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 EMERAA OP ID: KC ;�® n CERTIFICATE OF LIABILITY INSURANCE DA09/02/2016Y) a9foz/zo1 s 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must 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 endorsoment(s). PRODUCER NAAMMEAC7 Craig W. Schell, Pres. Scholl & Associates insurance ---_—" - -- - -- Appency - License #OE75909 n"c°Ne .Exn.658.541.7177 _ _ FAX 85$-541.7821 _ 7801 Raytheon Road E-MAL crai schBllassociates.net San Dieao. CA 92111 . ADDRESS: 9@ W SURER A..�a INSURED Emerald Isle Entertainment Inc INSURERS: 915S500E#110 American Fork, UT 84003 Nsuasac_ - IINSURER F: I r nWIZOAnPC r=PTIPICATP MI IMRPR- RPVISIr)N NUMRER- THIS IS 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 NMICH 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-- - _ - --- -- -AD UBR.----POLIOV EFF P LICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDII•YYY MMIDD/YYYY --' -- — -- LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ —_. _ DA Ati"tAETURE, a CLAIMS -MADE OCCUR PREMISES {Ea oC::atatwe) S ,,, MF,D EXP(Any one Earean) $ PERSONAL&ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY PRO- JECT LOG PRODUCTS-COMPO AGG S ����-' OTHER: $ ' M. AUTOMOBILE LIABILITY 'Qj BINED SINGLE I.I MIT $ TEa ampenq ANY AUTO - UOGLY INJURY (Per person) S _ AOVdNED SCHEDULED �rL' BODILY INJURY (Ps[alc:denU $ VUTOS TOS AUTOa r _. AUTOS V �`*• PROPERTY AGE $ _HIRED AUTOS AUrosNONJOJVRlEO _..—AU'r05 � (P SPor acciden0_ �d� �V UMBRELLA LIAR 'OCCUR 4 EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ OED RETENTION$ $ WORKERS COMPENSATION PER TH- J( STATUTE ER AND EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 9006057-15 02/09/2015 02/09/2016 ,. E,L. EACH ACCIDENT _ __$ 1_,0.00,0.00 OFFICERIMEMBER EXCLUDED? V_I NIA (Mandatory in NH) EL. DISEASE -EA LMPLOYEE:S 1,000,000 If yes, 'swipe under DESCRIPTION OF OPERA7IONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS t LOCATIONS i VEHICLES (ACORD 101, AddlBartal Remarks S.heduie, may be attaclerd If mam space is required) CITYSA4 City of Santa Ana PRCSA 20 Civic Center Plaza PO Box 1988 M-16 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. AUTHORIZED REPRESENTATIVE n 949R-7n1d ARr1Rn CORPr)RATION_ All rights reserved ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INSURANCE FINANCIAL PACIFIC INSURANCE COMPANY ® ALLSTATE INSURANCE COMPANY ❑ ALLSTATE INDEMNITY COMPANYALLSTATE TEXAS LLOYD'S THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, CERTIFICATE HOLDER NAMED INSURED Name and Address of Party to Whom this Certificate is Issued Name and Address of Insured Emerald Isle Entertainment DBA Bubble Rollers 1402 Cloyden Rd Santa Ana, Ca 92705 This is to certify that policies of insurance listed below have been issued to the insured named above subject to the expiration dale indicated below, 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. TYPE OF INSURANCE AND LIMITS Policy 648139975 Exp 02/04/2016 Amount LIABILITY AND MEDICAL EXPENSES LIMIT $ 1,000,000 per Occurrence FIRE LEGAL LIABILITY LIMIT $ MEDICAL EXPENSES LIMIT $ WORKERS' COMPENSATIONS & Policy EMPLOYER' LIABILITY Number Effective Expiration Date Date Coverage Limits WORKERS' COMPENSATION STATUTORY —applies only in the following slates: EMPLOYERS' LIABILITY BODILY INJURY BY ACCIDENT $ EACH ACCIDENT BODILY INJURY BY DISEASE $ EACH EMPLOYEE BODILY INJURY BY DISEASE $ POLICY LIMIT AUTOMOBILE LIABILITY Expiration Coverage Basis Limits ❑ ANY AUTO EJ OWNED AUTOS © HIRED AUTOS ❑ ❑ SPECIFIED AUTOS NON -OWNED AUTOS _ OWNED PRIVATE PASSENGER AUTOS ❑ OWNED AUTOS OTHER THAN PRIVATE PASSENGER Combined Single Limit of Liability BODILY INJURY& PROPERTY DAMAGE $1,000,000 EACH ACCIDENT Split Liability Limits Bodily Injury Property Damage Each $ IPERSON $ $ I ACCIDENT UMBRELLA LIABILITY Policy Number Effective Expiration Date Date EACH OCCURRENCE GENERAL AGGREGATE PRODUCTS —COMPLETED OPERATIONS AGGREGATE OTHER(Show Policy type of Policy) Number Effective Expiration Date Date CANCELLATION 30 DAYS NOTICE AGENT CHUCK ALLAN Date 02/04/2015 Authorized Representative Should any of the above described policies be cancelled before the expiration date, the issuing company will endeavor to mail within the number of days entered above, written notice to the certificate holder named above. But failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. Rev\PiVtl ��,�� .\\via, V,��Jr