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N-2018-083
<br />ACG?R®e
<br />16 . CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDNYYY)
<br />1 04/05/2018
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 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(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT; If the certificate 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 />car8ficate holder In lieu of such endorsement(s).
<br />PRODUCER 818-836-5800
<br />Lockton Insurance Brokers, LLC $18-7121.5800
<br />16633 Ventura Blvd., Ste. 1300
<br />Encino, CA91436
<br />ONTACT Tina Pastorius
<br />HONE —'- FAx
<br />AIc No Enh 818.836-B818 rvc No: 818-721.5818
<br />MAIL ss, tpastorius(filockton.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICe
<br />URER A: New York Marine & General Insurance Co.
<br />16608
<br />INSURED LBI Media, Inc,
<br />B1846
<br />Empire Avenue
<br />URERC:
<br />Burbank, CA 91504
<br />URERD:
<br />NSURERE: _ __
<br />INSURER F:
<br />UUVFRAGE,S C;eKHFIOA It NUMBER: REVLCNYNNUMRER-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING 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 />INSR
<br />I, IT
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />BURR
<br />WVO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM)DDIYY
<br />POLICY 9XP
<br />MMIODIYYYY
<br />LIMITS
<br />GENERAL
<br />LIABILITY
<br />EACH OCCURRENCE
<br />1,000,000
<br />A
<br />IX
<br />COMMERCIAL GENERAL UASIUTY
<br />CLAIMS -MADE OCCUR
<br />❑
<br />❑
<br />PK201700012086
<br />11/01/17
<br />11/01/18
<br />OAMAGETO RENTED
<br />PREMIS S Ep pcarrenca
<br />100,000
<br />MED EXP(Any orro pareon)
<br />5.000
<br />PERSONAL &ADV INJURY
<br />11000,000
<br />GENERAL AGGREGATE
<br />2,000,000
<br />GEML AGGREGATE U MIT APPLIES PER:
<br />PROOUCTS-COMPIOPAGG
<br />2,000000
<br />PRO,
<br />% POLICY JECT M LOC
<br />MOBILELIABILITYCOMBINED
<br />❑
<br />❑
<br />AU201700014269
<br />11/01/17
<br />11/01/18
<br />SINGLE LIMIT
<br />(Ea aefdem)ANYAUTOPhysical
<br />1,00E,00E
<br />BODILY INJURY (Per person)AWNEDN
<br />Damage
<br />FAALULOSSCHEDULED
<br />AUTOS
<br />DeductibleBODILY
<br />$1000 Comprehensive
<br />INJURY (Per acdtlenTO0
<br />HIREDAUTOSNONANMED
<br />AUTOS
<br />$1000 Collision
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />A
<br />X
<br />UMBRELLAUAS
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />❑
<br />❑
<br />UM201700006179
<br />11/01/17
<br />11/01118
<br />EACH OCCURRENCE
<br />10,000,00E
<br />AGGREGATE
<br />10,000,00E
<br />DED I % I 0. TENTION 1 10000
<br />A)FFICEIMEMSER
<br />RIVERS NOEMPLDYERS'ERS'LIABILITY YIN
<br />NY PROPRIETOR/PARTNERI EXECUTIVE
<br />EXCLUDED?
<br />Mandatory In NH)
<br />I yes, describe under
<br />WA
<br />❑
<br />WC201800016600
<br />EVIDENCE ONLY
<br />0310411E
<br />03/04119
<br />_
<br />%
<br />STATU.
<br />ORY LIMITS
<br />OTH-
<br />ER
<br />E. HACCIDENT
<br />1,000,000
<br />DISEASE -EA EMPLo E
<br />1,110,01E
<br />E.L.DISEASE -PO r3 MIT
<br />t 1,000,00E
<br />ESCRIPTION OF OPERATIONS below
<br />'QI�
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE$(Attach ACORD 101, Additional Remarks Schedule, Ir mom spa aa le a\Q1. @,'-
<br />RE: EVENT - CITY OF SANTA ANA CINCO DE MAYO FESTIVAL 2018 AND EVENT: OIA 8 U.KP FROM 1EAM—12NOON AT
<br />ANTA ANA PUBLIC LIBRARY, 26 CIVIC CENTER PLAZA, SANTA ANA, CA 92701
<br />he City of Santa Ana, Its officers, employees, agents, and representatives are Included as an Add4l Insured. Includes 30-day notice of
<br />ancellation. Coverage Is primary and non-contributory. Waiver of subrogation applies.
<br />CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />PO BOX 1968, M-16, SANTA ANA, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />[!` a J cmt[f4iw
<br />©1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD
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