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<br />Page 1 of 2 <br />Ejhjubmmz!tjhofe!cz! <br />Certificate of Insurance <br />Usbdz! <br />Usbdz!Kbdpct! <br />Ebuf;!3133/1:/3:! <br />Special Events <br />Kbdpct <br />27;24;64!.18(11( <br />Name Insured:Named Additional Insured: <br />Vyvyenne LuyenSANTA ANA CITY OF- INDEPENDENT CITIES <br />4255 Campus Dr. Unit 6566RISK MANAGEMENT (SPECIAL EVENT) <br />Irvine, Ca 9261620 Civic Center Plaza M-28 <br />SANTA ANA,CA 92701 <br />Certificate TermCertificate #COSA21-0057 <br />10/1/2022 to 10/1/2022 <br />Coverage CITY OF SANTA ANA Special Event Policy Company: Houston Casualty Company <br />Commercial General Liability Per Master Policy#H21TU00001 <br />Master Policy Effective Date:11/1/2021 to expiration <br />Limits <br />$2,000,000GeneralAggregate/$1,000,000EachOccurrence/$1,000,000Products&Completedoperations/ <br />$1,000,000 Personal & Advertising Injury/$300,000 Damage to Rented Premises/ Medical Payments Excluded <br />Deductibles <br />$100.00Premium (Fully Earned) <br />Taxes (Fully Earned) <br />$3.25 <br />) <br />$40.00Certificate Fee (Fully Earned <br />TRIA <br />Total Amount <br />$143.25 <br />Terms & <br />1. Premium and All fees are fully earned. No Cancellations Allowed. <br />Conditions <br />2. Hazard Class: 2 <br />3. Event Location: Rosita Park <br />4. Event Description: Translator for Mid-Autumn Festival <br />5. Total Attendance: 200 Vendors: None <br />6. Attachments: Limited Contractual Endt., Designated Premises, Classification Limitation Endt. <br />7. Event Date: 10/1/2022 to 10/1/2022 <br />8. NO LIQUOR LIABILITY COVERAGE PROVIDED. <br />9.THISPOLICYDOESNOTPROVIDECOVERAGEFORBODILYINJURYTOPERFORMERSOR <br />PARTICIPANTS AS A RESULT OF THEIR PARTICIPATION. <br />Department Parks and Recreation <br />Exclusions <br />Assault&Battery;TotalPollution;Asbestos;LeadContamination;Animals;Nuclear;EmploymentRelated <br />Practices;LiquorLiability;CrossSuits;IndependentContractors;CommunicableDisease;Subsidence;Non- <br />Owned/HiredAuto;NewEntities;UnscheduledactivitiesorEvents;AthleticParticipants;FireworksandExplosives; <br />PunitiveDamages;ProfessionalLiability;VoluntaryLabor(Foracompletelistoftheforms,conditionsand <br />exclusions of the policy, refer to Master Policy.) <br />Theinsuranceaffordedunderthespecifiedpolicyaboveissubjecttoallterms,conditions,andexclusionsofsuch <br />policy.(Acopyofthepolicyisavailableuponwrittenrequest.)Thiscoverageappliesonlytothecontractororevent <br />noted above and does not extend to any other activities or work performed by the holder. <br />MERRIWETHER&WILLIAMSINSURANCESERVICES,Inc.shouldbenotifiedatonceofanyclaimarising <br />fromyouroperation.Call1-800-420-0555andaclaimsrepresentativewillassistyouinthereportingprocess. <br />f <br />Coverageisprimaryandnotcontributingwithanyinsurancemaintainedbytheabovepublicentitiy.Thelimitso <br />insuranceapplytoeachevent.Ifmorethanonenamedinsuredforanyoneeventitwillnotincreasethetotallimits <br />of liability available for that event. <br />44 Montgomery St., Ste. 940 San Francisco, CA 94104 800.420.0555 415.986.3999 fax 415.986.4421 License# 0C01378 <br />www.imwis.com <br /> <br />