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<br />Tori Pierson Date: 2022.011522.15
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<br />CERTIFICATE OF LIABILITY INSURANCE
<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(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsemen s .
<br />PRODUCER
<br />CONTACT
<br />Maury, Donnell & Parr
<br />24 Commerce St.
<br />Baltimore, MD 21202
<br />PHONE FAX
<br />Alc, IN Eat): (410) 685-4625 JAIC, Ni 685-3071
<br />E-MAIL
<br />SS
<br />INSURERS AFFORDING COVERAGE
<br />NAIC p
<br />INSURER A:Gfeat American Insurance Company#
<br />16691
<br />INSURED
<br />INSURER B
<br />INSURER C:
<br />Backhaus Dance
<br />PO BOX 5890
<br />Orange, CA 92863
<br />INSURER 0:
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NIIMRFR- REVISION NUMBER.
<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 />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY UP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />GLP3961460
<br />6/312022
<br />6/312023
<br />EACH OCCURRENCE
<br />1,000,000
<br />DAMAGE I RENTED
<br />PREMISES (Ed occurenc,l
<br />1,000,000
<br />NED EXP An one arson
<br />20,00D
<br />PERSONAL &ADV INJURY
<br />1,000,00D
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ °EET LOC
<br />GENERALAGGREGATE
<br />2,000,000
<br />GENL
<br />X
<br />PRODUCTS-COMPIOPAGG
<br />21000,000
<br />OTHER
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AlC1HEDU
<br />BODILY INUURY Per arson
<br />BODILY INJURY Per accident)
<br />gg
<br />PPeOFE tle , Ai
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEO I I RETENTION$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMWRp EXCLUDED?
<br />(Mantlstory In NH)
<br />H yes, describe under
<br />NIA
<br />PER OTH-
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYE
<br />E.L. DISEASE - POLICY LIMIT
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Abuse & Molestation
<br />X
<br />GLP3967460
<br />61312022
<br />61312023
<br />Each Abuse
<br />1,000,000
<br />A
<br />Abuse & Molestation
<br />X
<br />GLP3961460
<br />61312022
<br />613/2023
<br />Aggregate Limit
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached if more space Is required)
<br />The City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers are additional insured. Coverage is primary and
<br />non-contributory. 30 day prior written notice of cancellation is in favor of the City of Santa Ana, Risk Management, its officers, employees, agents,
<br />representatives, and volunteers.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROV"""""
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<br />AUTHORIZED REPRESENTATIVE ° T IRMEVVEDL MrRT'®BY:
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<br />AUUMU zo ttul olual ©1988-2015 ACORD C( W 11
<br />The ACORD name and logo are registered marks of ACORD
<br />
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