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Liability Insurance Policy-Member Endorsement <br /> Special Event Liability Group Insurance Trust <br /> eventinsure.com <br /> This is to certify that the policy of insurance listed below has been issued and this endorsement adds the Named Insureds as Members for <br /> the event and dates indicated on this Member Endorsement. <br /> Notwithstanding any requirement,term or condition of any contract or other document with respect to which this endorsement may be <br /> issued or may pertain,the insurance afforded by the policy described herein is subject to all the terms,exclusions and conditions of such <br /> master policy. <br /> Producer <br /> Name:Hub International Insurance Services, Inc <br /> Mail Address:3000 Executive Parkway,#300 City:San Ramon State:CA Zip Code:94583 <br /> Phone#:(925)609-6500 <br /> Fax#:(925)609-6550 <br /> Email:specialevent@hubinternational.com <br /> Website:Hub International Insurance Services,Inc <br /> License State:CA License Number:0757776 <br /> First Named Insured/Member <br /> Name:Gabriela Pineault <br /> Mail Address:20107 Pintado City:Irvine State:California Zip Code:92618 <br /> Member Endorsement Number 24012363 <br /> Member Endorsement Effective Date 11/09/2024 <br /> Member Endorsement Expiration Date 11/10/2024 12:01 A.M.Standard Time at your <br /> Mailing Address. <br /> Event Description Dance Group or Solo Dancer <br /> Insurance Company Colony Insurance Company <br /> Master Policy Number 103 GL 0212472 01 <br /> Master Policy Effective Date 2024-01-01 <br /> Master Policy Expiration Date 2025-01-01 <br /> Endorsement Premium $ 40.00 <br /> Broker Fee 10.00 <br /> Processing Fee 15.00 <br /> State Tax 1.20 <br /> Stamping Fee 0.07 <br /> Total Cost $ 66.27 <br /> Member Endorsement Limits: <br /> Each Occurrence $ $1,000,000 <br /> Personal&Advertising Injury $1,000,000 <br /> General Aggregate $2,000,000 <br /> Products&Completed Operations $2,000,000 <br /> Damage to Premises Rented to You 1,000,000 <br /> Medical Payments 5,000 <br /> Liquor Liability Each Occurrence N/A <br /> If a Liquor Liability Each Occurrence limit is displayed,then Liquor Liability is subject to the General <br /> Aggregate Limit shown above. <br /> Liability Deductible $ 0 <br /> APPROVED <br /> By Cynthia Mora at 12:00 pm, Oct 30, 2024 <br />