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/ <br />A� " CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DDIYYYY) <br />3(MM/DD5 <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 endorsement(s). <br />PRODUCER <br />Olivier VanDyk Insurance Agency, Inc <br />2780 44th St SW <br />Wyoming MI 49519 <br />CONTACT <br />NAME: Certificate Department <br />PHONE FAX <br />AIC No Ext : 616-454-0800 AIC No): 616-454-7100 <br />ADDRESS: certificates.sbu@ovdinsurance.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURERA: Hudson Excess Insurance Company <br />14484 <br />License#: 0007645 <br />INSURED ULTIATT-01 <br />Ultimate Entertainment LLC <br />INSURERB: National Union Fire Ins Co of <br />12104 Park St <br />INSURER C : <br />INSURER D : <br />Cerritos CA 90703 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1146112918 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 />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDIYYYY <br />POLICY EXP <br />MM/DDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />HBD 10057571 <br />9/5/2024 <br />9/5/2025 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />Fv� <br />CLAIMS -MADE OCCUR <br />DAMAGE <br />PREM SES� RENTEa o_cur ence <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 0 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />POLICY ❑ PRO- <br />JECT ❑ LOC <br />X <br />PRODUCTS - COMP/OP AGG <br />$ Included <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />L <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE ER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />N/A <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />B <br />Accident Medical Liability <br />SRG 0009162922 <br />9/4/2024 <br />9/4/2025 <br />Maximum Benefit <br />$25,000 <br />Ded <br />$250 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Event: Dia de IDS ninos / Dia de los libros <br />Event Location: 26 Civic Center Plaza Santa Ana, CA 92701 <br />Digitally signed <br />Tu Tran by Tu Tran <br />Nguyen <br />Nguyen°653 szo°aa' <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attention: Michelle Loera <br />AUTHORIZED REPRESENTATIVE <br />26 Civic Center Plaza <br />Santa Ana CA 92701 <br />.r (Zc <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />