|
BRAISTU-01 RFNAR
<br />'4` oizo CERTIFICATE OF LIABILITY INSURANCE
<br />DATEYYYY)
<br />4/212022/2025
<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 endorsements .
<br />PRODUCER License # OM10410
<br />Armstrong/Robitaille/Riegle Business and Insurance Solutions
<br />18575 Jamboree Rd, Ste 500
<br />Irvine, CA 92612-2545
<br />CONTACT
<br />NAME:
<br />HONNo, EXt : (949) 381-7700 n1c, No):(949 861-9429
<br />)
<br />E-MAIL alcom
<br />grou p•
<br />ADDRE, arrinfo@aleragroup.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A:Philadelphia Indemnity Ins Co
<br />18058
<br />INSURED
<br />INSURER B
<br />INSURER C
<br />BrainStorm Studios, LLC
<br />INSURER D
<br />42 Waterworks Way
<br />Irvine, CA 92618
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE Nl1MRFR7 RPVISInK1 MHMRFa-
<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 />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPITR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />PHPK2579553
<br />9/1/2024
<br />911/2025
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES E
<br />$ 100,000
<br />VIED EXP (Any oneperson)
<br />5,000
<br />PERSONAL & ADV INJURY
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY jE LOC
<br />GENERAL AGGREGATE
<br />33000,000
<br />PRODUCTS - COMP/OP AGG
<br />3,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />a accident)P
<br />$ 1,000,000
<br />BODILY INJURY Per erson
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PHPK2579553
<br />9/1/2024
<br />9/1/2025
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY AMAGE
<br />Per acciden tt
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PHUB873718
<br />9/1/2024
<br />9/1/2025
<br />AGGREGATE
<br />2,000,000
<br />DED I X I RETENTION$ 10,000
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRI ETC R/PARTNERIEXECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />N I A
<br />PER OTH-
<br />STATUTE E
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYE
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />A
<br />Abuse & Molestation
<br />PHPK2579553
<br />9/112024
<br />9/1/2025
<br />Each Conduct
<br />1,000,000
<br />A
<br />Abuse & Molestation
<br />PHPK2579553
<br />911/2024
<br />9/1/2025
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability
<br />arising out of work or operations performed by or on behalf of the Permittee including materials, parts, or equipment furnished in connection with such work
<br />or operations. Primary & Non -Contributory coverage and a Waiver of Subrogation applies to the General Liability policy per the attached forms.
<br />TuTran Digitally signed by APPROVED
<br />Tu Tran Nguyen
<br />Nguyen Date:2025.04.14 By Tu Tran Nguyen at 8:32 am, Apr 14, 2025
<br />08:32s9-07•00•
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Parks, Recreation,
<br />and Community Services Agency
<br />20 Civic Center Plaza, CA 92701, M-23 AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701\\J
<br />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|