|
ACCIII 2i7®
<br />II CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDNYYY)
<br />04/0512018
<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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the
<br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER 818-836-5800
<br />Lockton Insurance Brokers, LLC 818-721-5800rrAMEle
<br />16633 Ventura Blvd., Ste. 1300
<br />ONTACT Tina Pastorius
<br />PAx
<br />o Ext: 818-836-5816 Alc No: 818-721 -5816
<br />A/C No,
<br />Encino, CA 91436
<br />Eool ESS: tpastorius@lockton.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICA
<br />NSURER A: New York Marine & General Insurance Co.
<br />16608
<br />INSURED LBI'Media, Inc.
<br />NSURER B:
<br />1845 Empire Avenue
<br />NSURER C',
<br />NSURER D:
<br />Burbank, CA 91504 N-2018-055
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIVVYV
<br />POLICY EXP
<br />MM/DD IYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE !6
<br />1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE x❑OCCUR
<br />❑
<br />❑
<br />PK201700012085
<br />11/01/17
<br />11/01/18
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100000
<br />MED EXP(Any one person)
<br />5,000
<br />PERSONAL& ADV INJURY
<br />1,000,000
<br />GENERAL AGGREGATE
<br />2,000,000
<br />GENT_ AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />2,000,000
<br />PRO-
<br />% POLICY JECT LOC
<br />LIABILITY
<br />❑
<br />❑
<br />AU201700014269
<br />11/01/17
<br />11/01/18(Ee
<br />COMBINED SINGLE LIMIT6
<br />accident)ANY
<br />1,0D0,000
<br />BODILY INJURY (Per person)
<br />AUTO
<br />Physical Damage
<br />AALL
<br />rMOBILE
<br />OWNED SCHEDULED
<br />AUTOS$1000
<br />Deductible
<br />Comprehensive
<br />BODILY INJURYAUTOS (Per accident)
<br />HIREDAUTOS X NON -OWNED
<br />AUTOS
<br />$100000IIISIon
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />A
<br />X
<br />UMBRELLA LIAa
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />❑
<br />❑
<br />UM201700006179
<br />11/01/17
<br />11/01/18
<br />EACH OCCURRENCE
<br />10,000,000
<br />AGGREGATE
<br />10,000,000
<br />DIED I % RETENTION$ 10000
<br />A
<br />ORKERS COMPENSATION
<br />FND EMPLOYERS' LIABILITY YIN
<br />NY PROPRIETOR/PARTNER/EXECUTIVE I
<br />OFFICE/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />Jf yes, desctlbe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />❑
<br />WC201800016600
<br />EVIDENCE ONLY
<br />03/04/18
<br />03/04/19
<br />'`>j
<br />X
<br />C STATU-
<br />ORY LIMITS
<br />OTH-
<br />ER
<br />E.L WACCIDENT
<br />1�000�QQQ
<br />i. ISEA;LCEA EMPLo . E
<br />1,000,000
<br />E.L. DISEASE -PO IMIT !6
<br />1,000,000
<br />�(h
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is d e`qN
<br />,°AS/-1�ROM
<br />RE: EVENT - CITY OF SANTA ANA CINCO DE MAYO FESTIVAL 2018 AND EVENT: DIA 10AM — 12NOON AT
<br />SANTA ANA PUBLIC LIBRARY, 26 CIVIC CENTER PLAZA, SANTA ANA, CA 92701
<br />The City of Santa Ana, Its officers, employees, agents, and representatives are included as an Addl#ail Insured. Includes 30-day notice of
<br />cancellation. Coverage is primary and non-contributory. Waiver of subrogation applies.
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PO BOX 1988, 1 SANTA ANA, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />/ {atho
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD
<br />
|