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HomeMy WebLinkAboutEMERALD ISLE ENTERTAINMENT, INC. DBA THE BUBBLE ROLLERS 2-2015City of Santa A Clerk of the Coun�l AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. COTC Office Use Only The agreement with �L a,2,2 r�a� N-2015-169 No. was completed on j ( Ig I&) ti -7) and final payment has been made. (List all amendments. Use space below if needed.) Department: r ZV SA Phone/Ext.: gQWA Signature: (�/'�; p/�j' 2�/ Date: "Il)a` on Revised 10-31-12 INSURANCE. ON VILE WORK MAY pROCEED UNTIL INSURANCE EXPIRES .9 � Qom✓ - L. ERRKK OFF COUNCIL DATE: 4 V5 AMUSEMENT DEVICE PROVIDER AGREEMENT W2MA 69 U THIS AGREEMENT is made and entered into this 10 day of October, 2015, by and rn between Emerald Isle Entertaimnent, Inc. dba The Bubble Rollers ("Provider") and the City of aSanta Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). ORECITALS A. The City desires to retain a specialized amusement device provider to supply a "bubble roller" water ball attraction for the City's Sunday on Main Open Street (SOMOS) event to be held on November 8, 2015, in Santa Ana (`Event"). B. Provider represents that Provider is able and willing to provide such services to the City, C. In undertaking the performance of this Agreement, Provider represents that it is Icnowledgeable in its field and that any services performed by Provider tinder this Agreement will be performed in compliance with such standards as may reasonably be expected. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Provider shall furnish a complete bubble roller water ball attraction for the Event, including without limitation, security and trained operators, as more specifically described on Exhibit A. City shall provide access to water and electricity and a suitable area for the attraction and storage. City grants Provider the right to enter its property for the purpose of delivery, set- m and pick-up. The attraction shall be set-up and ready for operation by 9:00 am on November 8", and shall be disassembled and removed immediately at the conclusion of the Event. 2. COMPENSATION a. City agrees to pay, and Provider agrees to accept as total payment for its services the amount of Ono, Thousand Seven Hundred and Fifty Dollars. (1,750.00). The cost is identified in Exhibit A, attached hereto and incorporated by reference. b. Payment by City shall be made within thirty (30) days following receipt of proper "invoice evidencing work pedbrined, subject to the City's accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by the City. 3. TERM This term of this Agreement shall commence on November 8, 2015 and end on November 9, 2015, unless terminated earlier in accordance with Section 11 below. Page 1 of 6 4. INDEPENDENT CONTRACTOR Provider shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City, 5. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Viability Insurance. Provider shall maintain commercial general liability insurance which shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Provider's operations in the performance of this Agreement, including, without limitation, acts involving vehicles, The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property dannage, in the total amount of $1,000,000 per occurrence and $2,000,000 in the aggregate, including coverage of sexual misconduct. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self insurance programs maintained by the City; and (c) contain standard separation of insured's provisions. b. Worker's Compensation Insurance. In accordance with the provisions of California state law, Provider, if Provider has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Provider agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. e, The following requirements apply to the insurance to be provided by Provider pursuant to this section: (i) Provider shall maintain all insurance required above in fall force and effect for the entire period covered by this Agreement, Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in. form by the City. Page 2 of 6 (ii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. d. If Provider fails or refuses to produce or maintain the insurance required by this section or fails or refiises to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith tenninate this Agreement. Such termination shall not affect Provider's right to be paid for its time and materials expended prior to notification of termination, Provider waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Provider agrees to and shall defend, indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the direct or indirect operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement. The Provider further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party asserting personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arising by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. CONFLICT OF INTEREST Provider covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. g. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the Cotuicil City of Santa, Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax (714) 647-6956 Page 3 of 6 With copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 26 Civic Center Plaza (M-75) P,O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: Emerald Isle Entertainment, Inc. 1402 Cloyden Rooad Santa Ana, CA 92705 Attn: Graham Hayden A party may change its address by giving notice in writing to the other party. Thereafter, any cormrranication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above, If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 9. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement' between the City and Provider regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 10. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. 11. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective dale of termination, Page 4 of 6 12. RECORDS Provider shall keep records and invoices in connection with the work to be performed Linder this Agreement. Provider shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum periodof three (3) years, or for any longer period required by law, from the date of final payment to City under this Agreement. Provider shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to City under this Agreement. 13. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or in connection with any activities colder this Agreement. 14. JURISDICTION — VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement, 15. LICENSES Provider shall, throughout the terra of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. 16, SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections containedin this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the parties hereunder, 17. EXHIBITS All Exhibits referenced herein and attached hereto .shall be incorporated as if fully set forth in the body of this Agreement. Page 5 of 6 18. AUTHORITY The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said parties and that he so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: MA] IA D. HUILAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALII0 City Attorney By: �- J IN M. FUND Assistant City Attorney RECOMMENDED FOR APPROVAL: GERARDO MOUET Executive Director of Parl , Recreation and Cornrnunit Services Agency CITY OF SANTA ANA DAVID CAVAZOS City Manager PROVIDER: EMERALD ISLE :ENTEKrAINMENT, INC. dba THE BABBLE ROLLERS By - G HAM HAS, EN Aor? Page 6 of 6 Exhibit A SCOPE OF SERVICES VENDOR INFORMATION: Emerald Isle Entertainment dba The Bubble Rollers EVENT: SOMOS 2015 SERVICE DATE(S): November 8, 2015 COMPENSATION DUE TO THE VENDOR: $1,750 DESCRIPTION: "_ 5 Bubble Rollers will provide a 23ft X 1711t or similar poolA Bubble Roller Balls and all necessary equipment for/Event on Sunday, November 8th, 2015 at Main Street, Santa Ana, Ca. from 09:00am to 2:00pm. Bubble Rollers will provide 2-3 staff members to setup and run the event. A` CERTIFICATE i1PP11 G CERTIFICATE ®F 1 LIABILITY ITY INSURANCE ACE DAT09/02/DI15 ., 1— L,M® L IYN7V R/1A\41G �rrr' 09/02I2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(1es) must be endorsed. If SUBROGATION IS WAIVED, subject to _ the terms and conditions Of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder In lieu of such andorsoment(s). _— ---.— PRODUCER Northeast insurance Center AI �sEUO:_L239 L_9-7._7 .._._._.-._-._._._.._.._...1.1FaA% P O Box 151886 � ncmCglnainecontaccom _ Cape Coral, FL 33915 _ _INSURERIS_LAFFOROING COVERAGE Phone (239) 244-9777 Fax (860) 627-8695 INSURERA: UNITED STATES FIRE INSURANCE CO _NAIOIi 21113 INSURED INSURERS: jNLLLRER EMERALD ISLE ENTERTAINMENT, INC DBA THE BUBBLE ROLLERS arid INSURER o 1402 CLOYDEN ROAD INSUfIE- SANTA ANA CA 92705 _ INSURER F: __ COVERAGES ICATE N CERTIFUMBER USP173967 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ---------------------�_- --------------- ADDL tlDk -' .__.. _..._. POLICY E F ppLICY E%P VIA_ _TYPE OF INSURANCE _ H Wp .._._._... POLICY N MHER l pp yx�yi MMIDD/ EXP _ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000, 00 CLAIMS -MADE IV OCCUR DAMAGE TO RENTED REMISES(Eaoccurrence S 300,000.00 MED EL (Any one erep on $ 5.000.00 A — "`-`" '"""_ — SRPGP-101-0414 03/0212015 03/02/2018 PERSONAL snnv INJURY $ 1,000,000.00 GEN'L AGGREGATE LI MIT APPLIES P E R: GENERAL AGGREGATE $ 2,000,000.00 POLICY JECOT --- LOG PRODUCTS - COMPIOP ADD s 2,000,000, 00 --- OTHER ---- S — AUTOMOBILELIABIUIFY COMBINEDSINGLE LIMIT Ee eccldenl ^� S____ BODILY INJURY IParpersan) S ANY AUTO -- ALL OWNED — SCHEDULED — AUTOS — AUTOS BODILY IN (Pnr accident ) S — --. NONOWNED hIIREDAUTOS _: AUTOS PROPERTY DAMAGE yPer ecclJonll__ — S �1 S UMBRELLA LIAB OCCUR EXCESS LIAB I CLAIMS.MADE U` �iJsJ�U vie \I EACH OCCURRENCE S AGGREGATE DEO_.i RETENTIONS R_ WORKERS COMPENSATION AND EMPLOYERS' LIASILITY YIN _ _______ __ a� _ ""' PER -- _IATUTE - ANY PROPRIETOWPARTNERIEXECUTIV �v RIMEMBER EXCWDED4 NIA `I AA W rYY�"• , E.L, EACH ACCIDENTOFFIC &L DIf rwYTsE_ ry in NH)c yes, describe underDESCRIPTIONOFOPERAHONEanew J,\V1G ��I l?" EL. DI3[ASC--POLICY .. {(�� 1.._._.�_�_ A DaSCRIPTIpN OF OPERATION8I LOCATIONSIVENICLSS (gileah RCORD tat, Additional Remarks 9Aledula, it more apeoe la required) MOBILE BUBBLE ROLLERS, ZORB BALLS, SUMO SUITS, Inflalables, mobile laser tag, mobile Indoor almoft range Certificate holder (landlord), It officers, employees, agents and representative are listed as additional insured In regards to general liability, within respects to the named insured operation. Insurance is p1lmary and non-contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ASOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City Of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: PRCSA ACCORDANCE WITH THE POLICY PROVISIONS, 20 Civic Center plaza M 23 gUTHtlftREO REPRESENTATIVE �J Santa Ana, California 92701_'=-^^-- ----- ©1988.2014 ACORD CORPORATION, All rights reserved. ACORD 25 (2014101) OF The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ORGANIZATION Policy Number: SRPG-101-0416/USP173967 Insured : Emerald Isle Entertainment Inc dba The Bubble Rollers and Task Laser Force This endorsement modifies insurance provided under the following: COMMERCIAL. GENERAL LIABILITY COVERAGE PART SCHEDULE The City of Santa Ana, its officers, employees, agents, and representatives Attn: PRCSA 20 Civic Center Plaza M 23 Santa Ana, CA 92701 Section II - WHO IS AN INSURED is amended to include as an insured the person(s) or organizations) shown in the Schedule, but only with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by your acts or omissions of the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. 0d 1.' ?li:Q05 CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 fC EMERA-1 OP 1D: KO AC'c��tcr CERTIFICATE OF LIABILITY INSURANCE DA09/0212015Y) 09/tl212016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate dose not confer rights to the certificate holder In lieu of such ondorsomen s . , PRODUCER NAME CT Craig W.,Schell, Pros. Scholl B Associates Insurance PHCNe" 868 641.7177 _-- FAX Apqenc - License #OE75909 LAIC N9, Eatl .... 01c,No): 868.641 W7821 7801 Raytheon RDad ADDRESS'. Qen r,I_X1 rA co,H, AODRa3s: craig�schellaaeociatas,net INSURED Soo 84003 a: INSURER e : INSURE%Fi PAWCOAn¢a COPTIPIr..ATP NIIMRPR• RFVISION NIJMPFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, iNSR "AODL SUBR .. _.. ._ qq((yy[[I'-yrr",.'V6LibY EXP LT TYPE OF INSURANOE 'INED WVD POLICY NUMpER �IMM7DOIYVYYI tMMIDD/ririI LIMITS _,,,,, COMMERCIAL BENERAL LIABILITY ,, EACH OCCURRENCE S 'DAMAGE TO RENTED" _ Ct.AIMS-MADF 1 OCCUR _._.. _ ,, PREMISES (Ea.mmonce) _ S MEREXP(Any one peleun) 5 PERSONAL&ADVINJURY 5 GEN'L AGGREGATE LIMIT APPLIES PER: GENEHALAGGREGAIE S ..., .. POLICY JECOT LOC , {. .PROIX7S:T5 COMPiOPAGG > �-y OTHER: l3. t-=(\ S AUTOMOBILE LIABILITY �� {�] � SIN —I ER ecclJdent) ED _.. __. f.LEI. $� ANYAUTO C` BODILY INJURY dew person) S ALL OVvNEO SCHEDULER n�.5 90DILV INJURY (Par, aocident) S OS _. AUTOS NO MEQ (� V' 'tt *' PRtSI+ERTY DAAiAGG S _ _. HIREDAUTOS AUTOS UMBRBLLA LIAR _'..00CUR 00"�'� EACHOCCORRENCE. _$ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS $ TION X PER OTH yTATUTE RR AND EMPSCDMPENSAILIT AND ROPRIEERS'LIATNERI A ANY EroRIPARTNEErEXSCurIVE YtIN'}..NIA 9005057.16 0210912015 02109I2010 � - - — _-- EL EACH ACCIRENT a 1,000,000 ` -- CERIM U -ral- ry In BER BXCLUPED'1 L J {MandaturyN NN) - EA EL DISEASE EA EMPLOYEES 1,000,00 _ _ IF pyPB, deattipa Gilder RESCRIPTION C.L. DISEASE. F%ICY liPb1T 3 1,000,000 DESCRIPTION OF OPERATIONS t LOCATIONS J VEHICLAS (ADDED 101, AdmUr ud Remarks Schedule, may be attached bosom space la ragWrad) CITYSA4 City of Santa Ana PRCSA 20 Civic Center Plaza PO Box 1988 M-16 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE n 19RR.2014 ACORn CORPORATION. All rinhts mserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INSURANCE FINANCIAL PACIFIC INSURANCE COMPANY X] ALLSTATE INSURANCE COMPANY P ALLSTATE INDEMNITY COMPANY F]ALLSTATE TEXAS LLOYD'S THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, CERTIFICATE HOLDER NAMED INSURED Name and Address of Party to Whom this Certificate Is Issued w Name and Address of Insured Emerald Isle Entertainment DBA Bubble Rollers 1402 Cloyden Rd .Santa Ana, Ca 92705 This is to canny that policies of Insurance listed below have been Issued to the insured named above subject to the expiration date indicated below, notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be Issued or may pertain. The Insurance afforded by the policies described herein Is subject to all the terms, exclusions, and conditions of such policies. TYPE OF INSURANCE AND LIMITS Policy _ 648139975 A Exp 02/04/2016 Amount LIABILITY AND MEDICAL EXPENSES LIMIT _ $ 1,000,000er Occurrence_ FIRE LEGAL LIABILITY LIMIT Y $ MEDICAL EXPENSES LIMIT _ WORKERS' COMPENSATIONS R Policy EMPLOYER' LIABILITY Number _ _ _ Effective Expiration Date Date Coverage Limps WORKERS' COMPENSATION STATUTORY—appfles only in the following slates: EMPLOYERS' LIABILITY BODILY INJURY BY ACCIDENT 1 $ EACH ACCIDENT BODILY INJURY BY DISEASE 1 $ EACH EMPLOYEE BODILY INJURY BY DISEASE _ $ POLICY LIMIT AUTOMOBILE LIABILITY Expiration Coverage Basis Limits ❑ ANY AUTO 6X OWNED AUTOS Cu7 HIRED AUTOS SPBCIRIEDAU705 NON•owNEDAUTOS D OWNED PRIVATE PASSENGER AUTOS CI OWNED AUTOS OTHER THAN PRIVATE PASSENGER �.. _ Combined Single Limit of Liability BODTLY INJURY s PROPERTY DAMAGE $1,000,000 EACH ACCIDENT Split Liability Limits Bodily Injury PropoMy Damaga Each $ PERSON $ $ ACCIDENT UMBRELLA LIABILITY Policy ._._. Number Effective Expiration Date Date EACH OCCURRENCE I GENERALAGGREGATE PRODUCTS —COMPLETED OPERATIONS AGGREGATE $ $ $ OTHER(Show Policy t e of Pollc __ Number Effective Expiration Date Date CANCELLATION 30 DAYS NOTICE 4 AGENT CHUCK ALLAN Data 0210412015 Authorize Representative Should any of the above described policies be cancelled before the expiration date, the issuing company will endeavor to mall within the number of days entered above, written notice to the certificate holder named above, But failure to mail such notice shall Impose no obligation or liability of any kind upon the company, Its agents or representatives. Gu�Vas ? Z)F