ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE (MM DDYYYY) 11/23/2022
INSURANCE DOES
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
CONTACT NAME: Mass Merchandising
K&K Insurance Group, Inc. PHONE 1-800-648-6406
(A/C, No, Ext): (AC. NO): 1-260-459-5940
1712 Magnavox Way E-MAIL [email protected]
Fort Wayne IN 46804 ADDRESS:
PRODUCER
CUSTOMER ID:
INSURERS) AFFORDING COVERAGE
INSURED 2001489568 CP# 595 INSURER A: Markel Insurance Company Joy Salas INSURER B:
DBA: Hawaiian Dance INSURER C:
501 South Catalina Avenue INSURER D:
edondo Beach, CA 9027 INSURER E:
Member of the Sports, Leisure & Entertainment RP(
INSURER F:
COVERAGES CERTIFICATE NUMBER: 2000564637 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.
SO POICE ITS SHONE MY AN EEN REDUCED BY PA CAN ESCARED HERE SULET AL FE FERNS EXCLUSIONS AND CONTIONS OF
ADDL SUBR
LTR TYPE OF INSURANCE INSD WD POLICY NUMBER LIMITS
A X COMMERCIAL GENERAL LIABILITY MIRPG0000000016500 08/25/22 08/25/23 $1.000.000 2:23 PM EDT 12:01 AM
]CLAIMS-MADE X OCCUR PREMISES (Ea Occurrence) $1,000,000 MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5.000,000 POLICY PROJECT LOC PRODUCTS - COMP.OP AGG $1,000,000
OTHER: PROFESSIONAL LIABILITY $1,000,000
LOSED STE TIMESS $1,000,000
AUTOMOBILE LIABILITY accident)
ANY AUTO BODILY INURY (Per person)
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accide
HIRED NON OWNEC
AUTOS ONLY AUTOS ONLY
Not provided while in Hawaii
UMBRELLA OCCUR EACH OCCURRENCE
LIAB
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTION
WORKERS COMPENSATION N/A /PER STATUTE JOTHER
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/ Y/N EL EACH ACCIDENT
XECUTIVE OFFICER MEMBER
EXCLUDED? (Mandatory in NH EL. DISEASE - EA EMPLOYEE
es. describe ur
CRIPTION OF OPERATIONS be EL. DISEASE - POLICY LIMIT
MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL
DESCRIPTION OF OPERAIONS LOCATIONS VEHICLES (ACORD 101, Aditional Remarks Schedule, may be altachedit more space 15 KES MEDICAL Non-Certified Instructor of: Hawaiian
CERTIFICATE HOLDER CANCELLATION
City of Redondo Beach
1922 Artesia Blvd.
Redondo Beach, CA 90278 THE POLICY PROVISIONS.
Owner/Manager/Lessor of Premises
AUTHORIZED REPRESENTATIVE
scott suched
© 1988-2015 ACORD CORPORATION. All rights reserved.
Coverage is only extended to U.S. events and activities •NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: M1RPG0000000016500 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) The City of Redondo Beach, its officers, elected and appointed officials, employees and volunteers 1922 Artesia Blvd.
Redondo Beach, CA 90278
Named Insured: Joy Salas
DBA: Hawaiian Dance
CP# 595
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section I| - Who Is An Insured is amended to include as an B. With respect to the insurance afforded to these additional insureds, additional insured the person(s) or organizations) shown in the the following is added to Section Ill - Limits Of Insurance:
Schedule, but only with respect to liability for "bodily injury". If coverage provided to the additional insured is required by a "property damage" or "personal and advertising injury" caused, in contract or agreement, the most we will pay on behalf of th whole or in part, by your acts or omissions or the acts or omissions dditional insured is the amount of insurance of those acting on your behalf:
1. Required by the contract or agreement; or
1. In the performance of your ongoing operations; or
2. Available under the applicable Limits of Insurance shown in
2. In connection with your premises owned by or rented to you. the Declarations; However: whichever is less.
1. The insurance afforded to such additional insured only This endorsement shall not increase the applicable Limits o applies to the extent permitted by law; and Insurance shown in the Declarations
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such
additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2