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2019/11/26 3HM Entertainment Certificate of Liability Insurance (7)
DocuSign Envelope 10: AE8CE307-914B-46CF-979C-5A95DC7C9251 ACORL70 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDmYY) 1012412019 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(tes) must have ADDITIONAL INSURED provisions or 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 does not confer rights to the certificate holder in lieu of such endorsements).. PRODUCER CONTACT NAME: NEX p E(888) 202-3007 A Hiscox Inc. 520 Madison Avenue n�� contaCt@hisoox.com ADR 32nd Floor New York, NY 10022 INSURERIN AFFORDING COVERAGE NAIL 9 INSURERA: Hiscox Insurance Company Inc 10200 INSURED INSURER B . 3HM Entertainment 1926 Pinehurst Drive INSURERC: Nashville, TN 37216 INSURER 0 : _ INSURER E . INSURER F COVERAGES CERTIFICATE NUMBER: 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 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 LTR TYPE OF INSURANCE ADOLSURR POLICY NUYSER Dp�YY MffRP EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 CLAIMS -MADE u OCCUR DAMAGETCRENTED PREMISES Eaoccunrenca S 100.000 MED EXP (Any one person) $ 5,000 X Primary & Noncontributory PERSONAL& ADV INJURY S 1,000,000 A Y UDCA003855-CGL-19 11/26/2019 11OW020 GEHL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ECT LOC PRODUCTS - COMPIOP AGG $ SIT Gen. Agg $ OTHER: AUTOMOBILE LIABILITY COMBINED D SINGLE LIMIT $ BODILY INJURY (Per person) S ANY AUTO OWNED AUTOS ONLY AUTOS UDC-4003855-CGL-19 1112&2019 11 /26/2024 BODILY INJURY (Per adidant) S PROPERTY DAMAGE [Per acclI.I X HIRED x NON -OWNED AUTOS AUTOS ONLY AUTOS ONLY CGL HNOA co) $ 1,000,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE OED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN QTH- NUT, R _ ANYPROPRIETORJPARTNERJEXECUTIVE OFFICERIMEMB ER EXCLUDED? NIA EL EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE S if yes describe under DESCRIPTION OF OPERATIONS below EL. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) City of Menifee and its ofroers, employees, agents and authorized Volunteers are additional insureds, CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Rd Menifee, CA 92586 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD DocuSign Envelope 10: AE8CE307-914B-46CF-979C-5A95DC7C9251 �► DATE IMMIDDYYY) cvRo0 IYCERTIFICATE OF LIABILITY INSURANCE 10124/2019 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 have ADDITIONAL INSURED provisions or 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 does not confer rights to the certificate holder in lieu of such endorsement(s). PnODUCER Hiscox Inc. 520 Madison Avenue 32nd Floor New York, NY 10022 INSURED 3HM Enterlainmenl 1925 Pinehufst Drive Nashville, TN 37216 COVERAGES CERTIFICATE NUMBER: rn�na ggg 202-30Q7 E-MAIL ,.. ADDRESS: Cantsr@hiscax.com ARE`�� INSURE AFF[?RDINOCOVERAGE HAIG INSURERA: Hiscox Insurance Company Inc INSURFR B; 10200 INSURER L. INSURER➢ INSURER E INSURER F . 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 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. IN SR LT TYPE OF INSURANCE ADOL SUBR POLICY NUMBER POLICY EFF POLICY EXIP LIMITS COMMERCIALGENERALLIABILITY EACH 0CCURRENCE $ CLAIMS -MADE FIOCCUR PREEMK IS ( aExcurren $ MED EXP (Any one on) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE f GEWL AGGREGATE LIMIT A P PL I ES PER, POLICY ACT 1:1 LOG PRODUCTS - COMPIOP AGO S $ OTHEW AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT We accident = BODILY INJURY (Per person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) ; PROPERTY DAMAGE Phan aockien $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY S UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER STAT ANYPROPRIETORIPARTNERIE%ECU I WL E.L. EACH ACCIDENT $ OFFICERIMEMBERExCLUDE07 ❑ NIA (Mandatory In NHI E.L. DISEASE - EA EMPLOYEE $ If yes, dearribo under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S A Professional Liability Y UDC-4003855-E0-19 11/2612019 11126/2020 Each Claim: $ 1,000,001) Aggregate: $1,000,001) DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additionat Remarks Schedule, may be attached if more space is required) City at Menifee and its officers, employees, agents and authorized volunteers are additional insureds, CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Rd Menifee, CA 92586 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 ACORD 25 (2016103) O 1988 2015 ACORD CORPORATION. All rights reserved. The ACORO name and logo are registered marks of ACORD DocuSign Envelope 10: AE8CE307-914B-46CF-979C-5A95DC7C9251 Am HISCOX Policy Number: Named Insured: Endorsement Number: Endorsement Effective U ❑C-4003855-CGL-19 3HM Entertainment 18 February 19, 2020 Hiscox Insurance Company Inc. 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 Persons Or Organization(s) City of Menifee and its officers, employees, agents and authorized volunteers are additional insureds 29714 Haun Rd Sun City,CA 92586 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) 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 or the acts or omis- sions 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. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 DocuSign Envelope 10: AE8CE307-914B-46CF-979C-5A95DC7C9251 Am HISC%C)X Policy Number: Named Insured: Endorsement Number: Endorsement Effective: U ❑C-4003855-CGL-19 3HM Entertainment 19 February 19, 2020 Hiscox Insurance Company Inc. THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE SCHEDULE — PART I Terrorism Premium (Certified Acts) $ 7.00 This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Cover- age Form(s) and/or Policy(ies): Additional information, if any, concerning the terrorism premium: SCHEDULE — PART II Federal share of terrorism losses 85% year 2015; 84% year 2016; 83% year 2017; 82% year 2018; 81 % year 2019 and 80% year 2020. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Disclosure Of Premium In accordance with the federal Terrorism Risk In- surance Act, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certi- fied under the Terrorism Risk Insurance Act. The portion of your premium attributable to such cov- erage is shown in the Schedule of this endorse- ment or in the policy Declarations. IL 09 85 01 15 a Insurance Services Office, Inc., 2015 Page 1 of 2 DocuSign Envelope 10: AE8CE307-914B-46CF-979C-5A95DC7C9251 B. Disclosure Of Federal Participation In Payment Of Terrorism Losses The United States Government, Department of the Treasury, will pay a share of terrorism losses in- sured under the federal program. The federal share equals a percentage (as shown in Part II of the Schedule of this endorsement or in the policy Declarations) of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses at- tributable to terrorist acts certified under the Ter- rorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. C. Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terror- ism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures es- tablished by the Secretary of the Treasury. Page 2 of 2 a Insurance Services Office, Inc., 2015 IL 09 85 01 15