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CERTIFICATE OF LIABILITY INSURANCE 06/05/2017

DATE (MM/DD/YYYY)

PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION


East Main Street Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Will Maddux HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 1298 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Grass Valley, CA 95945
Phone: (530) 477-6521 Email: info@theeventhelper.com INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Evanston Insurance Company 35378
Jason Kessler INSURER B:
1013 Altavista Ave Apt B
INSURER C:
Charlottesville, VA 22902
INSURER D:

INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS

GENERAL LIABILITY EACH OCCURRENCE INCLUDES $


BODILY INJURY & PROPERTY DAMAGE 1,000,000
A Y COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $
3DS5455-M1538832 08/12/2017 08/13/2017 5,000
CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ 1,000,000
Host Liquor Liability GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000
PRO-
POLICY JECT LOC DEDUCTIBLE $ 1,000
Retail Liquor Liability $

AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)

ALL OWNED AUTOS


BODILY INJURY $
SCHEDULED AUTOS (Per person)

HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)

PROPERTY DAMAGE $
(Per accident)

GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $


ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $

EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $


OCCUR CLAIMS MADE AGGREGATE $

DEDUCTIBLE $
RETENTION $ $
WC STATU- OTH-
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS


Certificate holder listed below is named as additional insured per attached CG 20 26 07 04.
Attendance: 400, Event Type: Meeting - Outdoor.

CERTIFICATE HOLDER CANCELLATION


Lee Park SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
201-299 2nd St NE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Charlottesville, VA 22902
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE

ACORD 25 (2001/08) © ACORD CORPORATION 1988


Policy Number: 3DS5455-M1538832 ›—””¤Œ›&fl‘ Ÿ¤“¤Œfl‘ ‘&flfi&‘&ë
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Lee Park
201-299 2nd St NE
Charlottesville, VA 22902

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