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000uSign Envelope ID: nene4non-8oEE-4rno'oo74-ornEsEo7nonn <br /> Lionstate Insurance Brokers <br /> U.B.A. Commercial General Liability Declarations <br /> Policy Number : pmo259B761-01 <br /> Named Insured � David Hersh D.B.A. Magic B9David <br /> 37O4 Carriage Manor Ct.Wendell N.C.Z7S9l <br /> Policy effective O3-04-2Ol5to 03'04-2018 begins and ends dates noted:at1I:81 a.m. standard tinme. Premium has <br /> been paid and was paid atinception. <br /> Commercial General Liability Declarations <br /> � <br />/ <br /> In return for the payment of the premium,we agree to provide you the insurance as stated. <br /> Each Occurrence Limit $500'000.00 <br /> Damage to premises you perform at $1OO,ODO.0O-any one premises. <br /> Medical expenses $10lOOO.8Q any person orpersons. <br /> Personal injury Limit $5OO,QQO.00 any persons urorganization. <br />� <br /> Aggregate limit $500,000.00 <br /> Form mf Business : Magic show with live animals, Balloon twisting and face painting. <br />� <br />� <br /> This is to certify that this policy of insurance is afforded and pertains to the event scheduled through orange <br /> County Library.Orange County Library are additional insured in regards to General Liability.The above limits apply. <br /> ^—� L.L0"A. <br /> z20O American Lane Schaumburg' Illinois 6nz9s1oas <br /> -------------------------------------------- --------------____------------------------------------------------------------------------------------------------------- <br />