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®® CERTIFICATE OF LIABILITY INSURANCE DA68/2018" 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 does not confer rights to the certificate holder In lieu of such endorsemant(s). PRODUCER CONTACTNancy Smith Governor Insurance Agency, Inc. IPANI4NNE.n Exi) (3.3.0)539-9999 q NJ,.(330)S39-999e 972 Youn stown-Rin sville Rd. 9 9 EMAIL N9mi th@OovernorIne.com apDPE$s. --- INSURERIS) AFFORDING COVERAGE NAICN P.O. BOX 770 WSURERA:R-T Specialty LLC._ Vienna OR 44473 INSURED INSURER B: INSURER C: YhteIrtdtiOndl prORl0tiO0a, Inc. INSURER D: DHA: Fiesta de Carnival 11279 LOB Alamitos Blvd INSURER E: INSURE Loa Alamitos CA 90720 COVERAGES CERTIFICATE NUMBER:CL185810768 REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. —__ _ POLIOYeFFTPGLICY LTR' TYPE OF INSURANCE POLICY NUMBER MMIOOIYYYY IDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY ! EACH OCCURRENCE S 11000,000 :PREMISES (Ea occurrence) 'i_$ A CLAIMS MADE X OCCUR _ 100,000 X V0A61774600 .I S/27/2010 5/27/2019 , MEDEXP(My one Person) $ 5,000 PERSONAL S ADV INJURY ',$ 1,000,000 GEHL AGGREGATE LIMIT APPLIES PER: '.GENERAL AGGREGATE ',g 2,000,000 ..__ _......�__ X POLICY 'PRP C�LOC PRODUCTS COMP/OP AGG '.S 2,000,000 JECT OTHER: S AUTOMOBILE LIABILITY fCOMBINED SINGLE LIMIT S CUFActlden0 _.._....— _ ANY AUTO__ - BODILY INJURY (Per person) '', S 'ALLOWHED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ _ '.�; _ _ _ NON.OMED HIRED AUTOS .AUTOS (Por accldeYnp AMAGE ; I UMBRELLA LIAO ;OCCUR EACH OCCURRENCE $ EXCESS LIAOil— CLAIMS -MADE n�� AGGREGATE I$ DED RETENTION$ \V " WORKERS COMPENSATION p R TH AND EMPLOYERS'LIABILITY YIN pyV ISTATUTE_ER ANY PROPRIETORIPARTNERIEXCCUTIVE "' ,h F OFFICERIMEMBER EXCLUDED? NIA G.1V wC�\\ U\ EL EACH ACCIDENT $ IfMyyestldesc�ibe unIn der - y\� ! 1�\P ' � E L DISEASE _EA EMPLOYEES DESCRIPTI N PERATIONS below \ t" E.L. DISEASE -POLICY LIMIT OESCRIPUON OF GPERATIONS i LOCATIONS / VEHICLE$ (ACORO 101, Audi flemarks Schedule, maybe attached if m0. apace to required) The City of Santa Ana, its officers, employees, agents and volunteers are included as named as additional insured per the attached Blanket Additional Insured Form #GBA105004(06/14) with respect to the operations of the named insured. This coverage is primary without contribution on behalf of the additional insureds. A 30 day notice of cancellation has been endorsed for the City of Santa Ana. City of Santa Ana 20 Civic Center Dr. Santa Ana, CA 92701 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 Thompson, Tr/NANCY ©1988.2014 ACORO 25 (2014101) The ACORD name and logo are registered marks of ACORD INS026 (201401)