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FIESTA DE CARNIVAL
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Last modified
7/23/2019 10:35:43 AM
Creation date
3/25/2019 12:36:47 PM
Metadata
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Contracts
Company Name
FIESTA DE CARNIVAL
Contract #
A-2019-042
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Council Approval Date
3/5/2019
Expiration Date
2/5/2020
Insurance Exp Date
1/1/2020
Destruction Year
2025
Notes
SECOND AMENDEMENT TO A-2018-019
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.4GLORLv® CERTIFICATE OF LIABILITY INSURANCE <br />fal10/26/2016 <br />°ATE(/26120IYYYY) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT- If the certificate holder Is an A DITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder In lieu of such endorsements). <br />PRODUCER <br />NA A Diana Co <br />Governor Insurance Agency, inc, <br />t <br />Pgn,NEb. , (330) 539-9999 I Ic Not: (330! 5394998 <br />972 Youngstown-Kln9sv1lle Rd. <br />ADDRESS, OGouldOGovernorins.com <br />P.O. Box 770 <br />;_ INSURER(S) AFFORDING COVERAGE <br />NAIC0 <br />Vienna ON 44473 <br />INSURER A: R-T Specialty LLC <br />INSURED <br />INSURER B: <br />International Promotions doe Fiesta de Carnival <br />INSURER C: <br />11278 Los Alamitos Blvd <br />INSURER D: <br />INSURER E: <br />LOS Alamilo9 CA 90720 <br />IN9URERF: <br />GDVERAOES CERTIFICATE NUMBER: G1.19bUIU04 REVISION NUMBER' <br />THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FORTHE POLICY PERIOD <br />INDICATED, NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INUR <br />LTR <br />TYPE OF INSURANCE <br />AOULISUURI <br />INSO <br />MD <br />POUCYNUMBER <br />POLICY EFF <br />MMIDD(YYYY) <br />PO Y MR <br />MMIDOIWYV <br />UNITS <br />x <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />EACHOCCURRENCE <br />s 1,000,000 <br />REMISISETb-REF1Y <br />ES Ea unence <br />; 100,000 <br />MEO EXPAnyonaPerson) <br />S 5,000 <br />A <br />Y <br />VBA617746 <br />05/2712018 <br />05/27/2019 <br />PERSONAL4ADV INJURY <br />$ 1,000,000 <br />GEN'LAGGREGATE <br />LIMITAPPLIES PER: <br />POLICY ❑ 764 LCC <br />GENERALAGGREGATE <br />$ 2,000,000 <br />PRODUCTS• COMPIOPAGG <br />; 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILELIABILIIY <br />COMBINED SINGLE LIMIT <br />$ <br />ANYAUTO <br />BODILY INJURY(Peronnon) <br />$ <br />OWNED SCHEDULED <br />AUTOSONLY AUTOS <br />HIRED NON.OWNED <br />AUTOS ONLV AUTOS ONLY <br />BODILY INJURY (Per a aldene <br />9 <br />_ <br />p p AMA E <br />Per accNona <br />; <br />$ <br />UMBRELIALIAB <br />OCCUR <br />EACH OCCURRENCE <br />S <br />AGGREGATE; <br />EXCESS LIAa <br />OUIMS•MAOE <br />DEC) I I RETENTION S <br />; <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPMETORIPARTNERIEXECUTIVE ❑ <br />OFHCERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />R yes, deacdbe under <br />DESCRIPTION OF OPERATIONS balm <br />NIA <br />0 W <br />STATUTE <br />E.L EACH ACCIDENT <br />S <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />E,L DISEASE -POLICY LIMIT <br />S <br />DESCRIPTION OF OPERATIONS /LOCATIONSIVENICLES tACORD 101,Addiaoml Ramcka &fwdula, ma, W anached if them apace Is rvinimal <br />The City of Santa Ana, its officers, employees, agents and volunteers are included as named as additional Insured per the attached SlanketAdt ihQQgqai <br />Insured Form aGBA105004(06114) with respect to the operations of the named Insured. This coverage is primary without contribution on banf jiba <br />additional Insureds. A 30 day notice of cancellation has been endorsed for the City of Santa Ana. "i\z Aa�L(?/�p�J, „\A <br />�aa .\�. <br />oc nnanlc nvwcrc GANf:ELLAIIUN -C? <br />SHOULD ANY OF THE ABOVE B RIBEDP ES SE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE 1 LBE DELIVERED IN <br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Dr. <br />AUTHORIZED REPRESENTATIVE <br />Santa Arta CA 92701 <br />Q 1988-2015 ACORD CORPORATION. All rights reserved. <br />AGORU 25 (2015103) The ACORD name and logo are registered marks of ACORD <br />
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