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Client#: 158 PAULMAUR DATE (MMIDD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 6/13/2019 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(ies) 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 endorsement(s). PRODUCER CONTACT NAME: Haas &Wilkerson Insurance PitONE 913 432.4400 FAX N fd: AIC, No AIC E 4300 Shawnee Mission Parkway E•MAfL ADDRESS, Fairway, KS 66205 INSURERS AFFORDING COVERAGE NAIC # 913 432-4400 INSURER A merACE Aican Inaurance Co 22667 INSURED Paul Maurer dba A-2019-042, A-2018-019 Paul Maurer Shows 16081 Warren Lane Huntington Beach, CA 92649 INSURER B : State National Inaurance Co 12831 INSURER D : INSURER E : COVFRAnFS CFRTIFICOTF NIIMRFR- 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 CONTRACTOR 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. NBR TR TYPE OF INSURANCE ADOL S POLICY NUMBER POLICY EFF MfdIDD/YYYY POLICY EXP MMIDD/YYYY, LIMITS A GENERAL LIABILITY G20496496 04/01/2019 02/05/2020 EACH OCCURRENCE $1 000,000 ]( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 5XI OCCUR DAMA ES EaENTEren;. $300000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 $ POLICYF]JeCT PRO X LOC A AUTOMOBILE LIABILITY H08133268 2/05/2019 02/05/202 CO (UsaB�B t) NGLE IMIT 1,000 000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED X SCHEDULED )L HRTEDSAUTOS AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE r accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOMPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? 7 (Mandatory In NH) NIA NFA0568554 1/01/2019 01/01/2020 X WCSTATU- I OTH- ER .TC)RYLIMITS E.L. EACH ACCIDENT $1 OOO 000 E,L, DISEASE - EA EMPLOYEE $1 000 000 E,L, DISEASE - POLICY LIMIT $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Additional Insured's: City of Santa Ana, it's officers, agents, employees, representatives and volunteers, and Fiesta de Carnival. ED BY' SEE ATTACHED ADDITIONAL INSURED AND NON-CONTRIBUTORY ENDORSEMENTS AMnaaVemenf Workers' Compensation coverage applies to the statutory requirements of the state of California. sk Division City of Santa Ana Risk Management 20 Civic Center Plaza Santa Ana, CA 92701 ANCELLATION 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 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S391139/M375076 SALAK