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Jr "L <br />,4c�oizo CERTIFICATE OF LIABILITY INSURANCE ° "TEr1101114Y <br />onlorla <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 ADDITIONAL INSURED, the policy(ies) must be endorsed. N SUBROGATION 19 WAIVED, subject to <br />the terns and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />xaraCER Phone: 71 <br />hivelckert b Company Fax: 71 <br />Peters Carryon Road <br />ine. CA 92808 <br />sme <br />1801 East Chestnut Ave. <br />Santa Ana, CA 92701 <br />X--�cic -ISIA--0► <br />--------- na101121rATe M1 IPamPO- REVISION NUMBER: <br />LrVYCILMVW vu . .. ....... .......��. -. <br />CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />THIS 15 TO <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />INDICATED. <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IN I <br />TYPE OF INSURANCE <br />20 CIVIC Center Plata <br />POLICY NUMBER <br />AU,,TT�HHOpORMED REPRESENTATIVE <br />Iyy <br />ITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />S 1,000,00 <br />P M ESMIM , <br />f 100,0 <br />A <br />X COMMIERGALOENERALLABIUW <br />INN428488 <br />OSA0114 <br />08!30115 <br />NED EXP We .0 WWI <br />S 5,OOC <br />CLAIMS44ADE OCCUR <br />PERSONAL S ADV INJURY <br />S 1+000, <br />_ - -._ <br />GENERAL AGGREGATE <br />S 2,000,00 <br />GEM AGGREGATE <br />LIMIT APPLIES PER <br />PRODUCTS - COfYYOP AGO <br />E Included <br />POLICY <br />- LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />f <br />(Ea OVAdW) <br />BODILY INJURY(PW PKIM) <br />S <br />! <br />IANY AUTO <br />"ALLOWNEDAUTOS <br />i <br />I <br />BODILY INJURY(PW acTxNN) <br />! <br />I <br />SCHEDLAEDAUTOS <br />HIREDAUTOS <br />fiPPROVED <br />�PIA�V <br />1V <br />'pY,�( <br />R14 <br />PROPERTYDAMAGE <br />(PMaaMea) <br />f <br />S <br />NOKOWNEO AUTOS <br />— _— <br />f <br />i <br />� <br />N <br />' UIMIRELLA UAB <br />otassLMB <br />OCCUR <br />q A5 MOE <br />�. <br />Assistant Gi <br />Attorne <br />EACH. OCCURRENCE <br />S <br />AGGREGATE <br />Y <br />/ <br />DEDUCTIBLE <br />S <br />6 <br />rypmralR COMPENSATION <br />rC STATU- TH- <br />Alb EMPLOYERS UABRJTY YtN <br />ANY PROPRIET(XWARTNEWFXECUTIVE r-- <br />E.L. EACH ACCIDENT <br />f <br />E.L. DISEASE - EA EMPLOYE <br />f <br />RM <br />OFFICEEMSER EXCLUI <br />11yaMaAdam In MI) <br />NIA <br />E.L. DISEASE - POLICYLIMIT <br />f <br />ff DESCRIPTION OO�PERATIONS aglow <br />A <br />Property <br />N14429480 <br />05730114 <br />06130115 <br />Carousel 438,00 <br />1,000 Ded <br />SPECIAL FORM <br />DESCI PTIM OF OPERATIONS I LOCATIONS U VEHICLES (Attach ACORD f0t, A40knM R AW MI SehsawlI4 N Port WHAO Is �Immn <br />The City of Santa Ana, its officers, amplcyess, agents, volunteers and <br />representatives are hereby named as additional insured as respeots the <br />liabiity arising out of the activities or operations of the named <br />insured.Znsurance is Primary and Non - Contributory wording applies to the <br />City of Santa Ana. <br />,vr are u^1 nee CANCFt 1 ETION <br />®1988 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />The City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC Center Plata <br />Santa Ana, CA 92702 <br />AU,,TT�HHOpORMED REPRESENTATIVE <br />®1988 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />