FIESTA DE CARNIVAL (A-2015-019)-2015

Home Browse Search

CERTIFICATE OF LIABILITY INSURANCE DATE(MM,°°'YYYY) 2/5/2015 ' 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 PRODUCER krthur J. Gallagher Risk Management Services, Inc. '77 108th Ave NE, #200 3ellevue WA 98004 INSURED Christiansen Amusements, Inc. P. O. Box 997 Escondido, CA 920330997 CHRIAMU-01 INSURERISI AFFORDING COVERAGE merican States Insurance Comp>a)L--.. COVERAGES CERTIFICATE NUMBER: ..R7'V1,g41AA 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDLISUBR -- POLICY EFF POLICY EXP LTR INSRI WVD POLICY NUMBER MMIDDIYVYY MMIDDIYYYY LIMITS GENERALLIABILITY EACH OCCURRENCE $ _ _ DAMAGETORENTED - COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) _$ CLAIMS -MADE OCCUR II. MED EXP (Any one person) $ PERSONAL B ADV INJURY_ $ _ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER',, PRODUCTS - COMPIOP AGG I$ POLICY JECOT LOC A AUTOMOBILE LIABILITY 01C15624863 /1/2014 /1/2015 Es accident _ 1000,000 x ANY AUTO BODI LY I INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODI LY I INJURY (Per accident) $ X NON -OWNED X. PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accitlent)._. I $ UMBRELLA LIAB __ OCCUR Q p�e�p Reviewed EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE $ DED RETENTION$ - WORKERS COMPENSATION Hsi WC STATU-' OTH- Y LIMITS AND EMPLOYERS' LIABILITYYIN ANY PROPRIETORIPARTNERIEXECUTIVE p Silvia Cuevas E L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? NIA – – $ - — (MandatorylnNH) If yes, describe untler PRCSAIAdr nn 1jf (11. E.L. DISEASE - EA EMPLOYEE $ _ - DESCRIPTIONOFOPERATIONSbelow EL. DISEASE -POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is required) The City of Santa Ana, its officers, employees, agents and representatives and Fiesta de Carnival are included as additional insureds but only as respects the operation of the named insured per policy terms and conditions per form CA7110 0307. For all Christiansen Amusement events during the period 4/1/2014 - 4/1/15 City of Santa Ana Attn: Robert Carroll 20 Civic Center Plaza Santa Ana CA 92701 USA 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 C) 1988.2010 ACORD CORPORATION All rarrHrc .eco ri ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD