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Client*: 1.58 <br />PAULMAUR <br />ACORDTa CERTIFICATE OF LIABILITY INSURANCE NCE DATE(M2117/22015015YYY) <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(les) mast be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Haas & Wilkerson Insurance <br />CONTACT <br />NAME: <br />_ <br />Pn"/c°NNa BM, 918432-4400AIC No: <br />4300 Shawnee Mission Parkway <br />Fairway, KS 66205 <br />E-MAIL ---� <br />ADDRESS: <br />INSURERIS) AFFORDING COVERAGE NAICN <br />913432-4400 <br />INSURERA.. ACE American Insurance Company 22667 <br />IN5URED <br />INSURER B: Star Insurance Company 10023 <br />Paul Maurer dba Paul Maurer <br />Shows; Paul Maurer Shows LLC <br />16061 Warren Lane <br />Huntington Beach, CA 92649 - <br />INSURER C <br />INSURERD: <br />INSURER E: <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY 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 SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTSNR <br />TYPE OF INSURANCE <br />AS Lyyyp <br />POLICY NUMBER <br />MM/DD EFF <br />POLICY EXP <br />LIMITS <br />A <br />GENERALLIABILRY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE N OCCUR <br />620496486 <br />4101/2019i <br />04/01/2010 <br />__ <br />EACH OCCURRENCE$1J___._000X000 <br />PREMISES (Ea ooa(fDancal $100,000 <br />1 MED EXP (Any one person) $Excluded <br />PERSONAL&ADV INJURY $11000000 <br />GENERALAGGREGATE $2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ECT X LDG <br />_ <br />PRODUCTS - COMP/OP AGG $2,000000 <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />ANY AUTO,.I <br />NED X SCHEDULED <br />AUTOSAUTOS <br />X HIRED/ X NON -OWNED <br />AUTOS <br />H08133266 <br />I1..�� <br />Reviewed I.1 <br />2105/2015 <br />s <br />02/05/201 <br />COMBINED cciden SINGLE LIMIT $1,000,000 <br />BODILY INJURY (Per person) $ <br />BODILY INJURY(Per accident) $ <br />PROPERTY DAMAGE $ <br />Per aceidanl <br />$ <br />UMBRELLA UAB <br />EXCESS LIAe <br />OCCUR <br />CLAIMS -MADE <br />Silvia 7ev <br />s i� <br />n. <br />EACHOCCORRENCE $ <br />- —----_._. <br />'AGGREGATE $ <br />DED RETENTION <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN <br />OFFICER/MEMBER EXCLUDED? - I Y1 <br />(Mandatory In NH) <br />describe under <br />If DE CRIPTION OF OPERATIONS aelmv <br />NIA <br />WC0568554 <br />1/01/2015 <br />01101/20161XWC <br />STAITU- OTH- <br />E.L. EACH ACCIDENT $1,000000 <br />1 E.L DISEASE- EA EMPLOYEE $1 000 0O0 <br />E.L DISEASEes, <br />-POLICY LIMIT $1,006,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (AGach ACORD 1M, Additional Remarks Schedule, If more space Is required) <br />Additional Insured: City of Santa Ana, It's officers, agents, employees, representatives and <br />volunteers, and Fiesta do Carnival.; Event Dates: Cesar Chavez Park <br />SEE ATTACHED ADDITIONAL INSURED AND NON-CONTRIBUTORY ENDORSEMENTS <br />Workers' Compensation coverage applies to the statutory requirements of the state of California. <br />Cit of Santa Ana, Parks, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Recreation & Community ACCORDANCE WITH THE POLICY PROVISIONS. <br />Services Agency <br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />@ 1988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD <br />#S210502/M210499 SALAK <br />