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CHRIS23 OR ID: JU <br />W —? <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE IWACIDAYYY) <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />0713072413 <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(!") must be endorsed, If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain Policies may require an andorsament. A statement oil tills certificate does not center rights to the <br />Certificate holder In fiou of such andorsomant {sue_ <br />PRODUCER <br />ry NT CT Craig Haft <br />Ills,So"., hic OB48084 Randolph <br />apo,iin, Ext):630. 562.9161 FAx <br />�,Mnit lac, NoP. 630552.6462 <br />522 Main Street <br />ADDRESS: craigh @wsrins.com <br />Woodland, CA 96596 <br />lIENERAL AGGREGATE S <br />Craig Hutt <br />INSURER(S) AFFORDING COVERAGE PAID <br />OTHEn. Reviewed <br />INSURERA;State Compensation insurance 36076 <br />INSURED Christiansen Amusements <br />INSURERS; <br />Stacy Brown <br />. <br />P.O. Box 997 <br />INSURER p: <br />Escondido, CA 92033 <br />INSURERD: <br />HIREOAUTOS AUYe )Vp <br />INSURER E', <br />Jt�„"yj jy j <br />NSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />'THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT NTH RESPECT TO WNICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />THEIR ADOL EVER POLICY EFT, POLICY EXP <br />_ TYPE OF INSURANCE INQp INYp ppLICy NUMBER IMMIgWYYYjSMMIDO(YYYTj <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACHOCCURRENCE $ <br />OAMAOG TO BENI'GO <br />CLAIM$4AOE OCCUR <br />PREMISES nea.urlenco). -$ <br />MED EXP(Ally one person) 3 <br />PERSONAL &ACV INJURY $ <br />GENL AGGREGATE UTA f APPLIES PER. <br />lIENERAL AGGREGATE S <br />POLICY IT <br />JE�r I.00 <br />by; <br />PRODUCTS- COMPOP AGO $ <br />OTHEn. Reviewed <br />$ <br />._.__ <br />AUTOMOBILE LIABILITY _ _�»_.�....� �.�_ -� �P /i <br />NEU INGLE LIMIT —8 " <br />ANY AUTO <br />BODILY INJURY (P., Telenet S <br />A". 08NED SCHEDULED <br />BODILY INJURY (Per I111000 S <br />AUTOS NOMOVINTED <br />PROPERTY DAMAGE q <br />HIREOAUTOS AUYe )Vp <br />Jt�„"yj jy j <br />UMBRELLA LIAR OCCUR <br />EACHOOCURRENCE S <br />EXCESS UAG CLAIMS MADE <br />AGGREGATE $ <br />pEp RETENTIONS <br />$ <br />WORI(ER$COMPENSANMONS <br />PER ��OTIb <br />X STATUTE rR <br />ANDEMPLOYERS'LIAOILIIY YIN <br />A ANY PNOPItIflTUNIPARTNF :HItCECEI YIVE 90680352014 0810912014 08/41/2010 <br />EL EACH ACCIDENT S 1,000,000 <br />CFFICERVMEMBER EXCLUDCU't � -..., NIA <br />(MRAINnueInHill <br />— <br />E.L. DISEASE- E.ASIAKOYE8 S 1,000 +000 <br />Ilyya& 6esenbe UT!" <br />DESCRIPTION OF OPERATIONS below <br />E.t. DISEASE. POLICY LIMIT S 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORU 141, AUJlllongl galtlPrka ScnoUUle, may W attaenoa 11 more space le requlmtl) <br />Evidence of insurance related to all Christiansen Amusements events between <br />Sllj14 - 913/26. <br />CITYSA3 <br />City of Santa Ana <br />20 Civic Center PIa2a <br />Santa Ana, CA 92701.4069 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />0 19118.2044 ACORD CORPORATION. A8 rights <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />