FIESTA DE CARNIVAL (A-2015-188)-2015

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AC40Ra CERTIFICATE OF LIABILITY INSURANCE 3!3012015 DATE tMMIDDIYYYY) 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(his) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the PRODUCER NAME7' Joanne Manion Arthur J. Gallagher Risk Management Services, Inc. PHONE ya.�kgy�- 45A-3386._ Nar425- 451 -371 777 108th Ave NE, #200 " . _ _..__ _ — __iac, "e -Ina -- Bollevue WA 98004 ADDRESS: INSURER(S) AFFORDING COVERAGE NAICp INSURER A:American States Insurance Company 19704 INSURED CHRIAMU -01 INSURERS: Christiansen Amusements, Inc INSURER C: P. 0. Box 997 Escondido, CA 92033 -0097 IN SURER D: INSURER E: INSURER P COVERAGES CERTIFICATE NUMBER: 177753472 REVISION NUMBER: THIS IS 1 "0 CERTIFY THAT THE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 'rO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 1'HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - -ADDL -SUER POLICY SEE POLICY EXP LTR TYPE OF INSURANCE IN SR WVp POLICY NUMBER IMMIDDIYYYYI _LMMIOOh Y) LIMITS GENERAL LIABILITY EACHOCCURRENCE S OAMAOETORENTED COMMERCIAL GENERAL LIABILITY PRFMISF.S traepcunenpa) 5 CLAIMS MADE OCCUR NED EXP(Any dialed) 5 PERSONAL$ ADV INJURY 5 GENERAL AGGREGATE 5 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGO 5 P M1 /1/715 4 /i POLICY FRO. tOC S A _ AUTOMOBILE LIABILITY U1CI56248840 F1172-6W I �E�1' —v� I(Ee acGldanpll SN' $1,e00,000 X ANY AUTO BOOR Y I NJURY(Per person) S ALL OMMFD sCHEnULED BODILY INJURY (Per accident) S AUTOS AUTOS X NON OMED PROPERTY DAMAGE HIRED AUTOS X AUTOS (Parecckwol) S UMBRELLA LI0.a OCCUR _.._,., T�C+V IG'Y° EACH OCCURRENCE 5 EXCESS LIAR CLAIM & -MAPEI ""7 �,.� AGGREGATE 5 DED RETENTIONS I 5 WORKERS COMPENSATION W STATU— OTH — ANDEMPLOYP.RS'LIABILITY Silvia Cuevas, IACH LIMITS FR ANY PROPANCTORIPARTHIR!EXEGUTIVE _ GG Cuevas EACH ACCIDENT 5 OFPICRRIMEMpEIi EXt;LU0Ep9 NIA (Mandatory in NSW) PRCSA/Adrnfn, E. L. DISEASE -EA EMPLOYEE 5 lielit deacdha under 1� 'P'riON OF OPERA TIONS aeNw E.L. DISEASE -POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Radiative Sclfedula, It edam space la Needed) 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 farm CA7110 0307. For all Christiansen Amusement events during the period 4/1/2015 - 411/16 City of Santa Ana Attm 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. REPRESENTATIVE Zt Y 'r' El Tarid -2010 ACORD O JKI`VKA ITUN. All rlgnts reserved. ACORD 25 (2010/05) The ACORD name anti logo are registered marks of ACORD