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rR-44. 498 <br />PAULMAUR <br />ACORD. CERTIFICATE OF LIABILITY INSU NCEDATE(MMMONYYY) <br />211712015 <br />THIS CERTIFICATE IS ISSUED ASA 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 />-to <br />IMPORTANT: If the c6rti6cate, holder Is an ADDITIONAL INSURED, the policy(Ioe) must be endorsed. If SUBROGATION 16 WAIVED, sub)ect <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 Ileu of such endorsement(s)- <br />PRODUCER <br />CONTACT <br />Haas & Wilkerson Insurance _ <br />AICNNR Vor 913 432.4499 Alo <br />4300 Shawnee Mission Parkway <br />Fairway, KS 66205 <br />pAp10pREB8i <br />INSURER(S) AFFORDING COVERAGE NAIC# <br />_ <br />INsuRERA:ACE American Insurance Company 22667 <br />912432-4400 <br />INSURED <br />Paul Maurer dba Paul Maurer <br />Shows; Paul Maurer Shows LLC <br />16081 Warren Lane <br />Huntington Beach, CA 92649 <br />INSURER R Star Insurance Company 19023 <br />INSURER 0 <br />INSURER 0 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NNMRFR! REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TILE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITH£TANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />cePTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IFS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />I Yd <br />TYPE OF INSURANCE <br />AOM <br />R <br />WEER <br />NNP <br />" <br />POLICY NUMBER <br />POO EfP <br />MWD D <br />LPOLICY EXP LIMITSLTR <br />M )YYYY) <br />A <br />GENERALLIABILITY <br />620496496 <br />4101120150410112016EEpAAq(M;NppoQCGURpmNCE <br />$1,090-,000 <br />X COMMERCIALGENERALLIABILITY <br />IIcREMIe TO oaaurRnGe) $109900 <br />CL11M3-MADE � OCCUR <br />MED EXP Any pnaperson) $EXc!uded <br />LEE RSONA&ADV INJURY $1999699 <br />I GENERAL AGGREGATE s2,000,000 <br />PROCAIOTB.ComplOPAGG $2,099000 <br />GEN'LAGGREGATE LIMBAPPLIES PER: <br />A <br />POLICY JPERC X LOc <br />AUTOMOBILE LIABILITY <br />H9813326a <br />9210512015 <br />$ <br />02J05/20i(3_&pMeINEROSINGLE LIMIT $1,000,009 <br />ANY AUTO <br />BODILY INJURY (Per racoon) $ <br />ALL OWNED SCHEDULED <br />X <br />BODILY INJURY(Pereo iftf) $ <br />_ AUTOS NON4)WNED <br />X HIRED AUTOS X <br />PROPCRTVOAMAGE $ <br />Peraccldent <br />AUTOS <br />_ <br />UMBRELLA LIM <br />OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIAB <br />CWMS.MAOE <br />'AGGREGATE $ m <br />DELd RETEMION$ <br />B <br />_ <br />WORKERS COMPENSATION <br />WC0568554 <br />9110112015 <br />011011201E X 1WTATO. OTH <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOILPARTNERIEXECUTIVE Y/N <br />EL EACHACCIDENT $1,099999 <br />OFFICERIMEMBER EXCLUDED? 5i <br />NIA <br />E.L DISEASE EA EMPLOYEE $1,000,000 <br />(MHO&Wq in m) <br />• <br />If yes, &Scribe under <br />DESCRIPnON OF OPERATIONS below <br />I EL DISEASE. POLICY LIMIT $1,000,099 -- <br />I <br />DESCRIPTION OF OPERATIONS! LOCATIONS f VEHICLES (AiLich ACORD 107, Adtlltlan8l RemarkR SC6Wdula, R mare sRace Is rCgl*se) <br />Additional Insured: City of Santa Ana, lVs officers, agonts, employees, representatives and S <br />volunteers, and Fiesta de Carnival.; Event Dates: Cesar Chavez Park�eV`d <br />SEE ATTACHED ADDITIONAL INSURED AND NON-CONTRIBUTORY ENDORSEMENTS ���)\'d I �60 <br />Workers' Compensation appllas to the statutory requirements of the state of Calif a. <br />coverage <br />City of Santa Ana, Parka, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BC 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 AUTNORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />ACORD 25 (2010100) 1 of 1 Tho ACORD name and logo are registered marks of ACORD <br />#$210502IM210499 SALAK <br />