FIESTA DE CARNIVAL (A-2015-188-01)

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DATE (MWDDfYYYY) A" R" CERTIFICATE OF 'LIABILITY INSURANCE 3r3i2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CON'F'ERS 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(ies) 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 certificate holder in lieu of such endorsement(s), PRODUCER CONTACT Christine Nidel NAME: Governor Insurance Agency, Inc. .,.IPHO,No,Ext): (330)539-9999 _ (AIC,..Nnj:tS�OI..539-9998. MAIL 972 Youngstown -Kingsville Rd. EACH OCCURRENCE P.O. Box 770 INSURER(S) AFFORDING COVERAGE NAIL # Vienna Oka 44473 _.INSURED.... INSURERA:R-T Specialty LLC '..X VEA457676 5/27/2016 5/27/2017 INSURER B: ...._. ....... -.... ... International Promotions, Inc.A-2015-188-02 INSURER C: Fiesta de Carnival A-2015-188-01 INSURER D: 11278 Los Alamitos Blvd INSURERS : Los Alamitos CA 90720 INSURER F. COVERAGES CERTIFICATE NUMBER:CL166108412 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ..... .RODE 3UBR.. __.POLICY NUMBER _. MMIDDIYYYY POLICY MMIoDIYYVPN...' LTRIN" LIMITS X COMMERCIAL GENERAL. LIABILITY EACH OCCURRENCE $ 1, 000, 000 A CLAIMS -MADE ! X OCCUR. DAMAGE TO RENTED PREMISES (Ea occurrence) ..... 100, 000... $ '..X VEA457676 5/27/2016 5/27/2017 MED EXP (Any one person) $ FXa17Aded PERSONAL 8 ADV INJURY $ 1, 000, 000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS - COMPIOP AGG $ 2,000,000 ',.... OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ (Ea accident)_.. ANY AUTO BODILY INJURY (Per persen) S _. _ ALL OWNFU SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS NON-OWNED NON -OWNED PROPERTY MAGE $ HIRED AUTOS AUTOS (Per accident)....... ...... ..... UMBRELLA LIAB OCCUR _ , q ,g .� �I EACH OCCURRENCE S EXCESS LIAB CLAVM_ S MADE O W� AGGREGATE $ DED RETENTION$r,,,� ,°' $ WORKERS COMPENSATION '" ,� AND EMPLOYERS` LIABILITY y G n �' ,,. PER OTH- STATUTE:. ER Y 1 N�^f ANY PROPRIETORYPARTNER/EXECUTIVE E L , EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E L DISEASE - EA EMPLOYEE S If yes, describe under T " ...... DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LpMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 1.01, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder is named as additional insured per the attached CG 2026 form City of Santa Ana 20 Civic Center Dr. Santa Ana, CA 92701 ACORD 25 (2014101) IN 025onuni) L91-20M.RP1111IF11116J9.1 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 Thompson, ,Jr./CNIDEL Q 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD