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`"CC"R" CERTIFICATE OF LIABILITY INSURANCE
<br />°A3/31/15'
<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 pollcy(ies) must 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 />PRCDUCERAllied Specialty Insurance,Inc
<br />10451 Gulf Blvd
<br />Treasure Island, FL 33706
<br />8002373355
<br />NAME:._
<br />PAx
<br />PHONE
<br />TYPR UFINSURANOE "I
<br />POLICY NUMBER WDdY IMM�QDP{YYYpI LIMITS W -
<br />OLNYSPF�7'IMM1DMYYY1
<br />,,,,-.,_,,,.___INB°RERS AFFOft0iN0 COVERAGE
<br />�NAIO#
<br />INSURED Christiansen Amusements, Inc.
<br />and Southland Shows, Inc.
<br />P. 0. Box 967
<br />INSURERA T.H E. Insurance Company.
<br />INSURER
<br />-- .... -- ---- ---
<br />INSURER C:
<br />12866
<br />__...._
<br />-
<br />Escondido, CA 92033INSURER;__
<br />INSURER E.
<br />110001000
<br />./Y „- "'�. /+` i` „_ ` CSC/
<br />GENERAL AGGREGATE �5
<br />t�
<br />INSURER P:
<br />' POLICY...__ PRO. _._ LOO
<br />QVVERAGE6 CERTIFICATE NUMRFR- OEV141nM nU rnnaem.
<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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
<br />AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS
<br />SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />TYPR UFINSURANOE "I
<br />POLICY NUMBER WDdY IMM�QDP{YYYpI LIMITS W -
<br />OLNYSPF�7'IMM1DMYYY1
<br />T-----
<br />IGENERALLWRILITY
<br />A MERCIACLAEMSGeNADE L IASILIY
<br />IAkOENERAL Li
<br />EACH OCCURRENCE $
<br />15 AMACET"r.N'reCi ..'—
<br />CPPOI00507.05 09/01/15 04101/16 S
<br />and
<br />EMISG6 (Ga acpar@opal
<br />1,000,000
<br />_.._ 1y0, 00O
<br />—� Ai OCCUR
<br />-P.
<br />MED Ia(P(fcaow pe $_
<br />lor
<br />PERSONALE ADV INJIIRV_ S
<br />110001000
<br />_._.—__.__...__—.___..__.._._�...,_
<br />OEN'L AGGREGATE LIMIT APPLIES PER,
<br />GENERAL AGGREGATE �5
<br />t�
<br />1—�1 11000
<br />' POLICY...__ PRO. _._ LOO
<br />ReviewedgRODUGTS-(.OMRfOP AOG S
<br />1\P.rVIPn�V�d L/------..._.-------$-.._..------
<br />11000,000
<br />AuroMoaael.welurY
<br />�.-
<br />cc
<br />E°awky, A—,__.�
<br />s
<br />BODILY INJURY (Per purFpnI
<br />S
<br />— ��-
<br />ANY AUTO
<br />^
<br />_
<br />ALLOWNEO SCMEGULED
<br />AUTOS AUTOS
<br />NONOWNEO
<br />"'"'—
<br />BODILY INJURY(Pae acutlene
<br />----
<br />$
<br />---
<br />n /'w
<br />SIiVIq �/uQ
<br />'�S
<br />�ROPiRPY G�—
<br />Pat
<br />d11REDAUTOS -. AUTOS
<br />PRCSA/Admin.
<br />-
<br />- —
<br />UMBRELLA LIAO i� OCCUR
<br />�
<br />EACH OCAURRENCE
<br />$
<br />4,004,000
<br />A
<br />ii
<br />EXCESS LIAS CLAIMS.MADE�
<br />I
<br />ELP0Q10195 -OS
<br />Od/01/15
<br />04101/lb
<br />AGOREGArE
<br />$
<br />__
<br />�b0, 000
<br />S
<br />DEO RETENTION
<br />WORKERBCOMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ATU (— D'�H
<br />T,:ORYDMITS.,—_LER_..._--__...._
<br />YIN
<br />ANY gRNME&C" "CLUERIEKHCLLTIYE
<br />OFRV
<br />F.rsidsonvi"N")EXOLUDEUY
<br />NIA
<br />_.... _
<br />E.L EACN ACCIDENT
<br />_
<br />S
<br />(Mpatlatdryin NNl
<br />ityyex. tl4miha uadar
<br />i
<br />EI/tISEA6E-EA EMPLOYE
<br />_._.
<br />4
<br />DEECR1PnGN OFOPHRATIGhlS dekwI
<br />E.L. DISEASEPOLICYLIMIT
<br />9
<br />DESCRIPTION OF OPERATIONSI LOCATIONSI VEHICLES (Added ACORD 101, Additional Remarks Schedule, 0 more space M raftakedl
<br />ADDITIONAL INSURED WITH RESPECTS
<br />TO THE OPERATIONS OF THE NAMED INSURED ONLY:
<br />CITY OF SANTA ANA, ITS OFFICERS,
<br />AGENTS, EMPLOYEES, REPRESENTATIVE AND
<br />VOLUNTEERS, FIESTA DE CARNIVAL.
<br />EVENT: FOR ALL OF CHRISTIANSEN AMUSEMENTS EVENTS FROM; 4/1/15 TO 4/1/16
<br />CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />PARKS, RECREATION AND COMMUNITY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />SERVICES AGENCY ACCO RDAN E WITH THE POUCY `;7 SEONS.
<br />26 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701 AUTHOR12E0 pESENF0. NE _
<br />01888.2010 ACOROOOC'.ORPORATION, All rights reserve
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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