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CHRI823 OP ID: JU <br />- CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDD/YYVYI <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />07/3012013 <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(los( must be endorsed. If SUBROGATION 18 WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In Ileu of such endoramnard a . <br />PRODUCER <br />NTAC <br />Craig Huft <br />Wraith, Scarlett & Randolph <br />Ins. GI!' Inc 0848084 <br />PH9N: FAx <br />ao. Na eM6530.662.0181 (AID, No): 630.662.6452 <br />Aon <br />622 Main Street <br />cress: cratgh@WSrtns.com <br />Woodland, CA 85596 <br />- --- <br />Craig Hutt <br />INSURER(al AFFORDING. COVERAGE NAIC0 <br />AUTOMoBiLEUAelurr +�I <br />INSURER A:StatO Compensation Insurance <br />INSURED Christiansen Amusements <br />_36076 <br />INSURERS: <br />Stacy Brown <br />__.. <br />PO BOX 997 <br />INEURERC: <br />Escondido, CA 92033 <br />INSURERD: <br />r�s�II/Via <br />INSURER E: <br />UMBRELLA UaB OCCUR <br />EACH OCCURRENCE 5 <br />COVERAGES CERTIFICATE NUMBER: RRVMION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CON017IONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />1Nsft __ TYPE OF INSURAN0A .-ArlDLSUBR-._-_- _-NqQ syn POLICY U._ ._.POLICY EFFPOwtogYtXEYL <br />XYPGDOYYY i' <br />LIMI76... <br />COMMERCIAL GENERAL LIABILITY <br />EACHOCCVRRENCE S <br />CLAIMS�MADE OCCUR <br />DAMAGETORCNTEO <br />PROMISES (EaoOpurrmaa7 ,S _ <br />MEDEXP(Anyono Feaw„ S _ <br />PERSONAL &ADV INJURY S <br />,.$. _ <br />GENT AGORWArE LIMIT APPLIES PER: <br />GENERAL AGOREGATE <br />POLICY JECT LOC <br />Reviewed by: <br />PRODUCTS COMP/OP AGO S <br />OTHER . <br />5.._- <br />AUTOMoBiLEUAelurr +�I <br />(Eo u6INVE—SI Lf '" s <br />ANYAUTO "'Y'S '/ I <br />BODILY INJURY (Per person) S <br />AUi'OOSS NED SCHEDULED <br />BODILY INJURY (Per awdem) S <br />C urevas <br />PROPERTYDAMAdE <br />MREDAUTOS AUTOWNEO <br />5..... <br />(Pat a"weral <br />r�s�II/Via <br />UMBRELLA UaB OCCUR <br />EACH OCCURRENCE 5 <br />EXCESS UAB CLAIMS-MA_DE <br />AGGREGATE 5 <br />DEC RETENTIONS <br />S <br />e� <br />WORKERS COMPENSATION <br />PER <br />AND EMPLOYERS' CIAeILiTYX <br />YIN <br />$YA14TE EH <br />A ANYPROPRIETUN,vARTNERIEXELUnVE 906803$2014 08/0112014 0810112016 <br />E.L. EACH ACCIDENT S 11000,000 <br />OFFICERAIEMRER EXCLUDED? NIA <br />(MeddQBFIn NH) <br />EL. DISEASE - EA EMPLOY WE S 1,060,000 <br />PEeC,ge <br />- <br />O8OF e <br />. DESOICY IT 1,000,900 <br />DESCRIPTION OF OPERATIONS ILOCAPONS I VEHICLES (ACORO 101, AddllleMl Bananas SahaduN, nay hsamu w areata Spee is raquhad) <br />Evidence of Insurance related to all Christiansen Amusements events between <br />8/1/14 - S/1/15. <br />CITYSA3 <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701-4068 <br />SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />All dome <br />ACORD 26 (20/4101) The ACORD name and logo are registered marks of ACORD <br />