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FIESTA DE CARNIVAL (A-2015-188-02)-2016
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FIESTA DE CARNIVAL (A-2015-188-02)-2016
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Last modified
3/27/2020 9:30:51 AM
Creation date
11/7/2016 4:00:53 PM
Metadata
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Template:
Contracts
Company Name
FIESTA DE CARNIVAL
Contract #
A-2015-188-02
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Expiration Date
2/2/2017
Insurance Exp Date
5/27/2017
Destruction Year
2022
Notes
A-2015-019; A-2015-188; 01
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DATE (MWDDfYYYY) <br />A" R" CERTIFICATE OF 'LIABILITY INSURANCE 3r3i2017 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CON'F'ERS 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 policy(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 />PRODUCER <br />CONTACT Christine Nidel <br />NAME: <br />Governor Insurance Agency, Inc. <br />.,.IPHO,No,Ext): (330)539-9999 _ (AIC,..Nnj:tS�OI..539-9998. <br />MAIL <br />972 Youngstown -Kingsville Rd. <br />EACH OCCURRENCE <br />P.O. Box 770 <br />INSURER(S) AFFORDING COVERAGE NAIL # <br />Vienna Oka 44473 <br />_.INSURED.... <br />INSURERA:R-T Specialty LLC <br />'..X VEA457676 5/27/2016 5/27/2017 <br />INSURER B: ...._. ....... -.... ... <br />International Promotions, Inc.A-2015-188-02 <br />INSURER C: <br />Fiesta de Carnival A-2015-188-01 <br />INSURER D: <br />11278 Los Alamitos Blvd <br />INSURERS : <br />Los Alamitos CA 90720 <br />INSURER F. <br />COVERAGES CERTIFICATE NUMBER:CL166108412 REVISION 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF INSURANCE ..... .RODE 3UBR.. __.POLICY NUMBER _. MMIDDIYYYY POLICY MMIoDIYYVPN...' <br />LTRIN" <br />LIMITS <br />X COMMERCIAL GENERAL. LIABILITY <br />EACH OCCURRENCE <br />$ 1, 000, 000 <br />A CLAIMS -MADE ! X OCCUR. <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) <br />..... 100, 000... <br />$ <br />'..X VEA457676 5/27/2016 5/27/2017 <br />MED EXP (Any one person) <br />$ FXa17Aded <br />PERSONAL 8 ADV INJURY <br />$ 1, 000, 000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />X POLICY PRO- <br />JECT LOC <br />PRODUCTS - COMPIOP AGG <br />$ 2,000,000 <br />',.... OTHER: <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br />_ <br />(Ea accident)_.. <br />ANY AUTO <br />BODILY INJURY (Per persen) <br />S <br />_. <br />_ ALL OWNFU SCHEDULED <br />BODILY INJURY (Per accident) <br />S <br />AUTOS AUTOS <br />NON-OWNED <br />NON -OWNED <br />PROPERTY MAGE <br />$ <br />HIRED AUTOS AUTOS <br />(Per accident)....... <br />...... ..... <br />UMBRELLA LIAB OCCUR _ , q ,g .� �I <br />EACH OCCURRENCE <br />S <br />EXCESS LIAB CLAVM_ S MADE O W� <br />AGGREGATE <br />$ <br />DED RETENTION$r,,,� <br />,°' <br />$ <br />WORKERS COMPENSATION '" ,� <br />AND EMPLOYERS` LIABILITY y G n <br />�' ,,. <br />PER OTH- <br />STATUTE:. ER <br />Y 1 N�^f <br />ANY PROPRIETORYPARTNER/EXECUTIVE <br />E L , EACH ACCIDENT <br />$ <br />OFFICERIMEMBER EXCLUDED? NIA <br />(Mandatory In NH) <br />E L DISEASE - EA EMPLOYEE <br />S <br />If yes, describe under T " <br />...... <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LpMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 1.01, Additional Remarks Schedule, maybe attached if more space is required) <br />Certificate holder is named as additional insured per the attached CG 2026 <br />form <br />City of Santa Ana <br />20 Civic Center Dr. <br />Santa Ana, CA 92701 <br />ACORD 25 (2014101) <br />IN 025onuni) <br />L91-20M.RP1111IF11116J9.1 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Thompson, ,Jr./CNIDEL <br />Q 1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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