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HomeMy WebLinkAboutFIESTA DE CARNIVAL (A-2015-188)-2015City of Sang 4na f Clerk of the C incil AGREEMENT TERMINATION FORM ----- —._.-._-_--______.___. COTC Office Use Only i -- Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. CITCL Y �h SaNTA ANC E�RK OF COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. j The agreement with V-1 f , l i - CLLY o 1 vao No. -A --,-�C%LS Ci�CA was completed on and final payment has been made. (List all amendments. Use space below if needed.) 4 IS f I Department: Phone/Ext.: Y'r ..52Cb,S7- j s�< OZ rD C IS - I -( Signature: Date: Revised 08-23-10 j .: (1NTIL INSURANGk @XFIHk6 0�- CI.kNK /F FIRST AMENDMENT TO NON - EXCLUSIVE AGREEMENT TO PROVIDE CARNIVALS AT CITY PARKS THIS FIRST AMENDMENT TO NON - EXCLUSIVE AGREEMENT TO PROVIDE CARNIVALS AT CITY PARKS is made and entered into this 20 °i clay of August, 2015, by and between Fiesta de Carnival, a California corporation ( "Promoter "), and the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("City "). RECITALS A. On February 3; 2015, the City entered into a Non - Exclusive Agreement to Provide Carnivals at City Parks, No. #A- 2015 -019, with Promoter for a term extending through February 3, 2016 C'Agreement "), as further specified in that Agreement. B. The parties now wish to amend the Agreement to include the provision of a "fun zone" event by Promoter at the City's Fiestas Santa Ana event to be held on September 12 and 13, 2015, in Downtown Santa Ana. The Parties therefore agree: 1. Section 2, Scope of Services, is amended to include the provision of a "fun zone" event, as described on Exhibit A to this First Amendment, at the City's Fiestas Santa Ana event to be held on September 12 and 13, 2015, in Downtown Santa Ana 2. Section 3, Fees/Deposits /Permits /Licenses, is amended to provide that Promoter shall pay the City $4,200 in exchange for the right to provide a "fun zone" event, as described on Exhibit A to this First Amendment, at the City's Fiestas Santa Ana event to be held on September 12 and 13, 2015, in Downtown Santa Ana, 3. Except as modified by this First Amendment, the terms and conditions of the Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement the date and year first above written. ATTEST: �_M QAA;X Z)'�! Maria D. Huizar Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho, City Attorney k!7v. Ire vp°_ B6/John M. Funk Assistant City Attorney �"yit..na6x FIESTA DE CARNIVAL Ted Ib V j «< @ \ : \"K, � \f Clienf#t 158 PAULMAUR ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD YYYY) a11n2o15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 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 Haas & Wilkerson Insurance 4300 Shawnee Mission Parkway Fairway, KS 66265 913432 -4400 - CO A NAME: PAIHCDNEd Ext:913432.4400 AIC No: E -MAL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER e; Star Insu ranter Company 16023 Paul Maurer dha Paul Maurer Shows; Paul Maurer Shows LLC 16081 Warren Lane INSURER C: AOCCUR ��P.ENCE 'PREMISS Ea oawr ante MED EXP(Any one person) INSURER D $Excluded $1,000,000 Huntington Beach, CA 92649 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LTR TYPE OF INSURANCE ABDLY o POLICY NUMBER MMIDON MMMOY/YEYYY - LIMITS A GENERAL LIABILITY G20496496 4/ 011201504101 /201q EACH _$1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR AOCCUR ��P.ENCE 'PREMISS Ea oawr ante MED EXP(Any one person) $100000 $Excluded $1,000,000 PERSONAL& ADV INJURY $2,000090 GENERAL AGGREGATE- GEN'L AGGREGATE LIMIT APPLIES PER: $2,000,000 (PRODUCTS- COMP /OP AGG $ POUCV PECI FXI LOC A AUTOMOBILE LIABILITY H08133268 21051'2015 _ 02/051201d CEO MBMEEDISINGLE OMIT $1,000,000 $ ANY ALTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS Jx BODILY I (Per accident) $ $ NON -OWNED HIRED AUTOS AUTOS rx PROPERTY RA MA Per.odco,m _ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ $ EXCESS LIAR CLAIMS -MADE : AGGREGATE DED RErEN'rION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICEWMEMTOIIEXCTUDEDEXECUTIVE= NIA WC0568554 1/01/2015 01101/2016 X i WC STATU- I OTH- .LIMEY E. L. EACH ACCIDENT $1,000,000 $1,000,000 (Mandatory in NH) E.L DISEASE- EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $1,000,000 _ ed �y•. DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (Adach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured: City of Santa Ana, it's officers, agents, employees, representatives and S volunteers, and Fiesta de Carnival.; Event Dates: Cesar Chavez Park GUeva SEE ATTACHED ADDITIONAL INSURED AND NON - CONTRIBUTORY ENDORSEMENTS 5�w�`d I Pd'('( 0 Workers' Compensation coverage applies to the statutory requirements of the state of Cali la. RcsP P City of Santa Ana, Parks, Recreation & Community Services Agency 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2010/05) 1 oil #S210502/M210499 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 Em 01988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SALAK MAN -01, (Oil R ENDORSEMEtff, ACE Afned"can IWW'4ancb Company Named insured Paul Maurer dba Paul Maurer Shows Effwave Data: ' 04/01/2015 Paul Maurer Shows LLC 12:Ot A.M., Started 11me Agent Names Agent No. THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA, CALIFORNIA 92701, OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES AND VOLUNTEERS FIESTA DE CARNIVAL, HINDS INVESTMENTS LP, AND DAYTOM ENTERPRISES, INC. ARE NAMED INSURED WITH REGARD TO LIABILITY AND DEFENSE OF SUITS ARISING FROM THE OPERATIONS AND USES PREFORMED BY ON BEHALF OF THE NAMED INSURED. WITH RESPECT TO CLAIMS ARISING OUT OF THE OPERATIONS AND USES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED, SUCH INSURANCE AS IS AFFORDED BY THIS POLICY AND IS NOT ADDITIONAL TO OR CONTRIBUTING WITH ANY OTHER INSURANCE CARRIED BY OR FOR THE BENEFIT OF THE ADDITIONAL INSURED. THIS INSURANCE APPLIES SEPARATELY TO EACH INSURED AGAINST WHOM CLAIM IS MADE OR SUIT IS BROUGHT EXCEPT WITH RESPECT TO TIIE COMPANY'S LIMITS OF LIABILITY. TIC INCLUSION OF ANY PERSON OR ORGANIZATION AS AN INSURED SHALL NOT AFFECT ANY RIGHT WHICH SUCH PERSON OR ORGANIZATION WOULD HAVE AS A CLAIMANT IF NOT SO INCLUDED. WITH RESPECTS TO THE ADDITIONAL INSURED, THIS INSURANCE SHALL NOT BE CANCELED, OR MATERIALLY REDUCED IN COVERAGE OR LIMITS EXCEPT AFTER THIRTY. 30 DAYS WRITTEN NOTICE HAS GIVEN TO THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA, CALIFORNIA 92701 EFFECTIVE APRIL 1, 2015 THIS ENDORSEMENT FORM AS PART OF POLICY NUMBER G20496496 ISSUED TO PAUL MAURER DBA PAUL MAURER SHOWS, PAUL MAURER SHOWS, LLC COUNTERSIGNED BY TITLE PRESIDENT INSURANCE COMPANY ACE AMERICAN INSURANCE COMPANY xo MAN -01, (Oil R POLICY NUMBER: OGLG20496496 NON - CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY COVERAGE Schedule Organization Additional Insured Endorsement CITY OF SANTA ANA, ITS OFFICERS, AGENTS, CG -2026 EMPLOYEES, REPRESENTATIVES & VOLUNTEERS (If no information is filled in, the schedule shall read: 'All persons or entities added as additional insureds through an endorsement with the term 'Additional Insured" in the title's For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IV.4.a: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured ") for a loss we cover under this policy, this insurance will apply to such loss on a primary basis and we will not seek contribution from the other insurance available to the Additional Insured. LD- 20267(06106) C "mpany Copy �s GSPIPd��r• PR Authorized Agent Page Iof1 POLICY NUMBER: CGLG20496496 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. �:JA1WWM1JI1L 101 MIN ot"11 I' 11-14111 M This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): FIESTA DE CARNIVAL Information re uired.to complete this Schedule if not shown above, will be shown in the Declarations. A. Section III — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for'bodily injury ", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 0413 B. With respect to the insurance afforded to these additional insureds, the following is added to Section 119 — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Company copy �ev`e�e d �P, �� �P I Pamir P� Page 1 of 1 POLICY NUMBER: OGLG2 0 4 9 6 4 9 6 NON - CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY COVERAGE Schedule Organization FIESTA DE CARNIVAL Additional Insured Endorsement CG -2026 (Y no information is filled in, the schedule shall read: 'All persons or entities added as additional insureds through an endorsement with the term 'Additional Insured" in the We") For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IV-4.a: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured') for a loss we cover under this policy, this insurance will apply to such loss on a primary basis and we will not seek contribution from the other insurance available to the Additional Insured, F2ev \oNed by'. F'�, Authorized Agent LD -20287 (06 /06) Page 1 of 1 company Copy CANCELLATION ENDORSEMENT Named Insured Endorsement Number Paul Maurer dba Paul Maurer Shows, Paul Maurer Shows LLC Policy Symbol Policy Number Policy Period Effective Date of Endorsement 620496496 04/01/2015 to 04/01/2016 Issued By (Name of Insurance Company) ACE American Insurance Company I nsen me on ley number. I ne remalnaef or me Imomanon Is io ce compiwao onry wrier sits enuur be ... eno. issues suuseyue ... . ... e i n.e THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Paragraph 2. of CANCELLATION (Common Policy Conditions) is replaced by the following: 2. We may cancel this Coverage Form by mailing or delivering to the first Named Insured and the person or organization shown in the Schedule written notice of cancellation at least: a. 30 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason. Name of Person or Organization: City of Santa Ana, Parks, Recreation & Comm Services Agency 20 Civic Center Plaza Santa Ana, CA 92701 SCHEDULE day. �e� °eke S� \� \a � pdm�r• PRGS Authorized Agent -D-5W26 (8/95) Page 1 of 1 I-AL a.J/6 4.'' DATE IMMIODIYYYYi, L___,,. CERTIFICATE OF LIABILITY INSURANCE 9/6/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED, the policy(les) 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 center rights to the certificate holder In lieu of such endorsemendsL Thompson Insurance Enterprises LLC 3380 Chastain Meadows Pkwy, Ste. 100 Kennesaw, GA 30144 INSURER(S) AFFORDING COVERAGE NAICN INSURED INSURER A: Essex InsuranceCOm�ariv 39020_, International Promotions, Inc INSURER B: National Union Fire Ins Co of Pittsburgh PA _12445__ DBA: Fiesta De Carnival INSURER 11278 Los Alamitos Blvd #101 INSURER O'. Los Alamitos, CA 90720 ..nr��� t _ t INSURER E: A- _C20 S& ,.,e - - - - -- - .�...- - -- -- /69134 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 CONE) ITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. I�R TYPE OF INSURANCE — - POLICY NUMBER I MMIODIYYYY POLTCXP MMIOOIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 000000 M1- LAMS -NV+UC f XLIAaI'CUG n I X FPG20011734 -02 4/19/15 4/19/16 _rEa _ �� -I" 1 _ 16U00 ME[ EXF oc oni sExcluded PERSONAL 3 ADV IIXRY _ $ 1,000,000_ GENERAL AGGREGATE_ :s 2,000,000 _ GEIJ I. AGGREGATE LIMIT APPLIES PER woouc Is t:OMPluk ADr, _ $2,000,000 X I POIJCY n 2 T LOC AUTOMOBILE . LIABILITY MY AUTO ALL OWtdED ACHFDULEC AU TOS AUTOS HIREDAUTO HCHrYrNGA AUTOS A y! �`, �r `` COMBINED JINGLE LIMI i' IEa DccldmA{ $ E LILT INJr iHI (Wa I rsar) $ 60DILY IN URY(Pel ardent) R Pf1pPEPTY DAINAGE Ire ucudentl $ UMBRELLA LIAR .1CV;UR v V' EACH nCCUPRFN- F $ EXCESS LIAR CIAIMS -MADC- `\J�V IP e AGGREGATF $ OF0 RETENTIriN$ $ WORKERS COMPENSATION ANDEMPLOYERTUABILITY YIN ANYFFOFRIErORIFAR7NLRlLREL'UTIVE UDED? ❑ OFFIKERIMEMOER EXCLUDED? NIA �] C^ Ytt'GTATI J. OTti- 7G(_Y UMCTS ER L EACH AOCIC�:. I`IT __- _'r EL DISEASE - EA EMPL OYEE — it (Manrlatory lnNH) If vyaas. d"Yne, under' DESCRIPTION �iFOPERATIONGbsB,, EL DISEASE - POLICY LOdIT $ B Accident and Health SRG9111254 -A- 4371 -00 4/19/15 4/19/16 EACH OCCURRENCE s 1,000,000 AGGREGATE $ 2,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Addiflonai Remarks Schedule, If more space Is required) City Of Sruita Aca; Parks, Recreation 3 Community Scrvices Ageucy; its officers, enlployees,reyresentatives, and volunteers me listed as Additional insured per (lie attrwLed CG 20 2G 04 13 endorsement. Coverage is primary per the ettachnd.MECY.. 0010 03 11 endursensau. City Of Santa Ana; Parks, Recreation & Community Services Agency SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, CA 92701 1 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 5 POLICY NUMBER POLICY CHANGES COMPANY FP G20011734 EFFECTIVE Essex lnsuranceCompany 9/3/15 NAMED INSURED AUTHORIZED REPRESENTATIVE International Promotions, Inc, DBA: Fiesta De Carnival Greg Thompson 11278 LosAlamltos Blvd 0101 Los Alamitos, CA 90720 COVERAGE PARTS AFFECTED Commercial General Liability Coverage Part CHANGES It is hereby agreed that the following Additional Insured is added: City of Santa Ana; Parks, Recreation & Community Services Agency 20 Civic Center Plaza Santa Ana, CA 92701 b� Form # CG 20 26 0413 �e6 Description Additional Insured - Designated Person or Organization Form # MEGL 0010 03 11 �g e Description Additional Insured - Primary and Non- Contributory (jU A. ALLOTHERTE- RMS AND CONDITIONSREMAINUNCHANGED. �R(jSP - � Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc , 1983 Page 1 of 1 Policy Number: FPG20011734.02 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART R'Z *J.I�rlW Name Of Additional Insured Person(s) Or Organization(s): City Of Santa Ana; Parks, Recreation & Community Services Agency; its officers, employees, representatives, and volunteers. A. Section II — Who Is An Insured is amended to include as an additional insured the persons) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. F e'O' N06 V1.. SRG NJ pdm`�'' CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER; FPG20011734 -02 MARKED ESSEX INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT - PRIMARY AND NON - CONTRIBUTORY This endorsement modifies Insurance provided under the fullowing: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE_ FORM SCHEDULE ADDITIONAL INSURED OR ENTITY: -- ° INTEREST; City Of Santa Ana; Parks, Recreation & Community Services Agency; its officers, employees, representatives, and volunteers. On Premises Set -Up and Operation of party rental devices Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorse- ment may or may not be defined in all coverage forma, SECTION II — WHO IS AN INSURED is amended to include as an Additlanel Insured the person(s) or entity(s) shown in the Schedule above, but only as respects negligent sots or omissions of the Named Insured and only for "nccurrences ", "claims" or coverage not otherwise excluded by this Ir19LIranoe. Where no coverage applies to the Named Insured, no coverage or defense applies to the Additional Insured shown In the Schedule above. No coverage applies to the Additional Insured scheduled above for any "bodily injury ", "personal and advertising injury', or "property damage" to any "employee" of the Named Insured of to any obligation of the Additional Insured to indemnify an- other because of damages arising cut of such injury Subject to the above, when coverage applies to the Additional Insured(s) listed above, it shall be primary insurance as respects any "claim ", loss, or liability arising out of the Named Insured's operations as covered by this insurance. If cov- erage applies under this policy, any carer Insurance maintained by the Additional Inswed(s) as a Named Insured shall be excess and non - contributory to the coverage provided by this insurance. All other terms and conditions remain unchanged, MEGL 0010 03 11 Inoludes copyrighted material of Insurance Services Cf ice, Inc, Page 1 of 1 with Its permission. A� " CERTIFICATE OF LIABILITY INSURANCE DA3%31/1Y51 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 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, tine pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to The terms and conditions of the policy, certain policies may require an endorsement. A statement oil this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Allied Specialty Insurance,InO CONTACT NAME_. 10451 Gulf Blvd PHONE 1 FAx Treasure Island, FL 33706 .ltll� 2�X1L -- _(AGC No);._.__. E.maa - 8002373355 ABDrsBSs 100,800 INSURERS) AFFORDING COVERAGE_ NNCp INSURER A' T.A.E. Insurance Company 12866 INSURED Christiansen Amusements, Inc. INSU Sea: and Southland Shows, Inc. — P. O, Sox 997 INSURERC Escondido, CA 92033 INSURERD .A « —Ck.IV 1111. �r „Cj INSURER E _ i"'Y 25 Cf INSURER F: 'r COVERAGES CERTIFICATE NUMBER: 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 HERFIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INr S R I ABOLTB IID' _ TYPE OR INSURANCE "`} VE %P POLICY NUMBER IMMID iY Y LIMITS GENERAL LIABILITY i EACH OCCURRENCE S 11000, 000 A XI COMMERCIAL GENERAL LIABILITY CPP0100507-05 _ 1. 04/01/15 ' 04/01116 PRMI�FTOJleee)I,tDe�nce) S 100,800 I CLAIMSMAbE X DCGUR MEU FOP (Any onP Pesan) S _ _ PERSGNALAADVINJURV IS 1,080,000 OFNERAL AGGREGATE S 10 000.000 GEN'L AGGREGATE LIMIT APPLIES PER Reviewed rrti by. PftODIICt SCOMPIOP AGG �S iJ 1,000,000 POLICY PRO LUC J 5 .. AUTOMOBILE LIABILITY �-^ .COMBINED SINGLE ((E91ii atC89...__.... ANY AUTO nG01LY INJURY (Per Veansurd 5 A MED i --- SCHEDULED AVTC,$ AU ME NON-OWNED Cuevas ITNmJyU (APGm a 5 drnSilvia j P EGDIPLEY HIRED Al705 AUTOS PRCSA /m PnO cR DRAY M S actlY t___~ UMafte"LIAR xI OCCUR - s EACH OCCURRENCE $ 41000,000 A I� E%CES6 UA0 CLAIMS MgIrE` ( ELP0010135 05 04/01/15 1 04/03/16 AGGREGATE 4 000,000 OED RETENTIONS S WORKERS COMPENSATION 0TH ' AND EMPLOYERS' YIN UT„T �— — Ei l __.. ANY PIOPRIEORIPARTNE/WXFtU1TYE OF J,NIA E L EACH ACCIDENT S (Mandate ryI.. —1, 1 EL OIEEASE - EA EMPLOYEE S — ECknPNO iON5 Um� aw E.L DIS6A9F POLICY LIMIT 5 l DESCRIPTION Of OPERATIONS i LOCAiiONS 1 VEHICLES (Attach ACORD 101. AtltllOCnal Remarks 9ohetlule, If Moro space 1s requiYeq) ADDITIONAL INSURED WITH RESPECTS TO THE OPERATIONS OF THE NAMED INSURED ONLY: CITY OF SANTA ANA, PI'S OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVE AND VOLUNTEERS, FIESTA DE CARNIVAL. EVENT: FOR ALL OF CHRISTIANSEN AMUSEMENTS EVENTS FROM: 4/1/15 TO 4/1/16 CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PARKS, RECREATION AND COMMUNITY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SERVICES AGENCY ACOOROAN911 WITH THE POLICY PRQ9iV� _ ISIONS. 26 CIVIC CENTER PLAZA 1% // SANTA ANA, CA 92701 AUTHORIZED RESENTATIVE / I „ ) All ACORD 25 (2070705) The ACORD name and logo are registered marks of ACORD CHRIS23 OR ID: JU W —? CERTIFICATE OF LIABILITY INSURANCE DATE IWACIDAYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 0713072413 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 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(!") must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain Policies may require an andorsament. A statement oil tills certificate does not center rights to the Certificate holder In fiou of such andorsomant {sue_ PRODUCER ry NT CT Craig Haft Ills,So"., hic OB48084 Randolph apo,iin, Ext):630. 562.9161 FAx �,Mnit lac, NoP. 630552.6462 522 Main Street ADDRESS: craigh @wsrins.com Woodland, CA 96596 lIENERAL AGGREGATE S Craig Hutt INSURER(S) AFFORDING COVERAGE PAID OTHEn. Reviewed INSURERA;State Compensation insurance 36076 INSURED Christiansen Amusements INSURERS; Stacy Brown . P.O. Box 997 INSURER p: Escondido, CA 92033 INSURERD: HIREOAUTOS AUYe )Vp INSURER E', Jt�„"yj jy j NSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 'THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT NTH RESPECT TO WNICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THEIR ADOL EVER POLICY EFT, POLICY EXP _ TYPE OF INSURANCE INQp INYp ppLICy NUMBER IMMIgWYYYjSMMIDO(YYYTj LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ OAMAOG TO BENI'GO CLAIM$4AOE OCCUR PREMISES nea.urlenco). -$ MED EXP(Ally one person) 3 PERSONAL &ACV INJURY $ GENL AGGREGATE UTA f APPLIES PER. lIENERAL AGGREGATE S POLICY IT JE�r I.00 by; PRODUCTS- COMPOP AGO $ OTHEn. Reviewed $ ._.__ AUTOMOBILE LIABILITY _ _�»_.�....� �.�_ -� �P /i NEU INGLE LIMIT —8 " ANY AUTO BODILY INJURY (P., Telenet S A". 08NED SCHEDULED BODILY INJURY (Per I111000 S AUTOS NOMOVINTED PROPERTY DAMAGE q HIREOAUTOS AUYe )Vp Jt�„"yj jy j UMBRELLA LIAR OCCUR EACHOOCURRENCE S EXCESS UAG CLAIMS MADE AGGREGATE $ pEp RETENTIONS $ WORI(ER$COMPENSANMONS PER ��OTIb X STATUTE rR ANDEMPLOYERS'LIAOILIIY YIN A ANY PNOPItIflTUNIPARTNF :HItCECEI YIVE 90680352014 0810912014 08/41/2010 EL EACH ACCIDENT S 1,000,000 CFFICERVMEMBER EXCLUDCU't � -..., NIA (MRAINnueInHill — E.L. DISEASE- E.ASIAKOYE8 S 1,000 +000 Ilyya& 6esenbe UT!" DESCRIPTION OF OPERATIONS below E.t. DISEASE. POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORU 141, AUJlllongl galtlPrka ScnoUUle, may W attaenoa 11 more space le requlmtl) Evidence of insurance related to all Christiansen Amusements events between Sllj14 - 913/26. CITYSA3 City of Santa Ana 20 Civic Center PIa2a Santa Ana, CA 92701.4069 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 0 19118.2044 ACORD CORPORATION. A8 rights ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD EXHIBIT B ADDITIONAL INSURED ENDQRSEl ENT FOR C(DIVIMERCLAL�CCEN BRAL LIABILITY POLICY InSUranee Company T.H.H. Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy 4Cljt�otposo,?wns __relatingto the following; 1, The Housing Authority for the City of Santa Ana (Agency), 20 Civic Center Plaza, Santa Ana, California 92701; their officers, employees, agents, volunteers and representatives are named as additional insureds ( "additional insureds ") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured, 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability, The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included, 4. With respect to the additional Insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the Housing Authority for the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Efl.'ective n/oI /a.s this endorsement Form as a part of Policy# CPPO100407 -o5 _ Issued to Christianeen AM Nenients, Inc. and Southland Shows, ins._ Named Insured Courrtersigned by _ Authorized Representative Reviewed by: Silvia Cuevas PRC AIAdmin, AC.(7R[7 DATEIMMIDONYYY) CERTIFICATE F LIABILITY INSURANCE _3/31/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 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 policylles) must he endorsed. if SUBROGATION IS WAIVED, subject to the tariffs and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer fights to the certificate holder In lieu of such endorsement s). PRODUCER CO TACT A11ied Specialty Snsurance,Inc NAME: _ 10451 Gulf Blvd PHONE ;talc NO); Treasure Island, FL 33706 EMAIL — 8002373355 ADDRESS INSURED Christiansen Amusements, Inc. and Southland Shows, Inc. P. 0. Box 997 Escondido, CA 92033 INSURERA; T.H.E. Insurance INSURER B: Cf1VFRArFR CERTIFCATF MIIMRFR• 09% /IRInM nBIkACCD- THIS IS TO CERTIFY THAT 1 H 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 OT14ER 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. IN AOOL SUBR T TYPE OF INSURANCE e; i'OUCY EFF PoLICY EXP POLICY NUMBER MMIDDIYYYV MM,DDIYYYY LIMITS OENF.RAL LIABILITY I EACH OCCURRENCE 5 1,000,000 1' CCU r - DAMAtiEWREBTECT - CPPOIOOS07 "05 04/01/15 04/Ol(16 - -- 100,000 PREMISES(E. avxu?ance) $ GLAIMS MADE a' I OCCUR CL ! MED"P(Aryona Perron) 5 _ PERSONAL A ADV INJURY _ I$ 1,006,060 I _. _ _ OENERAI Arr�RCanic tt��] AA` I�,,) ...__ 000 400 U_EM1'L AGGREGATE LIMIT AP PLIC9 PER __.. 1�8V(2VV u °Y. _PRODUCTS COMPIOP AUG _ IS 1,000,000 .. POLICY JECT 1LOC i5_ —.— AUTOMOBILE LIABILITY C,OMt1IDiCD SINGLE LIMIT AE. 0-owl S ANYAU10 I 5 I AtLOMED SCHEDULED AUTOS AUTO,9 `' OI'UjU � V �S BODILY tle 1 NON-OWNED PIED HiREDAlITO, AUTOS (� q /� ,4 1 ERTYUD MAGCew PRCSA�A� min. (Vic fltdgn¢_ ,_._. T _. 5 ! UMBRELLA LIAR X OCCUR "' E1ChI OCCURREPICE_ S 41000,000 A iK EXCESS LIAR CLAIMS MADE ELP0010135-05 04)01)15 04 /01 /IbgGriREOATC 4, 000, DOD I DER_ OI5 — It TWO—RER_COMpENSATIO N ~� LIABILITY YIN F.L EAGH ACCIOEhIT_ ANY PROPRIETOR /PA %ECUTIVF OFHOERIMEMBER EXCLUOEDn 'NIA if dto; (n NH Y 1 � .DISEASE CA EMPIOYr S a yes, tlendrlBN under I OPERATIONS t — — -- E'X'RIPTIODI OF W. 1 DISEASE - POLICY LIMIT S OESOMPTION OF OPERATIONSI LOCATIONS I VEHICLES IAHach ACORD 101, Addlllmmi Remarks Schedulo,1 more space Is requlred) ADDITIONAL INSURED WITH RESPECTS TO THE OPERATIONS OF THE NAMED INSURED ONLY: CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVE AND VOLUNTEERS, FIESTA DE CARNIVAL. EVENT: FOR ALL OF CHRISTIANSEN AMUSEMENTS EVENTS FROM 4/1/15 TO 4/1/16 CITY OF SANTA ANA ATTN: RISR MANAGEMENT 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BB DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 01998.2010 ACORD ADDED 25 (2090105) The ACORD name and logo are registered marks of ACORD F`� "' CERTIFICATE OF LIABILITY INSURANCE DAT j I jYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 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 pohcy(fes( must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require ark endorsement. A statement on this certificate does not center rights to the certificate holder In lieu Of such endorsererd s . PRODUCERAllied Specialty Insurance,Inc CONTAC _ r _ 109:51 Gulf Blvd PHONNe FAA Treasure Island, FL 33706 E.mAa 8002373355 gonRESS __. INSURER(JAFFORDING COVERAGE NAIC# INBORERq T H.E Insurance Company 112866 INSURno Christiansen Amusements, Inc. INSURERS and Southland Shows, Inc. INSURER C: P. 0. Box 997 Escondido, CA 92033 gsuReRO __ INSURER U:. INSURER COVERAGES CERTIFICATE NUMBER- RP \ /IRIMI MIIMpFR. 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. iLSRr -- -�IML�S,'A�^' POLICVEFF POLIC�,P. TR iYPE OF INSURANCE ++ca+c _ POLICY NUMBER �IMMIOtUYYVYf�f,MWDD)YYYY LIMITS GENERAL LIABILITY s 1,000,000 A ICOMMERCIALGENERALLIABILII'Y CPP0100507 05 04/01/15 04/01/16 IACHOOCURREIvCE hRE'MISCS(EacEianee) �3 100,E CLAIMS -MADE }{..00CUR MED EXP(Any one nenon) PERSDNALA AD_V .I_P._ LRV 5 ,000, OOD ReV. 2W8d by GEry s 11O 00010 6 0 GEN'L AGGREGATE LIMIT APPLES PER. PRO- ,��- yyy/'' ! ��,. -f! iCROpUCTS COMPMIP AGG 5 1,000,000 POLICY f7 ! LOC AUTUMOBI(ELIpaiLITV I cuqq KEMOINEDSINGLELIMN L l . S. ANYAUTO Silvia vCU BODILY HI JURY (Pere non? 3 A ONJEp -..OULED AU TOS AUTOS PRCSA /Admjn. BODILY INJURY (PeI amldoni) _. 5 NON ED �IIIREC>AUTOS AUTOS AU'I'OS PRt1PERTf DPMtiGF S _- .._. -iXj f — S ..0. —..00._ -A LIAR UMBRELLA LIAS $'i, ocouR DO EACIIOCCIIRREIJCE 3 Ar ODD, DDD V A XI i EXCEH9 LIgB ICLAIMSMADEI L:L,P0010135 -05 !, o4 /olns 04/01/16 _. _ _ AGGREGATE _ _ S 4,000,000 �I DED RETENTION i WORKERS COMPHNSgTION WE,TATU., 10TH- AND EMPLOYERS' LIABILITY YIN 1 AIIYPROPRIETOR IPARTNERIEXECUTIVE El. FACHACCIDENT 3 orr CERIMEMBER EXCLUDCIY NIA -- ELDISEASE EA EMPLOYEE (Mandatory lnAN) s If Yax, u dun. " �� 1— _ 0 SCRIPNON Of OPERATIONS below I EL DISEASE POLICY LIMIT TS jjj DESCRIPTION OF UPEPAI' IONS I LOCATIONS I VEHICLES (plYdch ACORD 101. Addltlannl RemuBa Schetlnle, IT more apace Is rngWretl) ADDITIONAL INSURED WITH REPS &CTS TO THE OPERATIONS OF THE NAMED INSURED ONLY: PAJARITO, LLC, MR. FRANK CHAVES, CITY OF SANTA ANA. FOR THE DATES: 4/29/15 THROUGH 5/04/15 ' PAJARITO, LLP FRANK CRAVES P.O. BOX 11412 SANTA ANA, CA 92711. ACORD 20 (2010105) SHOULD ANY OF THE ABOVE THE EXPIRATION DATE T ACCORDANCE WITH THE POI The ACORD name and logo are registered marks of ACORD CANCELLED BEFORE BE DELIVERED IN rinhrc rncn n,nH ACii CERTIFICATE OF LIABILITY INSURANCE DA3% ) 31/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOA'nVELY 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 Ilia certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to Ilia 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 andorsement(s). PRODUCERAllied Sralty Insurance,Inc CONIC __ 10451 Gulf Blvd PHONE PAX Treasure Island, FL 33706 10-119 -5el1 __ _ (AIC No) 8002373355 AboaESS INSURERIS) AFFORDING COVERAGE NAICk INSURERA T.H.E. Insurance Company 12866 INSURED Christiansen Amusements, Inc. INSURERB and Southland Shows, Inc. — P. O. BOX 997 INSURER Escondido, CA 92033 NsuneRD COVFRAr.FR CPRTIFICATF A HUPPR• RPVICInMMIAAMC.- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWI'THSTANOING 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _POLICY EFf POZICY EX MSA TYPEOPINSURANCE b"I ���y�i�}-- POLICY NUMBER MtNUWVYYY �� MAVbDIYYV .- .... —.. — LIMITS GENERAL LIABILITY I EACHOC(ARRENCE 5 11000, 000 IIr COMMERCIAL GR&RAL LIABILITY 04/01/15 04/01/16 __.. -100, 000 PRPMSrS( J eoc «e51— S CLAIMS MADE 1, .i OCCUR . ... _ MN FY.f (AnY ne Pereol) s __. PERSONAL S AOV INJURY s 11000,000 __.� I r 7.0 000,000 GENERAL AGGREGATE Is - AGGREGATE LIMIT APPLIES E—C R PRODUCTS COM_ PI_O. P AGO 11 000,000 '. POLICY ,r LPO� l III. IS S TOM LIABILITY IJ LE L @ilT I COMU IN L1Ea.exxbng ANY ADrD BODILY INJURY (Per peNoN 5 ALLOIMVEb SCHEDULED ( _ AUTO AUTOS F AUTOS BODILY INJURY (Vol daq 5 PRO ERTYDAMA7° -E— y NO AV1 U9 AUTOS ' _ ( UMBRELLA LIAD _ . OCCUR ReVii y, EAUVOCCURRENCE s EBGESS LIAD (RA CLAIMS MADE " AiiGRLGATE i S ....._ t DED I RE "rENYIOM$ RETENTITV I WORKERS COMPENSATION YV:. STATU� OTII .T RY I,yL1T¢— 6R AND EMPLOYERS' YIN' EL EACH ACCIDEN? s _ ANY (IV(a C OFFICERM rj INIA 7 Ievnn 5 If d If he RICSIf( 1+11(t)n• i EL DISEASE CA F.MPI OYFC S ..._— In OFF f F _ In PTION OF OPERATIONS W. E L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (AtMOh ACORD tai, Atldlllonel Remarks Schedulq, it mare SRauc IS regWretl) ADDITIONAL INSURED WITH RGPECTS TO THE. OPERATIONS OF THE NAMED INSURED ONLY: THE HOUSING AUTHORITY FOR THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS, LOCATION: 1120 & 1146 E. WASHINGTON, SANTA ANA, CA FOR THE DATES: 4/27/15 THROUGH 5/05/15 THE HOUSING AUTHORITY FOR THE CITY OF SANTA ANA 20 CIVIC CENTER PLAZA, M-2 SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROLISIONS. 4 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORO reserved. AC40Ra CERTIFICATE OF LIABILITY INSURANCE 3!3012015 DATE tMMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(his) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the PRODUCER NAME7' Joanne Manion Arthur J. Gallagher Risk Management Services, Inc. PHONE ya.�kgy�- 45A-3386._ Nar425- 451 -371 777 108th Ave NE, #200 " . _ _..__ _ — __iac, "e -Ina -- Bollevue WA 98004 ADDRESS: INSURER(S) AFFORDING COVERAGE NAICp INSURER A:American States Insurance Company 19704 INSURED CHRIAMU -01 INSURERS: Christiansen Amusements, Inc INSURER C: P. 0. Box 997 Escondido, CA 92033 -0097 IN SURER D: INSURER E: INSURER P COVERAGES CERTIFICATE NUMBER: 177753472 REVISION NUMBER: THIS IS 1 "0 CERTIFY THAT THE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 'rO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 1'HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - -ADDL -SUER POLICY SEE POLICY EXP LTR TYPE OF INSURANCE IN SR WVp POLICY NUMBER IMMIDDIYYYYI _LMMIOOh Y) LIMITS GENERAL LIABILITY EACHOCCURRENCE S OAMAOETORENTED COMMERCIAL GENERAL LIABILITY PRFMISF.S traepcunenpa) 5 CLAIMS MADE OCCUR NED EXP(Any dialed) 5 PERSONAL$ ADV INJURY 5 GENERAL AGGREGATE 5 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGO 5 P M1 /1/715 4 /i POLICY FRO. tOC S A _ AUTOMOBILE LIABILITY U1CI56248840 F1172-6W I �E�1' —v� I(Ee acGldanpll SN' $1,e00,000 X ANY AUTO BOOR Y I NJURY(Per person) S ALL OMMFD sCHEnULED BODILY INJURY (Per accident) S AUTOS AUTOS X NON OMED PROPERTY DAMAGE HIRED AUTOS X AUTOS (Parecckwol) S UMBRELLA LI0.a OCCUR _.._,., T�C+V IG'Y° EACH OCCURRENCE 5 EXCESS LIAR CLAIM & -MAPEI ""7 �,.� AGGREGATE 5 DED RETENTIONS I 5 WORKERS COMPENSATION W STATU— OTH — ANDEMPLOYP.RS'LIABILITY Silvia Cuevas, IACH LIMITS FR ANY PROPANCTORIPARTHIR!EXEGUTIVE _ GG Cuevas EACH ACCIDENT 5 OFPICRRIMEMpEIi EXt;LU0Ep9 NIA (Mandatory in NSW) PRCSA/Adrnfn, E. L. DISEASE -EA EMPLOYEE 5 lielit deacdha under 1� 'P'riON OF OPERA TIONS aeNw E.L. DISEASE -POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Radiative Sclfedula, It edam space la Needed) The City of Santa Ana, its officers, employees, agents and representatives and Fiesta de Carnival are Included as additional insureds but only as respects the operation of the named insured per policy terms and conditions per farm CA7110 0307. For all Christiansen Amusement events during the period 4/1/2015 - 411/16 City of Santa Ana Attm Robert Carroll 20 Civic Center Plaza Santa Ana CA 92701 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE Zt Y 'r' El Tarid -2010 ACORD O JKI`VKA ITUN. All rlgnts reserved. ACORD 25 (2010/05) The ACORD name anti logo are registered marks of ACORD