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Home My WebLink AboutFIESTA DE CARNIVAL (A-2015-188-01)City 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 COTC Office Use Only i -- Please complete this form when the attached agreement and all amendments (if any) are no longer in effect.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 MAYOR Miguel A. Pulida MAYOR PRO TEM Vincent F. Sarmiento COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Raman Reyna Sal Tinajero INNJHAMJG tjNF,h CITY OF SANTA ANA PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 . P.O. Box 1988 M-23 Santa Ana, California 92702 900anta-ana.org December 22, 2015 Ted Holcomb Fiesta de Carnival 11278 Los Alamitos Blvd, #101 Los Alamitos, CA 90720 A-2015-188.01 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Ret Extension of Non -Exclusive Agreement to Provide Carnivals at City Partes Agreement No. A-2015-019 Dear Mr, Holcomb: Pursuant to Section 5 of Agreement tato. A-2015-019, entered into by Fiesta de Carnival and the City of Santa Ana, dated February 3, 2015 and as amended by First Amendment No. A-2015-188, the term of the Agreement is hereby extended for an additional one (1) year period, from February 3, 2016 to February 2, 2017. The insurance certificates are required to be extended and/or renewed to cover this extension. The carnival event and fee schedule for this period is attached as Exhibit A. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, Gerardo Mouet Executive Director of Parks, Recreation, and Community Services Agency CITY OF SA David Cavazos City Manager APPROVED AS TO FORM M. Funk Assistant City Attorney ATTEST Maria D. Huizar Clerk of Council SANTA ANA CITY COUNCIL Miquat A. Potion VmCant F, Sarmiento Mlchele Martinez Angelis Amezdua Z P. David eerravidas Roman Reyna SM linajaro Mayor I Mayor Pro Tem, Ward I Wartl2i Wartl3 { Ward Ward Ward ull ra-e a.a VSarBjgpt4fd t oMM1itarr raz(p .te-arra urn i AAmezwa(dlsanla ana.4rn oBarm desr¢�saga-WARM R gM.— santP r9 Sime'. CONI ane om EXHIBIT A 2016 Carnival Dates Park Carnival Date License Fee 1 Jerome March 11-13 8,250 2 Cesar Chavez/Campesino April 8-11 4,500 3 Madison May 27-30 8,750 4 Rosita June 3-5 4,500 5 EI Salvador June 10-12 2,250 6 Jerome August 12-14 7,000 7 Madison Sept. 2-5 7,000 8 Cesar Chavez/Campesino October 14-16 4,500 46,750 ,A�ORL.F CERTIFICATE OF L IABILI LIABILITY INSURANCE 9/81151Gorvrvh THIS CERTIFICATE IS ISSUED ASA 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(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 confer rights to the certificate holder in lieu of such endorsementis), PRODUCER CONTACT NAME: Ruth Caner Thompson Insurance Enterprises LLC 3380 Chastain Meadows Pkwy, Ste. 100 Kennesaw, GA 30144 pHC."a EM qn T E•MAII, ADDRESS: rcalter@_.--—'Corp^com__ CUSTPMER -- INSURERtS),AFFORDING COVERAGE NAIC* -" . _....._.._..__...__—__.__—__ INSURED International Promotions, Inc DBA: Fiesta De Carnival 11278 Los Alamitos Blvd #101 Los Alamitos, CA 90720 (/ INSURERA: Essex Insurance COmpany_,�„_ 39020 INSURERS: National Union Fire.,ins Co of Pittsburgh PA 44 INSURERC: INSURERD:— — -- — _ INSURERF: 6100000 _— 1100000–"-- ir�C7Co�� leXaYla:CX13a�Maa1101Md\e�P111191Y�:1�Yi1!IK4 Ytl116Y61. KJ11L41_lyr� 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 CONTRACTOR OTHER DOCUMENT WITH RESPEOTTO 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. !Rets. LTR _.__.-_.,...._...__....._.. TYPE OF INSURANCE DER _____.._....�_—..�— POLICY NUMBER P�EICV EFpp MMlDWYYYY PDY E' MMICDIWYY ....—._._ _._..___._ LIMITS GENERAL LIABILITY EACH OCC'URRE'NCE_ $ 1 000,000 x 00MMERCIAI.GENERALiANLITY --1 CIAMSMADE [F]OCCURX FPG20011734-02 4/19115 4/19/16 PREMISE: Ea xp E- 'MED 6100000 _— 1100000–"-- EXP (AnVcn0parson) $Excluded PERSONALSADVINXrO $1,000,OQQ ATie___.- ._...,-._.__._.....e.. GENERN. AG,3REGATE _..— $ 2 000 OQa-- GEN 'LAGGREGATELIMn APPLIES PER PRODUCT'S - CCOMP/OP AGO $2,000,QOO X POLICY PRO-XCT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea coodon) $ ANY AUTO ALLOYMED SCHEDULED AUTOS AUTO£ HIREDA1JTpe NGN•04MJEU AUTOS UMBRELLA LIRE OCCUR y� H nn `i (� V�j�V� �� V EODILYINJURYIPorp,eisort EQUITY INJURY (Pei eec�den UAMAOIi $ EACH OCCURRENCE ��— $ EXCESS LIAR(+ _ CY,.AIMvMAUE DED[ E]R[ VTION$ G �� - •,-1* ufY�` `' g00REOATE T—�—_ $ $ WORKERS COMPENSATION AND EMPLOYERe•LIABILnY YIN ANY FROFRIETORIPARTNERIEXEPJTNEI� OFFICERd.ENSEREXCLUDED? El NIA 2STATU- DTH* TOf7Y LIMIT&, -,.... EF___„_,.__..._._.......�_ EL. EACHACCIDENT $ EL DISEASE -EA EMPLOYE — $ (MendalOrylnNH; oizsCRIP'I tomoi, eider hoiow I EL DISEASE -POLICY LIMIT _ $ B Accident and Health5RG9111254-A 4371-00 4119/15 4119116 EACH OCCURRENCE AGGREGATE $ 1,000,000 $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Reenacts Schedule, a mora apeee la required) City Of Sauna Aum; Parks; Recreation .Se C'onuiruuity Services Agency; its officer, employees, representatives, and volunteers are listed as Additional Insured per the attached CG 20 26 04 13 eluicrsemeut. Coverage is primary per the attached NIEG1. 0010 03 11 endorsement. 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. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REACT IT CAREFULLY, POLICY CHANGES Policy Change Number s POLICY NUMBER POLICY CHANGES COMPANY FPG200'I'1734-02 EFFECTIVE Essex Insurance Company p y 9/3/15 NAMED INSURED AUTHORIZED REPRESENTATIVE International Promotions, Inc, DBA: Fiesta De Carnival Greg Thompson 11278 Los Alamitos Blvd #101 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 Form # CG 20 26 04 13 Description -Additional Insured -Designated Person or Organization ?1e Form # MEGL 0010 0311 e60" Description -Additional Insured - Primary and Non Contributory .0 (I ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. CJt� PRGs Authorized Representative Signature IL 12 01 11185 Copyright, Insurance Services Office, Inc, 1983 Page 1 of 1 Policy Number: FPG20011734-02 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ! Z4:101 0 IM. r. 1110101 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Of Santa Ana; Parks, Recreation & Community Services Agency; its officers, employees, representatives, volunteers. A. Section II -- 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. ons. 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. `ay SRG �Pd�i�n� P CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY III POLICY NUMBER; FPG20011734-02 MARIA.°" 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 following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE ADDITIONAL INSURED —PER QN 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 forms, SECTION II — WHO IS AN INSURED Is amended to Include as an Additional Insured the person(s) or entity(s) shown in the Schedule above, but only as respects negligent acts or omissions of the Named Insured and only for "occurrences", "claims" or coverage not otherwise excluded by this insurance. 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 or to any obligation of the Additional Insured to Indemnify an- other because of damages arising out of ouch injury Subject to the above, when coverage applies to the Additional Insured(s) listed above, it shall be primary insurance as respects any'claim", lass, or liability arising out of the Named Insured's operations as covered by this insurance. If cov erage applies under this policy, any other insurance maintained by the Additional Insured(s) as a Named Insured shall or - excess and non-contributory to the coverage provided by this insurance, All other terms and conditions rernahn unchanged, oe. � "41k c P� P oLo MEGIL 0010 03 11 includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with Its permission. `"CC"R" CERTIFICATE OF LIABILITY INSURANCE °A3/31/15' 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 pollcy(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), PRCDUCERAllied Specialty Insurance,Inc 10451 Gulf Blvd Treasure Island, FL 33706 8002373355 NAME:._ PAx PHONE TYPR UFINSURANOE "I POLICY NUMBER WDdY IMM�QDP{YYYpI LIMITS W - OLNYSPF�7'IMM1DMYYY1 ,,,,-.,_,,,.___INB°RERS AFFOft0iN0 COVERAGE �NAIO# INSURED Christiansen Amusements, Inc. and Southland Shows, Inc. P. 0. Box 967 INSURERA T.H E. Insurance Company. INSURER -- .... -- ---- --- INSURER C: 12866 __...._ - Escondido, CA 92033INSURER;__ INSURER E. 110001000 ./Y „- "'�. /+` i` „_ ` CSC/ GENERAL AGGREGATE �5 t� INSURER P: ' POLICY...__ PRO. _._ LOO QVVERAGE6 CERTIFICATE NUMRFR- OEV141nM nU rnnaem. 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, TYPR UFINSURANOE "I POLICY NUMBER WDdY IMM�QDP{YYYpI LIMITS W - OLNYSPF�7'IMM1DMYYY1 T----- IGENERALLWRILITY A MERCIACLAEMSGeNADE L IASILIY IAkOENERAL Li EACH OCCURRENCE $ 15 AMACET"r.N'reCi ..'— CPPOI00507.05 09/01/15 04101/16 S and EMISG6 (Ga acpar@opal 1,000,000 _.._ 1y0, 00O —� Ai OCCUR -P. MED Ia(P(fcaow pe $_ lor PERSONALE ADV INJIIRV_ S 110001000 _._.—__.__...__—.___..__.._._�...,_ OEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE �5 t� 1—�1 11000 ' POLICY...__ PRO. _._ LOO ReviewedgRODUGTS-(.OMRfOP AOG S 1\P.rVIPn�V�d L/------..._.-------$-.._..------ 11000,000 AuroMoaael.welurY �.- cc E°awky, A—,__.� s BODILY INJURY (Per purFpnI S — ��- ANY AUTO ^ _ ALLOWNEO SCMEGULED AUTOS AUTOS NONOWNEO "'"'— BODILY INJURY(Pae acutlene ---- $ --- n /'w SIiVIq �/uQ '�S �ROPiRPY G�— Pat d11REDAUTOS -. AUTOS PRCSA/Admin. - - — UMBRELLA LIAO i� OCCUR � EACH OCAURRENCE $ 4,004,000 A ii EXCESS LIAS CLAIMS.MADE� I ELP0Q10195 -OS Od/01/15 04101/lb AGOREGArE $ __ �b0, 000 S DEO RETENTION WORKERBCOMPENSATION AND EMPLOYERS' LIABILITY ATU (— D'�H T,:ORYDMITS.,—_LER_..._--__...._ YIN ANY gRNME&C" "CLUERIEKHCLLTIYE OFRV F.rsidsonvi"N")EXOLUDEUY NIA _.... _ E.L EACN ACCIDENT _ S (Mpatlatdryin NNl ityyex. tl4miha uadar i EI/tISEA6E-EA EMPLOYE _._. 4 DEECR1PnGN OFOPHRATIGhlS dekwI E.L. DISEASEPOLICYLIMIT 9 DESCRIPTION OF OPERATIONSI LOCATIONSI VEHICLES (Added ACORD 101, Additional Remarks Schedule, 0 more space M raftakedl 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 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 ACCO RDAN E WITH THE POUCY `;7 SEONS. 26 CIVIC CENTER PLAZA SANTA ANA, CA 92701 AUTHOR12E0 pESENF0. NE _ 01888.2010 ACOROOOC'.ORPORATION, All rights reserve ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CHRI823 OP ID: JU - CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYVYI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 07/3012013 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(los( must be endorsed. If SUBROGATION 18 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endoramnard a . PRODUCER NTAC Craig Huft Wraith, Scarlett & Randolph Ins. GI!' Inc 0848084 PH9N: FAx ao. Na eM6530.662.0181 (AID, No): 630.662.6452 Aon 622 Main Street cress: cratgh@WSrtns.com Woodland, CA 85596 - --- Craig Hutt INSURER(al AFFORDING. COVERAGE NAIC0 AUTOMoBiLEUAelurr +�I INSURER A:StatO Compensation Insurance INSURED Christiansen Amusements _36076 INSURERS: Stacy Brown __.. PO BOX 997 INEURERC: Escondido, CA 92033 INSURERD: r�s�II/Via INSURER E: UMBRELLA UaB OCCUR EACH OCCURRENCE 5 COVERAGES CERTIFICATE NUMBER: RRVMION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CON017IONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1Nsft __ TYPE OF INSURAN0A .-ArlDLSUBR-._-_- _-NqQ syn POLICY U._ ._.POLICY EFFPOwtogYtXEYL XYPGDOYYY i' LIMI76... COMMERCIAL GENERAL LIABILITY EACHOCCVRRENCE S CLAIMS�MADE OCCUR DAMAGETORCNTEO PROMISES (EaoOpurrmaa7 ,S _ MEDEXP(Anyono Feaw„ S _ PERSONAL &ADV INJURY S ,.$. _ GENT AGORWArE LIMIT APPLIES PER: GENERAL AGOREGATE POLICY JECT LOC Reviewed by: PRODUCTS COMP/OP AGO S OTHER . 5.._- AUTOMoBiLEUAelurr +�I (Eo u6INVE—SI Lf '" s ANYAUTO "'Y'S '/ I BODILY INJURY (Per person) S AUi'OOSS NED SCHEDULED BODILY INJURY (Per awdem) S C urevas PROPERTYDAMAdE MREDAUTOS AUTOWNEO 5..... (Pat a"weral r�s�II/Via UMBRELLA UaB OCCUR EACH OCCURRENCE 5 EXCESS UAB CLAIMS-MA_DE AGGREGATE 5 DEC RETENTIONS S e� WORKERS COMPENSATION PER AND EMPLOYERS' CIAeILiTYX YIN $YA14TE EH A ANYPROPRIETUN,vARTNERIEXELUnVE 906803$2014 08/0112014 0810112016 E.L. EACH ACCIDENT S 11000,000 OFFICERAIEMRER EXCLUDED? NIA (MeddQBFIn NH) EL. DISEASE - EA EMPLOY WE S 1,060,000 PEeC,ge - O8OF e . DESOICY IT 1,000,900 DESCRIPTION OF OPERATIONS ILOCAPONS I VEHICLES (ACORO 101, AddllleMl Bananas SahaduN, nay hsamu w areata Spee is raquhad) Evidence of Insurance related to all Christiansen Amusements events between 8/1/14 - S/1/15. CITYSA3 City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701-4068 SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. All dome ACORD 26 (20/4101) The ACORD name and logo are registered marks of ACORD EXHIBIT13 A[MIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY htsuranceCompany T.H.L. ineurance Company This endorsement modifies such insurance as is afr'orded by tite provisions of Policy # CPPo100507-05 . _ relating to the following, I, The Housing Authority for the City of Santa Ana (Agency), 20 Civic Center Plaza, Santa Ana, California 92"701; 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.) Effective moi/is _ this endorsement form as a part of Policy # CPP0100507-05 Issued t0 Christiansen Amusements, Inc, .and Southland Shows, inc. Named Insured !7 Countersigned by Authorized Representative Reviewed by: f�a Silvia Cuevas ARCA/Admin, A,! a CERTIFICATE OF LIABILITY INSURANCE DA3/31/151 THIS CERTIFICATE IS ISSUED A$ 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: 11 the certificate 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 confer rights to the PRODUOEnAllied S ecialty Insurance,Inc 10451 Gulf Blvd PHO E Treasure Island, FL 33706 IA D..._._..__._..—.—__..._ E.AIL 8002373355 __INSUR SPHSIAFFORD INSURER A; T.H.E. Ins INSURED Christiansen Amusements, Inc. tNSURERe _ and Southland Shows, Inc. NSURERc: P. 0. Box 997 ------..---....._ Escondido, CA 92039 COVERAGES CERTIFICATE NUMBER: RFVIRU` M MUMIaPP. 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. 1. ______... _......_._._.__...—__�..._ NT TYRE CP INSURANCE DDL-SU6n POLICY NUMBER MMi Y A LIMITS OENP,RAL LIABILITY "',, A COMMERCIAL GENERAL LIABILITY I .._�CLAIMSMADE LXI OCCUR CPPOlOOS07.05 04/01/15 04/01/16 EACH OCCURRENCE E141 TtSRW—' PREMIBES(E...nenvo MED tXP(Any hnBrpar[An) PERSONAL A ADV INJURY S 1, 000, GOO g 1�U, OOO S ___ �$ 11000, 000 ..__.. _ I .... R�sT%(Qitlt%P.'.1 Reviewed L„`l. GENERN.AOGREGATC _ i S TII �w �0 PRODUCTS•COMPOP�AGG 11000,000 QEML A9Ocia(wr1E LIMIT APPLIES PER POLICY PR LOG UU IP jI �$ I $ -- 1AUTOMOBILE LIABR-ITY OMBINEDI SINGLE UMI? BODILY INJURY (Per pmsun) I r... ANY AUTO AUTOS ED _ AUTSCHOSU�D Ia112EDAUTO&' I(LNON.OWNED I�. AUTOS S(Iv(a u {'�r'�/'�pp(/� 1 RCSA1(!'1'Itr(n. Vas rn BODILY iNJURY(Per—ami Illn---III---3 -- RbP-� DAMAGE Laeagaidantj_, TS I I g A (K UMBRELLA LIAR 6XCE88 LIAa _ - OCCUR MS MAGE ELP0U10135'05 04/01115 04/01/16 EACH OCCURRENCE S 4 OOO 000 — AGGREGATE _ ._._ S 4 000 000 DEP RETENCOM$ MRKSRS COMPENSATION AND EMPLOYERS' LIABILITY YIN MSATU IOTH _...... Q ANY PR0PRIETORIPARTNER1UECUHVF OFnCEMMEMBER EXCLUDED? El '1Me0datmYln NH) Iii yea,tlaeTIONOSer O SCRIPTION OF OPERATIONS aelew N/A- E.L EACH ACCIDENT _ EL DIEEASE' AAVMPLOY 3 S � B.L. UIBEASE-POLICY LIMIT S i DESCRIPTION OF OPERATIONS ( LOCATIONS I VEHICLES (Attach ACORD IOg, Add01ata1 RMnRHl9 BaI1e0ule, Emolespace Ieregalratl) 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. EVENTt FOR ALL OF CHRIST'IANSEN AMUSEMENTS EVENTS FROM 4/1/15 TO 4/1/16 CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DI ATTN. RISK MANAGEMENT THE EXPIRATION DATE THE 20 CIVIC CENTER PLAZA ACCORDAN EWITH THEPOLIC SANTA ANA, CA 92701 AUTHORERI RESENTATIVE T— Q1888-2018 AC( ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD CANCELLED BEFORE BE DELIVERED IN TION. All rights AIII ICC)RDF CERTIFICATE OF LIABILITY INSURANCEDA3%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($), 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 Ilea of such ondorsement(s). PRODuceaAllied S ecialty Insurance,Ine M 10451 GA E S1Vd E: AX----_--___ Treasure Island, FL 33706 6002373355 INSURER A: T H.E Insurance Con INSURED Christiansen Amusements, Inc. INSURER 0; and Southland shows, Inc. - ----- P. Q. Box 997 INSUR0RO _ Escondido, CA 92033 gvaen P99TIRPArR MI lnnnco. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERMD INDICATED. NOT`MTHSTANDINO 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. TR TYPE OF INSUflANCE __—. — POLICYNUMBER V M Mf VVYY IjkLM�pfNYYYYL LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIADJU Y CLAIMS (� OCCUR CPP0100507-05 04/01/15 - p4/Ol{14 EACH OCCURRENCE s 11000,040 PREMISES is. occyugnouj_- MEUIXPIAnY ene Pmeenl S 150, 46 S aa,,..11 4lA Y. Reviewed 'r ( '. ✓ PERSONAL& 0.pY INJURY _.-_....._....._..--- GENERAL AGGREGATE . PRODUCTS. COMPIOP AGO _. S 1,000.440 __...0 00 —...._..._..—_._ S 11000,000 GEML AGGREGATE LIMIT APPLIES PER: 1 POLICY pNO. --]Loc $ AUTOMOBILE ...'.ALLOMMF..D I LIABILITY ANY AUTO - S'CHEpOLED AUTOS AUTOS FIIREU AUTOS AUTUS EO 1(E;gNQnt) Silvia Cuevas p �+/� q�4Mr�, Ft'\CJA'V/r-1Ut1 ��11. C A'V A I C E 1 BODILY INJURY (Par persen) S - '.0_.— eO01LY IDiJURY IN, w1deral S (PROPERTY—DAMAGEcl S A �{-IIIj'EXOEBSLIAO UMBRELLA LIAR X OCCUR CLAIMS•MAGE ELP0010135.05 04/01/15 04/01/16 F.ACH OCCURRENCE $ AGGREGATE _4,_0400000 $ 4,60b,000 — RErENTION 5..— 1 OCR WORKERSCOMPENSAVON ANO EMPLOYBRV LIABILITY Y1 ANYPROPRIETORIPARTNEWE%ECUTIVE❑ OPPiGBflIMIiMSER EXCLUDED? IMandalmyinNIN I yyeY dwribe and., I'm OGSCRIPTIONOFOPERA.TIONSbelft NIA Vvt 9TATU. OM. — EL. EACN ACCInENY EL. DISEASE • EA EMPLOY (S — ----- S — E, L, UNEA$E- POLICY LINO ---- S I DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (AAI ACORD 101, AddleRgW Remarks Schedule, IT mare space is rNulred( ADDITIONAL INSURED WITH REPSECTS 110 THE OPERATIONS OF THE NAMED INSURED ONLY: PAJARITO, LLC, MR. FRANK CHAVES, CITY OF SANTA ANA, FOR THE DATES: 4/29/15 THROUGH 5/04/15 PAJARITO, LLP SHOULD ANY OF THE ASOVE DESCRIBED POLICIES BE CANCELLED BEFORE FRANK CHAVES THE EXPIRATION DATE THEREOF, NOTICE WILL SE OELIVERED IN P.O. BOX 11412 ACCOROAN E WITH THE POLICYPR ISIONS, SANTA ANA, CA 92711 aurnoRl¢Bo flaeENTAnvE 4y W11-- 01988-2010 ACORD CORPORATION, All rights reserve ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AC !qD CERTIFICATE OF LIABILITY INSURANCE gA3/31D/151 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must he 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 endorsements . PROOUOERAIIied Secialty Insurance,Inc CONTACT Treasure £ Blvd PHONE FAX Treasurere Island, FL 33706 .MI 8002373355 ADD@.as; _ INSUBERSAPPORDIN COVERAGE RAID INSURER A: T.H.E. Insurance. Company 12866 INSURED Christiansen Amusements, Inc. INSUREH a. and Southland Shows, Inc. P. 0. Box 997 NsuaNSURBRD . ....___.. — _..._— Escondido, CA 92033 NauEERo: COVFRAGFS CFRTIFlr.ATF NIIMRFR� 291R3IAM MIIARnco. 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 ANDCONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_, INSE _ TYPE OF INSURANCE Was ±2LICYNUMBER MI U' . 0 Y Y Y UNITS OENERAL LIABILITY EACH OCCURRENCE_4S 1,000,000 ACOMMERCIAL GENERAL LIABILITY CPPOI00507^05 04/01/15 04/01/14 pREN1A19C5 (y Ea oA„ce) 45 100,000 -.J CLAIMe MAUI �. ]{ OCCUR MED PERSONAL B ADV INJURY S 1000,000 ... __ .___ _ _ GENERAL AGGREGATE S �—i gEN'4 A49REOATE LIMITAF+PLfES PER. -, PRODUCTS COMP;OP AOO S 11000,000 POLICY PRO• - LOC - $ - - AUTOMOBILE LABILITY COMBINEDSINGLEUMH --- BODILY INJURY (Par Pasan) 3 ANYAUTO _ _ AUTOWNEP AUT003ULED BODILY INJURY (PM epR@M} NED HIRED AUTOS AUTOS PROPERif DPAdAl3E IPar ac 'Iy�Ipyt ,,, S ,�_ UMBRELLA LIAR OCCUR 1_ )Psw Pi Y: CLAIMS MADE :Rev AJ� AGGREGATE S DED RETENT14Is WORKERS COMPENSATION NIC STATT 'OTF9 ANO EMPLOYERS'LIABILITY YIN -. I9T3Y.kIMIT.S. v ANY PROPRIETORIPARTNCWF.XF.CUi1VG OFFICERIMEMBER EXCLUDED' El NIA i ++�� ((''�� S)��i((A AJ eek�ee evas E_L.EACkI ACCIOEIT S.„_..�._.. (Mandatory In NHIEL., dmin. OISEA°iE-EA EMPLO 5 E.L. DISEASE- POLICY MIT _ _ S y4�a,daxrtamlder DEa4RIPTION OF OPERATIONS below p�GSf�I I DESCRIPTION OF OPERATIONS LOCATIONS r VEHICLES (Anwk ACORD tot. Additional Remarks $&howl¢, If ntare spoor is raeelred) ADDITIONAL INSURED WITH REFECTS TO THE OPERATIONS OF THE NAMED INSURED ONLY: THE HOUSING AUTHORITY FOR THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS. LOCATION: 1126 & 1146 E. WASHINGTON, SANTA ANA, CA FOR THE DATES; 4/27/15 THROUGH 5/05/15 THE HOUSING AUTHORITY FOR THE CITY OF SANTA ANA 20 CIVIC CENTER PLAZA, M-2 SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANQE WITH THE POLICY PRWISIONS. reserved. ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD acraazc� CERTIFICATE OF LIABILITY INSURANCE °ATe(MM,°°IYYYYI 3/30/201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HMR: Joanna Manion Arthur J. Gallagher Risk Management Services, Inc. P",�"u v.,,.d�F_ A -119A Pam ,,,.,.e')R_AA1_171A THIS IS TOCERTIFY 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, INSURER(S) AFFORDING COVERAGE RAICN INSURER A: American Slates Insurance Company .19704 INSURED CHRIAMU-01 INSURER 0: Christiansen Amusements. Ina INSURER C_ P. 0. Box 997 _ Escondido, CA 92033-0997 INSURER D -- -- ---------- PREMMEE(go asuganca) S INSURER E MED EXP(Any N.paraoni S INSURER F; COVERAGES CERTIFICATE NUMBER: 177753472 REVISION NUMBER: THIS IS TOCERTIFY 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. INSIR -S "GOLaBBR POII,,ICYEFFp POUCYEXP R TYPE OF INSURANCE INS POLICY NUMBER MIDC/YYYYI IMRAqb2V LIMITS GENERALLIAIPUTY EACH OCCURRENCE S DAMAGE TORENTED COMMERCIAL GENERAL LIABILITY PREMMEE(go asuganca) S CLAIMS -MADE OCCUR MED EXP(Any N.paraoni S _ PERSONALSADVINJURY j_. GENERALAGGREGATE $ OEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO S POLICY TPR LOCS A AUTOMOBILE LIABILITY ._._ 4/1/2015 4/1/2016 01CI562A6640 (Ea aacateg4 $1,000,000 X ANY AUTO BODILYINII/RY(P¢rgcersanl S AUTOS PO ._ _. SppiIX INJURY rPwacaltlglNl 5 .AUTOSULEO X AO Qs NED (Forr S HIRED AUTOS x_ _ aPoEkRT�Ytlf)JAMAGE UMBRELLA LIAR OCCUR fA'd r" EACH OCCURRENCE_ S SXCESSLIAS CLAIMS.MADE '"�r AGGREGATE 3 DED RLIENTIONS S Sri ANOEMP$COMPENSATION LIABILITYIN) �+ (� Cuevas _._...�,..,...... . TORY LIMr43__.. ANY PROPR MTORIPARTNEPo'EXECUTIVE Silvia OFFICERIMEMaER EXCLUOEO? �� "rA E L, EACH ACCIDENT S IManealary lR NH) _ pRIOSA/Admjn, EL CISEASE�EA EMPLOYEES Il ry1d dawre uMar i , RIPTiON EL. CISEASE,POU;Y S 0E3 OF OPERATIONS below LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AWgh ACORO 101, Addllloml Romuha Sohedule, if mow apaaa Is requlrad) 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 form CA7110 0307. For all Christiansen Amusement events during the period 4/112015.411/16 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Robert Carroll 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 USA A7 r ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD rR-44. 498 PAULMAUR ACORD. CERTIFICATE OF LIABILITY INSU NCEDATE(MMMONYYY) 211712015 THIS CERTIFICATE IS ISSUED ASA 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. -to IMPORTANT: If the c6rti6cate, holder Is an ADDITIONAL INSURED, the policy(Ioe) must be endorsed. If SUBROGATION 16 WAIVED, sub)ect 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 Ileu of such endorsement(s)- PRODUCER CONTACT Haas & Wilkerson Insurance _ AICNNR Vor 913 432.4499 Alo 4300 Shawnee Mission Parkway Fairway, KS 66205 pAp10pREB8i INSURER(S) AFFORDING COVERAGE NAIC# _ INsuRERA:ACE American Insurance Company 22667 912432-4400 INSURED Paul Maurer dba Paul Maurer Shows; Paul Maurer Shows LLC 16081 Warren Lane Huntington Beach, CA 92649 INSURER R Star Insurance Company 19023 INSURER 0 INSURER 0 INSURER E: INSURER F: COVERAGES CERTIFICATE NNMRFR! REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TILE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITH£TANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS cePTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IFS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I Yd TYPE OF INSURANCE AOM R WEER NNP " POLICY NUMBER POO EfP MWD D LPOLICY EXP LIMITSLTR M )YYYY) A GENERALLIABILITY 620496496 4101120150410112016EEpAAq(M;NppoQCGURpmNCE $1,090-,000 X COMMERCIALGENERALLIABILITY IIcREMIe TO oaaurRnGe) $109900 CL11M3-MADE � OCCUR MED EXP Any pnaperson) $EXc!uded LEE RSONA&ADV INJURY $1999699 I GENERAL AGGREGATE s2,000,000 PROCAIOTB.ComplOPAGG $2,099000 GEN'LAGGREGATE LIMBAPPLIES PER: A POLICY JPERC X LOc AUTOMOBILE LIABILITY H9813326a 9210512015 $ 02J05/20i(3_&pMeINEROSINGLE LIMIT $1,000,009 ANY AUTO BODILY INJURY (Per racoon) $ ALL OWNED SCHEDULED X BODILY INJURY(Pereo iftf) $ _ AUTOS NON4)WNED X HIRED AUTOS X PROPCRTVOAMAGE $ Peraccldent AUTOS _ UMBRELLA LIM OCCUR EACH OCCURRENCE $ EXCESS LIAB CWMS.MAOE 'AGGREGATE $ m DELd RETEMION$ B _ WORKERS COMPENSATION WC0568554 9110112015 011011201E X 1WTATO. OTH AND EMPLOYERS' LIABILITY ANY PROPRIETOILPARTNERIEXECUTIVE Y/N EL EACHACCIDENT $1,099999 OFFICERIMEMBER EXCLUDED? 5i NIA E.L DISEASE EA EMPLOYEE $1,000,000 (MHO&Wq in m) • If yes, &Scribe under DESCRIPnON OF OPERATIONS below I EL DISEASE. POLICY LIMIT $1,000,099 -- I DESCRIPTION OF OPERATIONS! LOCATIONS f VEHICLES (AiLich ACORD 107, Adtlltlan8l RemarkR SC6Wdula, R mare sRace Is rCgl*se) Additional Insured: City of Santa Ana, lVs officers, agonts, employees, representatives and S volunteers, and Fiesta de Carnival.; Event Dates: Cesar Chavez Park�eV`d SEE ATTACHED ADDITIONAL INSURED AND NON-CONTRIBUTORY ENDORSEMENTS ��)\'d I �60 Workers' Compensation appllas to the statutory requirements of the state of Calif a. coverage City of Santa Ana, Parka, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BC CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Recreation & Community ACCORDANCE WITH THE POLICY PROVISIONS. Services Agency 20 Civic Center Plaza AUTNORIZED REPRESENTATIVE Santa Ana, CA 92701 ACORD 25 (2010100) 1 of 1 Tho ACORD name and logo are registered marks of ACORD #$210502IM210499 SALAK PolkyKomber ENDORSEWNT, ACE American IlW ttr n Cbnpany Named Insurers Paul Maurer dba Paul Maurer Shows I; wtiveww''04/01/2015 Paul Maurer Shows LLC 1201 A.M., Siantlard Two Agent Name gent No. THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA, CALIFORNIA 92701, OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES AND VOLUNTEERS FIESTA DE CARNIVAL, HINDS INVESTMENT'S LP, AND DAYTOM ENTERPRISES, INC. ARE NAMED INSURED WITH REGARD TO LIABILITY AND DEFENSE OF SUITS ARISING PROM THE OPERATIONS AND USES PRFFOIUM BY ON BEHALF OF THE NAMED INSURED. WITH RESPECT TO CLAIMS ARISINCr OITI OF THE OPFRATIONS 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 CON7'RIEUTING 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 BXCEPT 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. WITH RESPECTS TO THE ADDITIONAL INSURED, TEI3 INSURANCE SHALL NOT BE CANCELED, OR MATERIALLY REDUCED IN COVERAGE OR LIMIT'S 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 G2049¢1¢ ISSUED TO PAUL, MAURER DBA PAUL MAURER SHOWS, PAUL MAURER SHOWS, LLC COUNTERSIGNED TITLE Nh IN INSURANCE COMPANY ACE AMERI(16 SURANC COMPANY MA"L(41104 (41104 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 (f no information is fitted in, the schedule shalt road, 'till persons or entities added as additional imureds through an endorsement witlrtheterm 'Additional Insured" inthetftie7 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 IVA.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. LU -20287(06106) company Copy V -p -m , U ��4vGS��d��• P� Q R, r Authorized Agent Page t of 1 POLICY NUMBER: OGLG20 496496 COMMERCIAL GENERAL LIABILITY CO 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): FIrSTA DE CARNIVAL A: Section 11 — who Is An Insured is amended to Include as an additional insured the person(s) or organizations) shown in the Schedule, but only with respect to liability for'bodlly 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 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. O Insurance Services Office, Inc., 2012 congwny (�Py Page 1 of 1 POLICY N UMBER: OGLG20 4 9 64 9 6 NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY COVERAGE Schedule Organization Additional Insured Endorsement FIESTA DE CARNIVAL CG -2026 (It no information is filled in, the schedule shalt read: 'All persons or entities added as additional Insureds through an endorsement with the term 'Additional Insured" in the 01W9 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 IVA.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. LCA -20287 (06/06) cempar rgpy F�GgP Authorized Agent Page 1 of 'I CANCELLATION ENDORSEMENT Named insured �— Paul Maurer dba Paul Maurer Shows, Paul Maurer Shows LLC Endorsement Nurtibsr — Policy Symbol Poiiey Number Policy Pedod Effective Dataof Endomemeoi G20496496 04/01/2015 to 04/01/2016 Issued Sy (Name of locum Ice ComPany) ACE American Insurance Company _. _ is rnxued aubsaouent to fhe orenamtlon of the Policy. mnea me pency nuome,. � nog 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 92704 Authorized Agent LD -5W26 (8195) Page 1 of 1 AC'CiRL7°° CERTIFICATE OF LIABILITY INSURANCE DATE 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 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 confer rights to the certificate holder in lieu of such endorsement(s). PRDDUCERAllied Specialty Insurance,Inc 10451 Gul£ Blvd Treasure Island, FL 33706�MalsJzl CONTACT PHONE —.. FA -- - (acNe): 8002373355 ADDRESS INSURERSAFFGRDINDCOVERAGE NAICa CPP0100507-05 _ INSURER" T.H.E. Insurance Company 12866_ _ INSURED Christiansen Amusements, Inc. and Southland Shows, Inc. P. 0. Box 997 INSURER B; B - — INSURER C -_... NsuRERD Escondido, CA 92033 INaURERE...__._ $ 1 1000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMRFa• -- 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, ---- ILTH TYPE OF INSURANCE ADD PINSA OLICY irODCPEK€-TsD1lf;YMP MMitl Y MMIDOIYYY -- --"— LIMITS A GENERAL LIABILITY XCOMMEROALGENF_R_ALLIABILAY ]CLAIMS�MAOE LXI OCCUR CPP0100507-05 04/01/15 04/01/16 EAC14OCCURRENCE AMASETSRENTEfS PREMIgE,SLa ourrence cc!_ S 11000,000 ].00,000 ,$ _ MED EXP(Anyane person) $ B ADV INJURY $ 1 1000,000 _ . _..._._— —.— IPERSONAL GENERALAOGREGATE $ 10,000,000 GENT AGGREGATE —'. LIMIT APPLIES PER ' PRODUCTS-COMP/UPAGG $ 1,000,000 POLICY P P LOG AUTOMOBILE LIABILITY COMBINED SINGLE LI BODILY INJURY (Per parson) $ ANY AUTO ( ALL OVvNED SCHEDULED AUTOS _ AUTOS AUTOS ED HIRED AUTOS _ AUTOS � BODILY INJURY(Pereccidont) $ _ ___ PROPERTY OAMAa[ jPer accidenij_ _ __ ---------- $ A UMBRELLA LIARX EXCESS LIAB OCCUR CLAIMSMADE ELP0010135-05 04/01/15 04/01/16 EACH OCCURRENCE 5 4,000,000 AGGREGATE. $ 4,000,000 DED ftETEiJTIOtJ$ $ WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY ANY PROPMETORAAR7'NER/EXECUTIVE YIN OFFICEMMEMBER EXCLUDED? � NIA ,p' l�i� R�,v I pp t„! "� ` ',y} ` WCSTATU OTH- --- _RY1i B .113 ... EL EACH ACCIDENT ..__......___ § EL DISEASE - EA EMPLOYE - — EL, DISEASE POLICY LIMIT S ---- -- -- $ (Mandatory in NH) Ins describe undo, DE54tBIPTIONOFOPERATIONS beioN e _ _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 401, Addition( BerlinfilIdiffif, Iflnore space is required) ADDITIONAL INSURED WITH RESPECTS TO THE OPE "TIONS 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: RISK 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 BE DELIVERED IN ACCORDAN9E WITH THE POLICY PRQVISIONS. All ACORD 25 (201 D/05) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE MIDDIYYY ) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 3!330/20012015 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(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 confer rights to the certificate holder in lieu of such endorsoment s . PRODUCER CONTACT NAME: Joanne. Manion Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 777 108th Ave NE, #200 E-MAIL Bellevue WA 98004 _Ao0REse: GENT AGGREGATE LIMIT APPLIES PER: INSURERIS) AFFORDING COVERAGE NAIC4 POLICY'. PR0- LOC INSURER A:American States Insurance Company 19704 INSURED CHRIAMU-01 INSURER 8: Christiansen Amusements, Inc. INSURER c: P. O. Box 997 BODILY INJURY (Per.rddent)' S - Escondido, CA 92033-0997 INSURER D: -- - -- HIREDAUTOS INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 177753479 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 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. !NSR TYPE OF INSURANCE 'ADDUSUBR'. _ POLICYEFF POLICY E%P L INWVO "'. POLICY NUMBER MMIDOIYYYYI IMMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY ',. ''. DAMAGE TO RENTED P EEMGeS.(Eaecounence) ; S :. CLAIMS -MADE OCCUR : MED EXP (Any one person) S PERSONAL&ADV INJURY S GENERAL AGGREGATE S GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGE $ POLICY'. PR0- LOC S A ", AUTOMOBILE LIABILITY OICIBB248640 41112015 4/1/2016 (Ea aocident) '', $1,000,000 X ANY AUTO_ BODILY INJURY(Per person) L5 ALL OWNEDSCHEDULED AUTS BODILY INJURY (Per.rddent)' S - X X NON -OWNED '., ,.AUTOS OPER nDAMAGE �$ HIREDAUTOS (PROPERTY UMBRELLA LIAR OCCUR EACHOCCURRENCE 4 EXCESS LIAR CLAIMS -MADE AGGREGATE $ DEC RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYnn/� N t WC STATU. OTH- TORY LIMITS. ER ANY PROPRIETORlpAR'rNEftIE%ECUTIVE YIN ry,.y� -L EACH ACCIDENT $ nC/ . OFFICERIMEMBER EXCLUDED9 N IA ,p y+' } I (MendaWry In NH) 1 If desrsibe under EL DISEASE - EA EMPLOYEE ffi Yee, Com' DESCRIPTION OF OPERATIONS below 'E. L. DISEASE -POLICY LIMIT $ egc- DESCRIPTION OF OPERATIONS I LOCAtIONS I VEHICLES (Attach ACORD 101, AddiftnetAg.rks Sch$�4,�, $Neta Is requiredl The City of Santa Ana, its officers, employees, agents and representatives n Fiesta de Carnival are included as additional insureds but only as respects the operation of the named Insured per policy terms and conditions per form CA7110 0307. For all Christiansen Amusement events during the period 4/1/2015 - 4/1/16 City of Santa Ana Attn: Robert Carroll 20 Civic Center Plaza Santa Ana CA 92701 USA ACORD 26 (2010/06) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 0 1958-2010 ACORD CORPORATION. All riamn The ACORD name and logo are registered marks of ACORD - - CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDNYYY) _ 07/30/2013 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 air 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 confer rights to the PRODUCER INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WI'liCll THIS NA'Aim 1 Craig Hutt EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Wraith, Scarlett & Randolph Ins. Serv., Inc OB48084 - - POLICYEFF - POUCYEXP IMWDDIYYYYII IMMIDDIYYYYI: LIMITS PHONE FAX (AIC, No, Ex0; 630-662.9181 INC. Np)p 530.662.6462 622 Main Street DAMARENTED EMAIL crei h^ wsrins.com ADDRESS: g 4 '., PREMISESEa ocemeNes) S Woodland, CA 95695 ',. MED EXP (Any one person)_ _ $ PERSONAL&ADV INJURY ! S Craig Hutt ! GENERAL AGGREGATE S INSURERS) AFFORDING COVERAGE NAICM .OTHER' $ INSURERA:StataCompensation Insurance ,35076 INSURED Christiansen Amusements (Ea accuard) INSURER D: BODILY INJURY (Par Person) $ Stacy Brown BODILY INJURY(Pefaccident)S NON -OWNED PROPERTY DAMAGE $ P.O. Box 997 (Paraccident) INSURER C: Escondido, CA 92033 F:ACH OCCURRENCE S INSURER D: '.. AGGREGATE S DEO RETENTIONS " S INSURER E I,.. X PER: AND EMPLOYERS' LIABILITY STATUTE ER INSURER F : 0810112016'.06101/2016 Et EACH ACCIDENT 5 1,600,609 COVFRA(;FR CFRTiFICATF NIIMRFR- RFVISIr1NNI1MRER- (Mandatory in NH) : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIME POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WI'liCll 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'. ;ADDLSUBR' LTRTYPE OP INSURANCE '- INSD WVD POLICY NUMBER - - POLICYEFF - POUCYEXP IMWDDIYYYYII IMMIDDIYYYYI: LIMITS COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE S City Of Santa Ana DAMARENTED CLAIMS -MADE OCCUR '., PREMISESEa ocemeNes) S Santa Ana, CA 92701.4050 ',. MED EXP (Any one person)_ _ $ PERSONAL&ADV INJURY ! S GENT AGGREGATE LIMrI APPLIES PER. - ! GENERAL AGGREGATE S POLICY PRO JECT LOC _ PRODUCTS - GOMPiOP AGO $ .OTHER' $ _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I.$ (Ea accuard) ANY AUTO BODILY INJURY (Par Person) $ ALL OWNED SCHEDULED AUTOS ! AUTOS BODILY INJURY(Pefaccident)S NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Paraccident) UMBRELLA LIAR OCCUR - F:ACH OCCURRENCE S EXCESS LIAR CLAIMS -MADE '.. AGGREGATE S DEO RETENTIONS " S - WORKERS COMPENSATIONYIN I,.. X PER: AND EMPLOYERS' LIABILITY STATUTE ER A ANY PROPRIE'I'CRIPARTNERIF.XECUTNE I .90680352016 '., 0810112016'.06101/2016 Et EACH ACCIDENT 5 1,600,609 AFFIC'ERWEMBER EXCLUDEWCI NIA (Mandatory in NH) : EL DISEASE - EA EMPLOYEE S 1,000,000 Ityee, descilbeundor DESCRIPTION OF OPERATIONS below EL. DISEASE -POLICY LIMITS 1,606,060 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is comeredNQr Evidence insurance to Christiansen Amusements between of related all events 811/15.8/119 6 t 0. r9QTIVIr ATF Pint nPO rAMrFI I ATInM CITYSA3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOl'ICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Santa Ana 20 Civic Center Plaza AUTHORIZEDREPRAE�S�ENTATIVE Santa Ana, CA 92701.4050 (01988.2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD AR Y CERTIFICATE OF LIABILITY INSURANCE °A3/31/155' 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(les) must be endorsed. it 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). PRODucERAllied Specialty Insurance,Inc 10451 Gulf Blvd Treasure Island, FL 33706 NAME: PHONE tA-'O,_a�x) - - r1AX - p _ TP -Ax No). 8002373355 ADDRESS. INSURER��FFORDINO COVERgGE NAICM CPP0100507-OS ., INSURERA: T.H.E. Insurance Company 12866 _ INSURED Christiansen Amusements, Inc. and Southland Shows, Inc. P. O. BOX 997 INSURER 8:_— _ — _- - INSURER C: INSURER D: Escondido, CA 92033 INSURER E: INSURER F: 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 HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS R LTR TYPEOFINSURANCE .ADSL eebR- -------"""""'_ "—PoUOY PDLICYNUMBEft ERR- fMMIDDNyyYL LOY-ET( (MMIDDYYYYTLIMITS A' GENERAL LIABILITY -X COMM12RCIALGENER�AyL�UABILITY CLAIMS MADE LJ OCCUR CPP0100507-OS 09/01/15 09/O1 J16 EACH OCCURRENCE $ 1,000,000 PORFM�S Ee mance--i .EX Ar 1 MED EXP (Any ona porsnrp 100'000 _._. $ PERK ADV INJURV _ $ 1,000,000 --1 GENERAL AGGREGATE $ 10,000+000 PRODUCTS_COMP/OP AGG S 11000,000 CENT AGGREGATE LIMIT APPLIES PER: POLICY PRP LOC $ AUTOMOBILE LIABILITY! ANY AUTO GO INV SIN LELMIT Ea accident s BODILY INJURY (Per Forrsm0 ALLOWIJED SCHEDULED 'AUTOS AUTOS NONAWNED C HIRED AUTOS AUTOS BODILY INJURY (Par cadm,Q S $ S Per acyid, eni)___ UMBRELLA LIAR X OCCUR EAGH OCCURRE14CE S 4,000,000 A XI EXCESS LIAR CLAIMSMADE ELPOOI0135-05 'x1/15 04/01/16 _ AGGREGATE x,000,000 DED RETENTION$ •t $ WORKERS COMPENSATION•�� AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESLIRIPTIONOFOPERATIONSbelow NIA Qac yEL. �` 1 / "� �N�, WGSTATU- IOIH TORY i IMITg, _ EACH ACCIDENT$ E. L. DISEASE - EA EMPLOYEE --- S S —_-- "'---- E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attack ACORD 101. Additional Remarks SoeodUlo If more 61mco Is required) 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 CERTIFICATE HOLDER CANCELLATION 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 ACCO RDAN E WITH THE POLICY PR ISIONS. 26 CIVIC CENTER PLAZA SANTA ANA, CA 92701 AUTHORIZED RESENTATIVE T— m 1950.2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD ACC>RH CERTIFICATE OF LIABILITY INSURANCE D"3/3'10/15 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 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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERAllied SpeCi.alty Insurance,Inc 10451 Gulf Blvd Treasure Island, £L 33706 CONTACT NAME: PHONE-- JAVM E.41 lac xo7. Le ErV .__.... .. .._ 8002373355 ADDRESS_..._._ CPP0100507.05 __ INSURER�AFFOR0INP_COVERAOE _-._._ NAICa 09/01(15 _ _, _ INSURER A; Company $ 11000,000 INSURED Christiansen Amusements, Inc. and Southland Shows, Inc. P. 0. Box 997 ,12866_ INSURERS - -- -`--' — INSURERC INSURER D: Escondido, CA 92033 $ 1.000,00_0 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAI' THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 1'HE 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. ILTNTVPE OF INSURANCE A LS eR D POLICYNUMBER 'POLICY FF fMWDWYYYI POLICYE%P (MMflDDfYYYYJLIMITS 'D' GENERAL LIABILITY COR1MERCIALGENERAL LIABILITY ,CLAIMS -MADE DRIOCCUR CPP0100507.05 09)01/15 09/01(15 EACH OCCURRENCE $ 11000,000 MA�EY� R� LD-- PREMISgSLapmunance -- $ 100,000 $ MED L-XP(Any one person)_. PERSONAL &ADV INJURY $ 1.000,00_0 CENERALAGGREGATE $ 10 000, 000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGO $ t000,000 POLICY PRCO, LOC $ _ AUTOMOBILE LIABILITY __—.. COM 1 E' t LELW BCDIIYINJURY(Per,mcn) $ -- -- ANYAUTO ( ALLOWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS or BODILY INJURY Paccidanl $ R�YDAMAGE —� LPorpccid_enj_,—, --- $ A UMBRELLA LIAR EXCESS LIAR I X OCCUR CLAIMS -MADE ELP0010135-05 OA/01/1. e 09/Ol/lb EACH OCCURRENCE AGGREGATE S 4, 000,000 S 4,000,000 $ DED RErEIJTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Ally PROP EMBER EXCLUDE09 GUfIVE OF EMBER E%CLUUEDT (MandatorylnNH) ayyes describe under UEBGRIPTION OP OPERATIONS below NIA nn��e� QV C``'" (Jtt / /�-QTV#_,+> L r� YYdw WC S1 ATU. OI H ORYLIMIIS kR .. E L EACH ACCIOENI ._. S - - EL DISEASE EA EMPLOYEE$ — — E. L. DISEASE -POLICY LIMIT - --__ S DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES IAeach ACORD 101, Addlflonal Remarks Schedule, If morespaceIs repulred) 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 CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: RISK MANAGEMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDAN EWITH THE POLICY PR ISIONS, SANTA ANA, CA 92701 AUTHORIZED RESENTATIVE -7— ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT Insurance Company T.H.E. Insurance Company This endorsemen CPP0100507-05tt modifies such insurance as is afforded by the provisions of Policy 4 relating to the following: 1. The Cit/ of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers are named as additional insured ("additional insured") 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 insured. 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 add.tional insured, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to 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.) Effective 04/01/2015 this endorsement form as a part of Policy q CPP0100507-05 Issued to Christiansen Amusements, Inc. and Southland Shows, Inc. Named Insured z( �e Countersigned by Authorized Signature ��5 POLICY NUMBER: CPP0100507-05 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ! T B it Ai 9 E « • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Santa Ana 20 Civic Center Dr Santa Ana, CA 92701 A. Section ii — 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. 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. 6vi *Pv\O\NO '0 CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 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 POLICY NUMBER: VBA457078OO COMMERCIAL GENERAL LIABILITY CG3U2G0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement nnoddieoinsurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section UU —Who Is An Insured is emended to include as an additional insured the (a) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "'property damage" or "personal and advertising injury" oaused, in whole or in port, by your acts or omissions or the acts or omissions of those acting onyour beMa|f� 1. |mthe performance nfyour ongoing npemfione� or 2. In connection with your premises owned by or rented bzyou. However: 1.The insurance afforded to such additional insured only applies hzthe extent permitted by law; and 2. If coverage provided tothe additional insured ia vaqu/rmU 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 inaunada, the following is added to Section III — Limits Of Insurance: U coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf ofthe additional insured is the amount ofinsurance: 1. Required bythe contract oragreement; or 2. Available under the applicable Limits of Insurance shown inthe Dao|aratione- . whichever isless. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ~ CG 20 26 04 13 C Insurance Services Office, Inc., 2012 Page 1 of COVINGTON SPECIALTY INSURANCE COMPANY This Endorsement Changes The Policy. Please Read It Carefully. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - PRIMARY AND NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of Santa Ana Location(s) as specified in written contract with the 20 Civic Center Dr. Additional Insured shown in the schedule of this endorsement Santa Ana, CA 92801. Information required to com tete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted bylaw; 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is addedON III — Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement the mo t' 41 -0 on behalf of the additional insured is the amount of insurance: 7e'4 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declaration whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Policy No.: VBA457676 GBA 104025 0614 D. If the contract between the additional insured and you requires that the insurance afforded by this policy be primary and noncontributory, this insurance shall be primary and noncontributory but only as to the general liability policy(ies) where that additional insured is listed as the named insured on the declaration page(s) of such policy(ies). All other terms and conditions of this policy remain unchanged. GBA 104025 0614 ADDITIONAL INSURED ENDORSEMENT Insurance Company This endorsement modifies such insurance as Is afforded by the provisions of Policy# Relating to the followidg,: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; is named as ("additional Insured") 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 orfor 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 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 insured, this insurance shall not be canceled, or miateriall!y reduced in coverage or limits except after thirty (30) days written notice has, been given to the City of Santa Ana, 20 Civic Center Plan, Santa Ana, California 92701. (Completion of the following/ including countersignature, is required tomake thisendorsement effective Effective, this endorsement form, as a part of VbA Policy # h 45-1UM-19 COVINGTON SPECIALTY INSURANCE COMPANY This Endorsement Changes The Policy, Please Read It Carefully. POLICY CHANGES This endorsement modifies insurance provided under the following: ❑ COMMERCIAL GENERAL LIABILITY COVERAGE PART ❑ COMMERCIAL PROFESSIONAL LIABILITY COVERAGE PART ❑ COMMERCIAL INLAND MARINE COVERAGE PART ❑ COMMERCIAL PROPERTY COVERAGE PART ❑ LIQUOR LIABILITY COVERAGE PART ® ALL COVERAGE PARTS APPLICABLE TO THIS POLICY Policy Number: VBA457676 00 Named Insured: International Promotions DBA Fies Endorsement No.: 3 Endorsement Effective Date: 3/2/2017 By: R -T SPECIALTY, LLC It is hereby, understood and agreed that the following additional insured is added to form CG2026: per the attached Premium Fully Earned ❑ No change in premium ® Additional Premium $ 100.00 ❑ Additional taxes and fees $ .00 ❑ Return Premium $ ❑ Return taxes and fees $ ® Total $ 100.00 All other terms and conditions of this policy remain unchanged. Policy No.: VBA457676 GBA 904001 0208 COVINGTON SPECIALTY INSURANCE COMPANY This Endorsement Changes The Policy. Please Read It Carefully. CANCELLATION BY US TO OTHERS This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS It is hereby understood and agreed that if we cancel this policy, written notice of cancellation will be mailed or delivered to the First Named Insured and the following: Schedule City of Santa Ana 20 Civic Center Dr. Santa Ana, CA 92801. Number of Days: 30 COMMON POLICY CONDITIONS, A. Cancellation, 2. is replaced by the following: 2. We may cancel this policy by mailing or delivering to the First Named Insured and the entity shown in the Schedule above written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. The number of days shown in the Schedule above before the effective date of cancellation if we cancel for any other reason. This endorsement does not apply if this policy is cancelled by the Finance Company or the Insured. Policy No.: VBA457676 G BA 904019 0814