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Clipnt#- 15R
<br />PAULMAUR
<br />11111, ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />D4;0;;2o„n''
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, TWPFER1 FK4itE JIO4I@R.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, ain policies may requ(rppri endorsement. A statement on this certificate does not confer rights to the
<br />certntii(5).
<br />certificate holder in lieu of such end '.: y i-�
<br />r, r
<br />PRODUCER
<br />Haas & Wilkerson Insurance �� ! ` I
<br />4300 Shawnee Mission Parkway
<br />Fairway, KS 66205
<br />913 432-4400
<br />CONTACT
<br />PHONE 913 432-4400 FAX
<br />A/C No Ext): AIC, No
<br />E-MAIL
<br />ADDRESS:
<br />PRODUCER
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A: ACE American Insurance Company 22667
<br />Paul Maurer dba Paul Maurer
<br />INSURER B: Star Insurance Company 18023
<br />Shows, Paul Maurer Shows LLC
<br />71 1/2 Terrace View Drive
<br />INSURER C
<br />Scotts Valley, CA 95066
<br />INSURER D
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />D L U
<br />N D POLICY NUMBER
<br />R
<br />POLICY EFF
<br />(MM/DDYYY
<br />POLICY EXP i
<br />MM/DDIYYYY LIMITS
<br />A
<br />GENERAL LIABILITY
<br />! 620496496
<br />04/01/2011
<br />04/01/2012. EACH OCCURRENCE $1,000,000
<br />X COMMERCIAL GENERAL LIABILITY;
<br />_
<br />DA ENTED
<br />PREMISa occur encs $100,000
<br />CLAIMS -MADE I A OCCUR
<br />MED EXP (Any one person) $Excluded
<br />'PERSONAL&ADV INJURY $1,000,000
<br />GENERAL AGGREGATE $2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:',
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />POLICY PRO X LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />1H08133268
<br />02/05/2011
<br />02/05/2012 COMBINED SINGLE LIMIT
<br />(Ea accident) $ Iy000,000
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS'',
<br />L
<br />>�(,,) yl. j}
<br />C'
<br />�TOE.p '
<br />f jZl"0 ;BODILY
<br />X
<br />SCHEDULED AUTOS''
<br />.3
<br />INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />X
<br />HIRED AUTOS'',
<br />/
<br />(Per accident)
<br />X
<br />NON -OWNED AUTOS
<br />,.,..,.. ._.��
<br />__.
<br />_._. ._,.._.. $
<br />aura Stit
<br />lady
<br />$
<br />UMBRELLALIAB
<br />OCCUR
<br />-�iSSltiCat]C;l'
<br />/�i(n?'al:;�,
<br />iEACHOCCURRENCE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />:AGGREGATE $
<br />DEDUCTIBLE
<br />$
<br />RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATIONWC0568554
<br />01/01/2011
<br />01/01/201x X WC STATU- OTH-
<br />!TORY`—''LIMITS FIR
<br />AND EMPLOYERS' LIABILITY Y f N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE❑
<br />E.L. EACH ACCIDENT $1,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />i
<br />i
<br />I
<br />I
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />(See Attached Descriptions)
<br />LnA 3 l la LMYGaa i PJ 01"Ail
<br />City of Santa Ana, Parks,
<br />Recreation & Community
<br />Services Agency
<br />Reservations Admin. Corbin Comm
<br />Center 2215 W. McFadden, Suite B
<br />Santa Ana, CA 92704
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />©1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S81070/M73070 SALAK
<br />
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