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ACORH CERTIFICATE OF LIABILITY INSURANCE D06/25/DD/Y 06/25/2012 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 1-425-454-3386 Arthur J. Gallagher Risk Management Services, Inc. CONTACT NAME: Joanne Manion PHONENo, WC.425-454-3386 FAX A!C No 425-451-3716 E-MAIL ADDRESS: P.O. Box 367 INSURERS AFFORDING COVERAGE NAIC# Bellevue, WA 98009-0367 INSURER A: General Insurance Company of America INSURED Christiansen Amusements, Inc. INSURER B INSURER C : INSURER D: P. 0. Box 997 INSURERE: Escondido, CA 92033-0997 INSURER F : COVERAGES CERTIFICATE NUMBER: 27846677 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 LTR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence S MED EXP (Any one person) S CLAIMS -MADE OCCUR PERSONAL & ADV INJURY S GENERAL AGGREGATE $ GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ POLICY PRO LOC $ A AUTOMOBILE LIABILITY 24CC2779362 04 01 1 04 01 12 COMBINED SINGLE LIMIT Ea accident__ 1,000,000 BODILY INJURY (Per person) S X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR - t EACH OCCURRENCE $ AGGREGATE $ EXCESS LIARH CLAIMS-MADE DED RETENTION $ $ WORKERS COMPENSATION _ _.. ..._...__ WC STATU- OTH- AND EMPLOYERS'LIABILITY Y / N ANY PROPRIETOPJPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N / A .- .. _.1 _ TORY...LIMI ....._..__.._.._......._.__.... E.L. EACH ACCIDENT .............._..... S E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below - - E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, its officers, employees, agents and representatives are included as additional insureds but only as respects the operation of the named insured per policy terms and conditions. RE: Jerome Park Carnival Event Dates: August 6 - 12, 2012 City of Santa Ana Attn: Robert Carroll 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2010/05) jomanion 27846677 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. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD