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Client#: 158 PAULMAUR
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDfYYYY)
<br />2/09/2012
<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, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />NAME: _
<br />Haas & Wilkerson Insurance PHONE FAX
<br />c, No, Exti913 432-4400 — (A1C, Nor.
<br />— ----
<br />4300 Shawnee Mission Parkway E-MAIL
<br />Fairway, KS 66205 ADDRESS:__ --
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />9134324400-
<br />13 432-4400— -
<br />---- ------
<br />-- - INSURERA: ACE American Insurance Company 22667
<br />INSURED
<br />Paul Maurer dba Paul Maurer
<br />Shows, Paul Maurer Shows LLC
<br />71 1/2 Terrace View Drive
<br />Scotts Valley, CA 95066
<br />wsuRER B: Star Insurance Company 18023
<br />INSURER C
<br />INSURER D_:- -
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CFRTIFICOTF NIIMRFR• ocvrer�u unuerr..
<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 ADDL
<br />LTR TYPE OF INSURANCE INSR
<br />A GENERAL LIABILITY
<br />- -- -
<br />SUBRI
<br />WVD POLICY NUMBER
<br />620496496
<br />- - -
<br />POLICY EFF POLICY EXP
<br />MM/DD MM/DD/YYYY LIMITS
<br />4/01/2012 04/01/201 EACH OCCURRENCE _ _ $1 000 i
<br />-- -
<br />X COMMERCIAL GENERAL LIABILITY
<br />--i —,
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $100,000
<br />CLAIMS -MADE _ Xj OCCUR
<br />MED EXP (Any one person) $ Excluded
<br />_.
<br />N'L AGGREGATED LIMIT APPLIES PER,
<br />L---
<br />PERSONAL & ADV INJURY I $1,000,000
<br />GENERAL AGGREGATE $2,000,000
<br />PRODUCTS COMP/OP AGG $2,000,000
<br />_.
<br />POLICY JECT
<br />-
<br />Ali
<br />fes-
<br />$
<br />-. AUT
<br />AUTOMOBILE LIABILITY
<br />H08133268
<br />'COMBINED SINGLE LIMIT
<br />2105/2072 02/05/2013
<br />j -CEaaccidentl _ $1,000,000
<br />ANY AUTO
<br />I�ALL OWNED X SCHEDULED
<br />h AUTOS _ AUTOS
<br />X, NON -OWNED
<br />X
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per accident) 1 $
<br />- EY DAMAGE - + --- — -_...
<br />PROPRT
<br />HIRED AUTOS AUTOS
<br />i
<br />Per accident $
<br />UMBRELLA LIABOCCUR
<br />EXCESS LIAB CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />EACH OCCURRENCE $
<br />AGGREGATE - $
<br />B WORKERS COMPENSATION
<br />$
<br />WC STATU OTH-
<br />r _
<br />, AND EMPLOYERS' LIABILITY
<br />WCO568554
<br />1/O1/2O721 :01/01/207 X_ T RY�TS
<br />Y! N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEL,
<br />OFFICER/MEMBER EXCLUDED? NIA
<br />-
<br />ry
<br />E.L. EACH ACCIDENT
<br />ID $1,000,000
<br />(Mandatory in NH)
<br />i If yes, describe under -
<br />DESCRIPTION OF OPERATIONS below
<br />�
<br />-
<br />E.L. DISEASE EMPLOYEE $1,000,000 _._
<br />-- --- -
<br />E L DISEASE - POLICY LIMIT$1,000 OOO
<br />_ _-
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Additional Insured: City of Santa Ana, it's officers, agents, employees, representatives and
<br />volunteers, and Fiesta de Carnival, This insurance is primary and non-contributing.
<br />Event Dates: Cesar Chavez Park, April 6-8, 2012; SEE ATTACHED ADDITIONAL INSURED ENDORSEMENT
<br />Workers' Compensation coverage applies to the statutory requirements of the state of California.
<br />City of Santa Ana, Parks, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Recreation & Community ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Services Agency
<br />Attn: Silvia Cuevas AUTHORIZED REPRESENTATIVE
<br />26 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />(D 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S705573/M99742 SALAK
<br />
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