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Client#: 158
<br />PAULMAUR
<br />ACORDT. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />3/09/2012
<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
<br />CONTACT
<br />NAME:
<br />Haas &Wilkerson Insurance
<br />a/c°Nry Ext): 913 432-4400
<br />4300 Shawnee Mission Parkway
<br />E-MAIL
<br />Fairway, KS 66205
<br />ADDRESS:
<br />913 432-4400
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A: ACE American Insurance Company 22667
<br />INSURED
<br />INSURER B: Star Insurance Company 18023
<br />Paul Maurer dba Paul Maurer
<br />INSURER C:
<br />Shows, Paul Maurer Shows LLC
<br />71 1/2 Terrace View Drive
<br />INSURER D:
<br />INSURER E:
<br />Scotts Valley, CA 95066
<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 CONTRACTOR 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 />INSLTR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL',SUBR,
<br />INSR'.WVD'. POLICY NUMBER
<br />POLICY EFF
<br />MM/ODIYYW
<br />POLICY EXP
<br />MM/ODlYYYY '', LIMITS
<br />A
<br />GENERAL LIABILITY
<br />620496496
<br />4/01/2012
<br />04/01/2013 EACH OCCURRENCE $1,000,000
<br />-- ----
<br />X COMMERCIAL GENERAL LIABILITY
<br />''�.
<br />DAM
<br />OEa oocur ante $100,000
<br />CLAIMS -MADE C. 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 />JECT
<br />$
<br />A
<br />AUTOMOBILE LIABILITY',
<br />'i, H08133268
<br />2/O5I2012
<br />02/05/20131 COMBINED SINGLE LIMIT
<br />Ea accident $1,000,000
<br />ANY AUTO'','',
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />X
<br />AUTOS AUTOS
<br />:BODILY INJURY Per accident $
<br />( )
<br />NON -OWNED
<br />X HIRED AUTOS X
<br />' ',
<br />PROPERTY DAMAGE
<br />$
<br />'.,_
<br />AUTOS
<br />Per acci_den0
<br />-- .. ...........
<br />UMBRELLA LIAB OCCUR
<br />— -----.. ....---- ---....--- ------ ----
<br />—_ ..-----
<br />.EACH OCCURRENCE [$
<br />EXCESS LIAB CLAIMS -MADE
<br />'AGGREGATE $
<br />DED 1 :RETENTION $
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />WC0568554
<br />1/01/2012
<br />WC STATU- OTH-
<br />X TORYLIMIT ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED
<br />❑
<br />N / A
<br />(p1/01/2013
<br />E.L. EACH ACCIDENT $1,000,000
<br />(Mandatory in NH)
<br />/
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below'
<br />i
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />i
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I 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 FigSta de Carnival.; Event Dates: WObafts PNOV , Apiri1 -1, 2012; -
<br />SEE ATTACHED ADDITIONAL INSURED AND NON-CONTRIBUTORY ENDORSEMENTS
<br />Workers' Compensation coverage applies to the statutory requirements of the state of California.
<br />City of Santa Ana, Parks, Rec SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />& Community Services Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Silvia Cuevas
<br />26 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />©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 />#S108182/M99742 SALAK
<br />
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