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AC40R" CERTIFICATE OF LIABILITY INSURANCE DATE 6/27/12) 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). PRODUCERAllled Specialt Insurance 85 N. E. Loop 4 1� Suite 600 San Antonio, TX 78216 NAME: CONTACT PHONE FAX Ext: A/C,No: E-MAILo ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # _ - INSURER A : T . H . E . Insurance Company 12866 INSURED Christiansen Amusements, Inc. and Southland Shows, Inc. P. O. Box 997 INSURER B: INSURERC: INSURER D: Escondido, CA 92033 INSURER E: INSURER F: 04/01/12 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. INSR LTR TYPE OF INSURANCE AINSR DDLSWVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY _ _ CLAIMS -MADE X OCCUR CPP0100507-02 04/01/12 04/01/13 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence___ $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 17 POLICY PRO- JECT 71 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ if ZS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE . DED RETENTION $ $ _ --------- '"` WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OF EXCLUDED? ❑ NIA ' " TORY LIMITS ER E.L. EACH ACCIDENT $ E . DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ADDITIONAL INSURED WITH RESPECTS TO THE OPERATIONS OF THE NAMED INSURED ONLY: CITY OF SANTA, ITS OFFICERS, AGENTS, EMPLOYEES, FIESTA DE CARNIVAL. EVENT: CARNIVAL AT MADISON PARK. FOR THE DATES: 8/27/12 THROUGH 9/05/12 - I Ir"II.M 1 C nwV ucR I.ANI.t LLA I IVN CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY ATTN: SILVIA CUEVAS 26 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI REPRESENT TIVE Cc] 1988-2010 ACl9Rn CORPORATION SII rinh4c racar rael i ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD