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" h'rCERTIFICATE OF LIABILITY INSURANCE D 06/25 IDDIY 06/25/20122 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 ......._ _ PHONE 425-454-3386 FAX 425 451-3716 A/C No Ext : (A/C No) E-MAIL ADDRESS: P.O. Box 367 INSURER(S) AFFORDING COVERAGE NAIC# Bellevue, WA 98009-0367 INSURER A: AmeriCan States Insurance Company INSURED Christiansen Amusements, Inc. INSURER B COMMERCIAL GENERAL LIABILITY INSURER C INSURER D: P. O. Box 997 INSURER E: Escondido, CA 92033-0997 i INSURER F: CLAIMS -MADE '� OCCUR COVFRAGFS CFRTIFICATF NIIMRFR- 27846909 RFVISIAN NIIMRFR• 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. INSIRLTR LTR TYPE OF INSURANCE INSRADDL WVDSUBRI POLICY NUMBER MMIDDIYYYY ''. MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY li : DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE '� OCCUR '.. PERSONAL B ADV INJURY I$ GENERAL AGGREGATE '',$ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG'', $ POLICY PRO-JECT LOC A AUTOMOBILE LIABILITY O1CI5624861 04/01712 04/01/13 COMBINED SINGLE LIMIT 1, 000, 000 Ea accident''. $ BODILY INJURY (Per person) $ X ANY AUTO', X'. ALL OWNED —� SCHEDULED'' AUTOS AUTOS NON -OWNED HIRED AUTOS R AUTOS ', BODILY INJURY (Per accident):. $ PROPERTY DAMAGE Per accident)$ $ UMBRELLA LIAB �', OCCUR', ~', EACH OCCURRENCE', $ AGGREGATE'', $ EXCESS LIAB CLAIMS -MADE DED 77FETEWION$ $ WORKERS COMPENSATION j _ - '', WC STATU- OTH-', AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N I A i � / �(( ORY IMITS R _ E.L. EACH ACCIDENT, $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) _.. FFF If yes, describe under ', E.L. DISEASE - POLICY LIMIT '', $ D DESCRIPTION OF OPERATIONS below }. 'l �: I i i DESCRIPTION OF OPERATIONS I LOCATIONS / 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. Policy form CA 7110 0307 provides blanket additional insured wording - copy attached. RE: Carnival at Madison Park Event Dates: August 27 - September 4, 2012 ULK I IFIt:A I t HULUtK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Robert Carroll 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 Jj USA �r)1� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD jomanion 27846909