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"" CERTIFI�,ATE QF LIABILITY INS6..ANCE DATEtMM1VDOl(YYY) 3/2/2012 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 CONTACT Lisa Grant NAME: Kallff Insurance PHONE (210) 829-7634 FAX .(210)829-7636 P.O. Box 171225 E-MAIL .lisaa@kaliff.com INSURERS AFFORDING COVERAGE NAIC p San Antonio TX 78217-8225 INSURERA:First MercuryInsurance Co. _ INSURED Davis Enterprises NSURER B : Tom & Sharie Davis INSURER C: INSURER D 17010 Windflower Avenue INSURER E - Fontana CA 92336 COVFRAt;FR fl=nT rrr.wT. INSURER F : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE KtVISiON NUMBER: BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE DOCUMENT WITH RESPECT TO WHICH THIS POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN INSR REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADWVD POLICY NUMBER IPOLI tYYYFY MM IC YYYY LIMITS GENERAL LIABILITY X EACH OCCURRENCE $ 1,000,000 _ COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE I� OCCUR/1/2012 AMA ORE D PREMISES (Ea occurrence $ _ 50 , 000 -CGL-0000003451-01 /1/2013 MED EXP (Any one person) $ EXCL l PERSONAL. & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT GGREGA"f C LIMIT APPLIES PER X FRO- PRODUCTS - COMPiOP AGG IS 1,000,000 POLICY LOC Is AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i Ea accidentL„__ I $ ANY AUTO ALL OIPMED SCHEDULED I BODILY INJURY (Per person) $ AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident) $ UMBRELLA LIAB X OCCUR A EXCESS LIAR CLAIMS-MADE. EACH OCCURRENCE $ 4,000,000 X A GGREGATE $ 4,000,000 DED RETENTIONS -EX-0000003419-01 /1/2012 /1/2013 WORKERS COMPENSATION $WC AND EMPLOYERS' LIABILITY STATU- OTH- - ANY PROPRIETOR/PARTNERiEXECUTIVE YIN OFP3CERthAEMEsER EXCLUDED N t A A„�-)i'� i�..O v i.i + � i.:"S t e L ..d ;°, . *'I E.L EACH ACCIDENT $ Mandatory in NH) IIf yes, describe ;Index E L. DISEASE - EA EMPLOYE $ DESCRIPTION OF OPERATIONS below00 E L. DISEASE POLICY LIMIT $ r DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) ADDITIONAL INSURED AS RESPECTS TO INSURED'S OPERATIONS: City of Santa Ana, Parks, Recreation and Community Services Agency, Bob Acosta. Event Location: Rosita Park, 706 New Hope Street, Santa Ana, CA 192703.; Event Dates: June 8-10, 2012. (On Site: June 5-12, 2012) f�C�TICII+A Tr t —1— CANCELLATION (714) 571-4 211 SCuevas@santa-ana.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Parks, Recreation and Community Services Agency AUTHORIZED REPRESENTATIVE Attn: Silvia Cuevas 26 Sa Civic Center Plaza Sa nta Ana, CA 92701 Mitchell ilaliff/LAG T ACORD 25 (2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025 ao±oos).al The ACORD name and logo are registered marks of ACORD