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'', "� CERT1F11..ATE OF LIABILITY INS6.,ANCE DATE{MMtQQYYYY) 3f2f2012 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 NAME: NTACT Lisa Grant Kaliff Insurance PHONE (210) 829-7634 FAX t a;t-7.07929-7635 P.O. Box 171225 E-MADDRAILFSR• lisaa@kaliff.com �naurccn a RrrurtulNii 6:OVERAGE NAIC M San Antonio TX 78217-8225 INSURERA:First Mercury Insurance Co. INSURED --- _ INSURER B : _ Davis Enterprises INSURERC: Tom & Sharie Davis — 17010 Windflower Avenue INSURER D :INSURERS: Fontana CA 92336 INSURER F COVERAGES r`csrTICIrATC ur ift-1 s.nr 171 nn nnn 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 A R POLICY NUMBER PAMtODYYYF MOMI IO YYYY LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LABILITY A CLAIMS -MADE OOCCUR-CGL-0000003451-01 /1/2012 /1/2013 EACH OCCURRENCE $ 1,000,000 �RENT9O— PREMISES (Ea occurrence) = 50,000 MED EXP (Any one, person) $ EXCL PERSONA{_ 8 ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER X POLICY "0- JFCT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AG G $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO At. L.OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS NON -OWNED AUTOS COMB WED SINGLE LIMIT Ea accident] BODILY INJURY (Per person) BODILY INJURY fPer accident) $ PROPERTY DAMAGE ,Per arcdent" $ $ A j UMBRELLA UAB UAB EXCESS X OCCUR CLAIMS -MADE L-EX-0000003419-01 EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 DED RETENTON$ /1/2012 /1/2013 WORKERS COMPENSATION AND EMPLOYERS' UABIUTY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFF ICERIMEMBER EXCLUDED ❑ (Mandatory in NH) If yes. describe under N!A YVC STRTU- OTH- E.L. EACH ACCIDENT $ E L. DISEASE - EA EMPLOYE " S DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMI"1 $ T I DESCRIPTION OF OPERATIONS I LOCATIONS, VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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: Delhi Park, 2314 S. Holliday Street, Santa Ana, CA 92707. Event Dates: October 19-21, 2012. (On Site: October 16-23, 2012). (714)571-4211 SCuevas@santa-ana.org 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. AUTHORIZED REPRESENTATIVE tchell Kaliff/LAG ACORD 25 (2010106) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025 (2()1005) 01 The ACORD name and logo are registered marks of ACORD