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OP ID: JU CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONYYY) 03/28/2013 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 poiicy(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). PRCOUCER Phone: 530-662-9181 Wraith, Scarlett & Randolph Fax: 530-662-6452 Ins. Serv., Inc 0648084 622 Main Street Woodland, CA 95695 Craig Huft CON PHONE FAX ,vc No Ext : E-MAIL ADDRESS: PRODUCER CHRIS23 CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Christiansen Amusements, Inc INSURER A: Companion Propert & Casualty ,12157 Southland Shows, Inc Stacy Brown P.O. Box 997 INSURER B : INSURER C INSURER D : Escondido, CA 92033 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: RFVIRInId MLIMRFR- 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 POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMlDDr4YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR N PREMISES JEa occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ HIRED AUTOS $ NON -OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LU1BH CLAIMS-MADE DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? NIA CPCA15858 08/01/2012 08/01/2013 WC STATU- OTH- X T Y I TS E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Evidence of Insurance related to all Christiansen Amusements events between 4/l/13 - 7/31/13. CERTIFICATE HOLDER CANCELLATION CITYSA3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC ELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92701-4058 AUTHORIZED REPRESENTATIVE APPROVFI7 AS ' F�JR ©1988-2009 ACORD CORPCb1 scar ACORD 25 (2009/09) The ACORD name and logo are registered marks offACORD--- IvF{ S -IORCK Assistant C&i Attorney