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SX AC'ORD CERTIFICATE OF LIABILITY INSURANCE �_. OAT/27/ O20I 03/27/YYYY)3 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). PRODUCER 1-425-434-3386 Arthur J. Gallagher Risk Management Services, Inc. CONTACT NAME: Joanne Manion PHONE FAX Hs. Eat) 425-454-3386 (AC No): 425-431-3716 E-MAIL ADDRESS:_____ P.O. Box 367 ___ Bellevue, WA 98009-0367 INSURERS AFFORDING COVERAGE T NAICI INSURER A: American States Insurance Co. INSURED Christiansen Amusements, Inc. INSURER B : INSURER C : INSURER D: P. 0. Box 997 INSURER E: Escondido, CA 92033-0997 INSURER F : COVFRAGFR CERTIFICATE NIIIMRFR• 32689290 DFVICIn AI Ku I"Mr-D. 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 j TYPE OF INSURANCE ADDL SUER'T— ! POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMI.DIYYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 17 OCCUR i EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence _$ MED EXP (Any one person) S PERSONAL 8 ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S POLICY F I PRO- LOC $ A AUTOMOBILE LIABILITY 01CI5624862 04 O1 1 04 01 14 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) S I X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS I BODILY INJURY Per accident ( ) S X PROPERTY DAMAGE Per accident S HIRED AUTOS X NON -OWNED AUTOS S UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ f_ EXCESS LIAB _ �DED CLAIMS -MADE I AGGREGATE I RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNEPJEXECUTIVE OFFICEFL'MEMBER EXCLUDED? ❑ N / A WC STATU- I IOTH- ___LTQRy_LIIAffS i E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE S (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS / LOCATIONS I 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 per form CA7110 03 07. For all Christiansen Amusement events during the period 4/1/2013 - 4/1/2014 Lg1091R91a:1 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. Attn: Robert Carroll 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 USA ©1 C ORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD- jomanion 32689290 USA E. S i ORCK Assistant City Attorney 1