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ACC?RV CERTIFICATE OF LIABILITY INSURANCE ��. O06/25IDOI/201122 06/25 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 S. Gallagher Risk Management Services, Inc. CONTACT Joanne Manion ;_ ann NAMEPHONE Exit,LVCNo, 425-454-3386 aC No: 425-451-3716 P.O. Box 367 E-MAIL ADDRESS: INSURERSI AFFORDING COVERAGE NAICA Bellevue, NA 980 09-03 67 INSURER A' American States Insurance Company INSURED Christiansen Amusements, Inc. INSURER a' EACH OCCURRENCE Is INSURER C: INSURER O: P. O. Box 997 INSURER E: Escondido, CA 92033-0997 INSURER F: AMA N PREMISES Ea occurrence $ COVERAGES CERTIFICATE NUMBER: 27846909 REVISION NUMBER - 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 ADOL I= SUER WVO POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDMYY LIMITS GENERAL LIABILITY EACH OCCURRENCE Is COMMERCIAL GENERAL LIABILITY CLAIMS -NAPE F—IOCCUR AMA N PREMISES Ea occurrence $ MED EXP (Arty ane person) 1. PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY F7 PRO- LOC JECT is A AUTOMOBILE LIABILITY OICI5634861 04/01/12COMBINED SING LE LIMIT ( 1,000,000 Ea acatlant BODILY INJURY (Per person) $ X ANY AUTO - ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per acadent).s PROPERTY DAMAGE is P r X HIRED AUTOS X NON -OWNED AUTOS Is UMBRELLA LIAR OCCUR EACH OCCURRENCE i.. s AGGREGATE !s EXCESSLIAB CLAIMS -MADE 4, DED RETENTION$ WORKERS COMPENSATION_ WC STATU- OTH-i AND EMPLOYERS' LIABILITY ANYPROPRIETORNARTNER/EXECUTIVE Y/N OFFICER/MEMBERE%OLUDE07 NIA Pn _ - -- — E.L. EACH ACCIDENT $ (Mandatory lnNH) If yes, describe under.— DESCRIPTION OF OPERATIONS below LBUi� tib'.[ E.L. DISEASE -EA EMPLOYEE$ E.L. DISEASE - POLICY LIMIT 1 $ AsstsLa 11 L LI'4 r... , DESCRIPTION OF OPERATIONS I 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. Policy form CA 7110 0307 provides blanket additional insured wording - copy attached. RE: Carnival at Madison Park Event Dates: August 27 - September 4, 203.2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ity of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ttn: Robert Carroll 0 Civic Center Plaza AUTHORIZED REPRESENTATIVE ,(/,�j�/y)�yy ante. Ana, CA 92701 DSA "_/"- ' "" )1/11� All rights ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD jomanion 27846909