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Al /ZO CERTIFICATE OF LIABILITY INSURANCE ®8/2013 YY> 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(lea) 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 Kaliff Insurance P.O. SOX 171225 San Antonio TX 78217-8225 CONTACT Lama Grant NAME; _ PHONE (0)829-7634 Ax fAIC (210)829-7636 21Silkaliff.Com E-MAIL ,1i; INSURERS AFFORDING COVERAGE NAIC N INSURERA;Certain Underwriters @ Lloyds INSURED Davie Enterprises Tom & Sharie Davis 17010 Windflower Avenue Fontana CA 92336 INSURER B:General Star Indemnity Co. INSURER C: _ INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL131210800 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 INSURANCEADDLSUBR POLICY NUMBER POLICY EFF M DD YYY) POLICY XP (MM/DDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $� 1,000,000 PgEMI ESE occurrence $ 50,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ®OCCUR XKL00756 1/1/2013 /1/2014 VIED EXP(Any one person) $ EXCL PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS � COMNOP AGG $ 2,000,000 X POLICY D PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT Ea accident) BODILY INJURY (Per person) $ ANY AUTO ALL OWNED F7 SCHEDULED AUTOS AUTOS HIRED AUTOS AUUTOSNON-OWNED BODILY INJURY (Per accident ) $ PentFlOPEer IdAMAGE $ UMBRELLAI X OCCUR EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 B EXCESS HAS CLAIMS -MADE DED I I RETENTION$ $ X0414178 1/1/2013 1/1/2014 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ LU OFFICER/MEMBER EXCDED? (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / 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 Parke, Recreation and Community Services Agency, Bob Acosta. Event Location: Delhi Park, 2314 S. Holliday Street, Santa Ana, CA 92707. Event Dates: October 23-29, 2013 APPROVED AS TO FORM I z __. Q // L_..—_....�.� / (714)571-4211 SCuevas@santa-ana.crg City of Santa Ana Parks, Recreation and Coaenunity 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 Xali£f/LAG "^'"` ✓+"'� 1_ INS025 (201005).d1 The ACORD name and logo are registered marks of ACORD