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OP ID: JU —� CERTIFICATE OF LIABILITY INSURANCE DATE I3 /20Y3 07/3012013 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 Wraith, Scarlett & Randolph Ins. Serv., Inc 6848084 622 Main Street Woodland, CA 95695 Craig Huft CONTACT NI PHONE FAX AIC No E.AIC No: EMAIL ADDRESS: PRODUCER CHRIS23 CUSTOMER ID r: INSURERS AFFORDING COVERAGE NAIC k INSURED Christiansen Amusements, Inc INSURERA: State Compensation Insurance 35076 Southland Shows, Inc Stacy Brown P.O. Box 997 INSURER B: INSURER C: COMMERCIAL GENERAL LIABILITY Escondido, CA 92033 INSURER O: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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. /NSR R TYPE OF INSURANCE ADOL POLICY NUMBER I POLICY EFF POLICY LIMITS GENERALLIABILITY EACH OCCURRENCE 5 COMMERCIAL GENERAL LIABILITY PREMISES Ea occuence �$ CLAIMS -MADE 1:1 OCCUR MED EXP (Any one person) i S PERSONAL& ADV I INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LI MIT APPLIES PER: PRODUCTS - COM PIOP AGG $ POLICY PRO_ RO JEST LOC $ AUTOMOBILE LIABILITY ANY AUTO y # 0� =� l.��=' COMBINED SINGLE LIMIT accident) $ BODILY INJURY (Per person) 8 ALL OWNED AUTOS i�^tq#¢.�w Sy r _ BODILY INJURY IPer accidenp$ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTos I ( ,�^"aJ,,I:.Jl� f\sslst< .--�^'=} Ji�Y{-,' G. G T`' r� � PROPERTY DAMAGE $ IPERACCIDENT) S s /UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEDUCTIBLE $ 1 Is RETENTION $ 1 A. WORKERS COMPENSATION AND EMPLOYERT LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 90680352013 0810112013 08/01/2014 I X WCSTATU- 0TH -i TORY T ER E. L. EACH ACCIDENT $ 1,000,000 OFFICERWEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE - EA EMPLOYEE/$ 1,000,006 If yes, describe under DESCRIPTI ON OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mere space n required) Evidence of Insurance related to all Christiansen Amusements events between 8/1/13 - 8/1/14. CITYSA3 City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701.4058 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 <__� © 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD