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CERTIFICATE OF LIABILITY INSURANCE DAT20 MIDDIYYYY) 3/11 /20 14 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(les) 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 Arthur J. Gallagher Risk Management Services, Inc. 777 108th Ave NE, #200 Bellevue WA 98004 CONTACT NAME: Joanne Manion PHONE FAx AIc Noxti.425-454-3a8_0_Alc Ne: 2 -4' - _ E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICft INSURER A : I1070A INSURED CH RIAM U-01 INSURER B: INSURER C: Christiansen Amusements, Inc, P. 0. Box 997 Escondido, CA 92033-0997 INSURER D: INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER: 1426321791 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 ADDLSUBR INSR WVp POLICY NUMBER POLICY EFF MMIDDIYYYV POLICY E%P MWDD/YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:1 OCCUR EACH OCCURRENCE $ �AMATiET REN— PREMISES Ea occurrenceL,_ $ MED EXP (Any one person) $ PERSONAL B ADV INJURY 5 GENERAL AGGREGATE ( GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG 1 $ ECT7POLICY PRO LOC S A AUTOMOBILE LIABILITY OICI5624863 /1/2014 /1/2015 Eaaccident 100_0,000 BODILY INJURY (Per person) $ ANY AUTO Ix ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident $ ) NON -OWNED HIRED AUTOS X AUTOS PROPERTYDAMAGE $ PeruDad1t� — $ UMBRELLA LIAB OCCUR�y� ,tt EACH OCCURRENCE $ AGGREGATE $ EXCESS OAS CLAIMS -MADE 44 dr � � �,'V�' j.Eu1 V4 DED RETENTION$ _ WORKERS COMPENSATIONRS'LIILIT w@�1 WC STATU- OTH- ANDEMPLOYERS'UABILITV YIN y( 1"'+�` W R IMILi E.L. EACH ACCIDENT S OFFICER'MEMeANY CREXCLUDEDPLCUTIVE❑ (Mandatory in NH)�,,..=�,5�F. If yes describe under DE SC RI PTION OF OPERATIONS below NIA F,sa,•.ri S- - _ { G1�. �{ AgOT nPN E.A.. DISEASE - EA EMPLOYEE S E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additions Remarks Schedule, If more sL/pace 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 0307. For all Christiansen Amusement events during the period 4/1/2014 - 4/1/15 CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS, Attn: Robert Carroll 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 USA © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD