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STRADIS -01 ALOUCK
<br />'4� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 11112014V)
<br />9/11/2014
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # 0252636
<br />Guardian Risk & Insurance Services
<br />P.O. Box 55127
<br />Riverside, CA 92517 1 y
<br />f� loz /
<br />CONTACT
<br />NAME:
<br />PHONE (9511 368 -0700 FAx (951) 368 -0707
<br />k C N Ex J AIC, No
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S)AFFORDING COVERAGE
<br />NAICN
<br />-n -• P
<br />U
<br />A/— D O)
<br />INSURER A: Travelers Property Casualty CO.
<br />INSURED
<br />INSURER B: Insurance Company Of the West
<br />$ 1,000,00
<br />INSURER C:
<br />CLAIMS -MADE � OCCUR
<br />Straub Distributing Co. LTD
<br />INSURER D
<br />Y6300159L799TIL13
<br />4633 La Palma Ave.
<br />Anaheim, CA 92807
<br />INSURER E:
<br />PREMISES Ea occurrence
<br />INSURER F :
<br />MED EXP(Anycne person)
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />UBR
<br />VWD
<br />POLICYNUMBER
<br />POLICYEFF
<br />MMIDOM'VY
<br />POLICVEXP
<br />MM)DD,YYYYI
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />CLAIMS -MADE � OCCUR
<br />X
<br />X
<br />Y6300159L799TIL13
<br />12/31/2013
<br />12/31/2014
<br />PREMISES Ea occurrence
<br />$ 300,00
<br />MED EXP(Anycne person)
<br />$ 10,000
<br />PERSONAL& ADV INJURY
<br />$ 1,000,00
<br />LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 5,000,00
<br />GEN'LAGGREGATE
<br />X
<br />POLICY PEA E LOG
<br />PRODUCTS - COMPIOP AGO
<br />$ 2,000,00
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,00
<br />A
<br />X
<br />ANYAUTO
<br />Y8100159L799TIL13
<br />12131/2013
<br />12/3112014
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />( BODILY INJURY Per accident )
<br />$
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 25,000,000
<br />A
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />YSMCUP0159L799TIL13
<br />12/3112013
<br />12131/2014
<br />AGGREGATE
<br />$
<br />DED X RETENTION$ 0
<br />Aggregate
<br />$ 25,000,000
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITV
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />WSD502056502
<br />02/01/2014
<br />02/01/2015
<br />X
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1 $ 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is req ul red)
<br />Anheuser Busch Fiestas 2014
<br />The City of Santa Ana, It's officers, employees, agents, and representative are named as additional insured in regards to general liability, coverage is primary
<br />and non - contributory, per the attached policy form. Waiver of subrogation applies in regards to general liability per the attached pool'ICy fpf{ptA��y notice of
<br />cancellation. . k`°
<br />*�
<br />qy ggjj
<br />Alp?Y �
<br />100,
<br />CERTIFICATE HOLDER CANCELLATION —III 1-'I�� .Vrrtv AttOltt`'
<br />ACORD 25 (2014101)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />Assts
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana Parks, Recreation & Community Services
<br />Agency -M23
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Silvia Cuevas
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />PO Box 1988
<br />Santa Ana, CA 92702
<br />ACORD 25 (2014101)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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