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To: <br />arf.rw /1 Cs <br />From: Marianne Hochmuth 9/19/2014 4:14:17 PM (Page 4 of 4) <br />f►v QW CERTIFICATE OF LIABILITY INSURANCE <br />09DATE ( <br />/19/2014) <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(SJ, 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 ondorsement(s). <br />PRODUCER Allied Specialty Insurance, Inc. <br />85 N.E. Loop 410, Suite 600 <br />San Antonio, TX 78216 <br />CONTANAME: CT <br />AHONNo, Ext: gA/XC No: <br />ADD IESS, <br />INSURERS AFFORDING COVERAGE <br />MAC <br />210-341.1321 800.235-8774 <br />INSURER A:T.H.E.Insuranca Com pan <br />12866 <br />INSURED Carnival Midway Attractions <br />INSURER B; <br />NsuRERc: <br />Linton Park Holdings, Inc. <br />2560 E. Chapman Ave. #245 <br />Orange, CA 92869 <br />INSURERD: <br />INSURER E: <br />I <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NIIMRRR- <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 />TYPE OF INSURANCE AB <br />aR <br />POUCYNUMBER <br />POUCYEFF <br />YYYY <br />POUCYEXP <br />fMNIJDDNYM <br />LIMITS <br />A <br />GENERALLIABILITY <br />j( COMMERCIAL GENERAL LIABILITY <br />CLAIMS -WADE 1XI OCCUR <br />CPP01001016.04 <br />04/01/2014 <br />0410112015 <br />EACH OCCURRENCE <br />$1,000,000 <br />E TED <br />PREIJ119E5 Eaoccurrence <br />$100,000 <br />UED EXP(Any one p.mon) <br />$ <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$5,000000 <br />GENT AGGREGATE <br />POLICY <br />LIMIT APPLIES PER <br />PF T LOC <br />PRODUCTS - COMP'OP AGG <br />$1,000,000 <br />$ <br />a <br />AUTOMONL.FLIABILITY <br />X <br />ANYAUTO <br />ALL OWNED X SCHEDULED <br />AUTOS AUTOS <br />HIREDAU-OS X NON -OWNED <br />AUTOS <br />CPP01001016-04 <br />04101/2014 <br />04/0W2015 <br />e"O.Wd.hfl GNU <br />1,000,000 <br />BODILY INJURY(Yer pb=ii) <br />$ <br />JURY ( Per ) <br />BODILY INacck{ant <br />$ <br />PROPERTYDAMAGE <br />Ee,' accident <br />$ <br />A <br />)( <br />UMBRELLA LIAR <br />EXCESS JAB <br />X <br />OCWR <br />OLAINIG-MADE <br />ELP0010197.04 <br />04/01/2014 <br />0410V2015 <br />FAC.HDCCl1RRFNC,F <br />$4,000,000 <br />AGGREGATE <br />$4,000,000 <br />DED ETE TICN$ <br />$ <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILIW YIN <br />ANY PROPRIETCRIPPRTNERIEXECUME <br />CFFICEWMEMNER EXCLUDED? ❑ <br />(Mentletary In NHl <br />If yes, describe under <br />OESCRI PTION OF OPERATIONS below <br />NIA <br />yt <br />�Jk0V'D ,CT <br />VV,G <br />( <br />L L. <br />,( <br />OR Cf` <br />,L <br />./vdV <br />WC STATU- OTH- <br />TOBY LIMITS <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE -POLICY UNIT <br />$ <br />Assistant G1 <br />y pt o <br />CESCRIPVON OF DPERATION9 i LOCATIONS /VEHICLES (Attach ACORD 101, Addtianal RnmarM 3chadule, it mom space in rnyulrad) <br />EFFECTIVE FROM 10/14/14 THROUGH 10/21/14 <br />ADDITIONAL INSURED: CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES; ROBERT ACOSTA <br />COVERAGE IS PRIMARY AND NON-CONTRIBUTORY AS RESPECTS TO THE OPERATIONS OF THE NAMED INSURED ONLY <br />30 DAY CANCELLATION CLAUSE APPLIES <br />y of Santa Ana <br />in: PRCSA <br />Civic Center Plaza - M-23 <br />nta Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POUCY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE �"I f Lny'rr <br />©1939.2010 ACORD CORPORATION. All riahiw <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />