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STRADIS -01 AILEENV
<br />,4CO�t0, CERTIFICATE OF LIABILITY INSURANCE DAT OIYYYV)
<br />416 /2 a/snols
<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 CONTACT
<br />NAME:
<br />Gallant Risk &Insurance Services, Inc. PHONE FAX /951 368.0700 FAX 951 368.0707
<br />4160 Temescal Canyon Rd., #402 AIC, N , Ext __t_ ) (AIC, NnL ) -
<br />Corona, CA 92883 EMAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC9
<br />INSURER Travelers Property Casualty Insurance Company 36161
<br />INSURED INSURER B: Insurance Company Of the West .27847
<br />Straub Distributing Co. LTD INSURER C:
<br />4633 La Palma Ave. INSURER D:
<br />Anaheim, CA 92807 _ —r_- - -- --
<br />INSURER E
<br />INSURER F
<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 CONTRACTOR OTHER DOCUMENTWTH RESPECTTO
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR - ADOL SUBR - -- POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE POLICY NUMBER MMIODIVYW MMIDD/YVYV
<br />_
<br />LIMITS
<br />- - --
<br />A X COMMERCIAL GENERAL LIABILITY.
<br />EACH OCCURRENCE $
<br />1,000,000
<br />CLAIMS MADE _X OCCUR X 6300159L799TIL14 1213112014 12/31/2015
<br />PREMISES (EEa aI ccu teat ''. S
<br />300,000
<br />MED EXP (Any one person). $
<br />10,000
<br />_
<br />PERSONAL &AOV INJURY $
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE '$
<br />5,000,000
<br />X POLICY PRO- ''. LOG III
<br />PRODUCTS- COMP /OP AGG $
<br />2,000,000
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT '$
<br />(Ea accident)
<br />1000,000
<br />,
<br />A X ANY AUTO X �,8100159L799TIL14 1213112014 12/31/2015
<br />__
<br />BODILY INJURY(Perperson) $
<br />ALL OWNED SCHEDULED !
<br />__._. AUTOS _ AUTOS '..
<br />'BODILY INJURY (Per accident) $
<br />NON OWNED '.,
<br />Reviewed by,
<br />PROPERTY DAMAGE _ $
<br />--
<br />HIRED AUTOS AUTOS
<br />1Per accitlent) _
<br />$
<br />UMBRELLA LIAR OCCUR �.--
<br />�'
<br />EACH OCCURRENCE _ $
<br />EXCESS LIAR CLAIMS -MADE
<br />! AGGREGATE $
<br />DED'', RETENTION $' Silvia
<br />$
<br />WORKERS COMPENSATION
<br />PER 0TH
<br />X I STATUTE ER
<br />AND EMPLOYERS' LIABILITY �'SJglAdmin
<br />VIN
<br />_
<br />B ANY WSD50 0 02101/2015 02/01/2016
<br />E. L. EACH ACCIDENT ' $
<br />1,000,000
<br />EXCLUDED? ❑!NIA :
<br />CERIMEETORI EXCLUDED'
<br />-
<br />(Mandatory
<br />E. L. DISEASE - EA EMPLOYEE', $
<br />1,000,000
<br />If yea rte and
<br />'�, Byes,RIPTI NOFO
<br />:DESCRIPTIONOFOPERATIONSbelow '
<br />_ -'_-
<br />E. L. DISEASE - POLICY LIMIT :$
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Anheuser Busch Fiestas 2015
<br />The City of Santa Ana, its officers, employees, agents and representatives are listed as additional insured in regards to general liability and auto
<br />liability per
<br />the attached policy forms. Coverage is primary and non - contributory per the attached policy forms.
<br />30 day notice of cancellation.
<br />ua
<br />City of Santa Ana, Parks, Recreation & Community Services
<br />Agency -M23
<br />Attn: Silvia Cuevas
<br />20 Civic Center Plaza
<br />PO Box 1988
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />TICIN All .inNla mco...od
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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