CHRISTIANSEN AMUSEMENT, INC. 3 - 2015

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CHRIS23 OF ID: JU — CERTIFICATE OF LIABILITY INSURANCE DATE,MMIDDIYYYY) - - 07/30/2013 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 CONTACT NAME:Cf HUft Wraith, Scarlett & Randolph Ins. Sew., Inc OB48084 PHONE -- FAX AID No,Es :530.662.9181 t 530.662.6452 - -_--(A/CN.:_- - 622 Main Street EMAIL— — ADDREss: craigh@wsrins.com Woodland, CA 95695 PRO_ '.. POLICY JECT I_ LOCPRODUCTS ��. by:..g Craig Huff INSURER(S) AFFORDING COVERAGE _ NAICp_ INSURERA:.State Compensation Insurance 35076 INSURED Cllrtstlansen Amusements B. Stacy _INSURER _ Box P.O. BBox 99977 INSURER C: ---- ----- - - Escondido, CA 92033 INSURER D: (Pere ciidentDAMAGE 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. INSRR TYPE OF INSURANCE ADDL SUER. POLICY EFF POLIOE%P INS.POLICY NUMBER Mai MMIODIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMSMADEOCCUR —_ DAMAGETORENTEb _.- PREMISESEa occurrence) $ — -- MED EXP (Any one person) $ PERSONAL$ ADV NJURY GEN'LAGGREGATE LIMITAPPLIES PER. .. GENERAL AGGREGATE $ PRO_ '.. POLICY JECT I_ LOCPRODUCTS ��. by:..g - COMP/OP AGO $ — OTHER: Reviewed AUTOMOBILE LIABILITY ®�I COMBINED SINGLE LIMIT $ ANY AUTO---T`l './ BODILY INJURY (Per person)I,$ ALL OWNED _ SCHEDULED Es'� AUTOS AUTOS -- BODILV INJURY (Per accident) $ O S)IVIa CUeV�IO $ HIREDAUTOS _ AUTOSWNED (Pere ciidentDAMAGE UMBRELLA LIAB.OCCUR - �'. EACH OCCURRENCE '.. $ EXCESS LIPS CLAIMS -MADE. AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION : X PER OTH- ANDEMPLOYERS' LIABILRYSTATUTE YIN ER A ANY PROPRIETOMPARTNER/EXECUTIVE 90680352014 08/0112014.08101/2015 E.L.EACH ACCIDENT $ 1,000,000 OFFICER)MEMBER EXCLUDED4 �INIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE: $ 1,000,000 If es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASEPOLICYLIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD ur, Additional Remarlis Schedule, may be attached If more space Is required) Evidence of Insurance related to all Christiansen Amusements events between 8/1/14 - 8/1/15. 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD