CHRISTIANSEN AMUSEMENT, INC. 3 - 2015

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A� O CERTIFICATE OF LIABILITY INSURANCE DATE 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(ies) 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). y CONTACT PRODUCER Allied Specialty Insurance,InC NAME: 10451 Gulf Blvd AICNE Ext: FAX No: Treasure Island, FL 33706 EMAIL 8002373355 INSURERA: T.H.E. Insurance Company 12866 INSURED Christiansen Amusements, Inc. INSURER B: and Southland Shows, Inc. P. 0. BOX 997 INSURER C: Escondido, CA 92033 INSURER D: 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. INSR LTR TYPE OF INSURANCE 'ADDL INSR SU BR WVO POLICY NUMBER POLICY EFF MMIDDIYYYV POLICY EXP MMIDOIVVVV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AX COMMERCIAL GENERAL LIABILITY CLAIMS -MADE C OCCUR 04/01/15 04/01/16 100,000 PREMISESfEsaa.'Er,Hricel._ $ 100,000 MED EXP (Any one parson) $ PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE _ i $ 10, UUU, IGEN'L Reviewed `e,Q Reviewedi by. AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OPAGG I $ 1,000,000 PRO - POLICY JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Par person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS --� Silvia CU oo Var.GJ BODLYINJURY(Per accident IS PROPERTY DAMAGE Peraccitlent $ NON OWNED - HIRED AUTOS AUTOS J� /n� ,.f PRCSA//y`1II'Ii11. rmye n„ $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 A X EXCESS LIAB CLAIMS MADE] ELP0010135-05 04/01/15 04/01/16 AGGREGATE $ 4, CCS, 00D DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANDPROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER E%GLUDEDP NIA 'TWOCRSTATLLS OER E.L. EACH ACCIDENT $ E.L_DISEASE - EA EMPLOYEE $ ---'- (Mandatary in NH) If yes, describe under DESCRIPTIONOFOPERATIONSbelow iE.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) ADDITIONAL INSURED WITH RESPECTS TO THE OPERATIONS of THE NAMED INSURED ONLY: CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVE AND VOLUNTEERS, FIESTA DE CARNIVAL. EVENT: FOR ALL OF CHRISTIANSEN AMUSEMENTS EVENTS FROM 4/1/15 TO 4/1/16 CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA ATTN: RISK MANAGEMENT 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRQMISIONS. (x11000 011 Arnon rnDDn DATInhl All dnkb —--d ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD