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CHRISTIANSEN AMUSEMENT, INC. 3 - 2015
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CHRISTIANSEN AMUSEMENT, INC. 3 - 2015
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Last modified
5/30/2017 2:29:29 PM
Creation date
5/4/2015 11:27:24 AM
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Contracts
Company Name
CHRISTIANSEN AMUSEMENT, INC.
Contract #
A-2015-061
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Council Approval Date
4/21/2015
Expiration Date
5/31/2015
Insurance Exp Date
4/1/2016
Destruction Year
2020
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A� ®® CERTIFICATE OF LIABILITY INSURANCE <br />°A3/31/15 <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(les) 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 y <br />Allied S ecialt Insurance, InC <br />10451 Gulf Blvd <br />Treasure Island, FL 33706 <br />8002373355 <br />CONTACT <br />NAME: <br />JPA Ext: FA[AIX Ne: <br />EMAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAICN <br />INSURER A: T.H.E. Insurance Company <br />12866 <br />INSURED Christiansen Amusements, Inc. <br />and Southland Shows, Inc. <br />P. O. BOX 997 <br />Escondido, CA 92033 <br />INSURER B'. <br />INSURER C'. <br />INSURER D: <br />INSURER E: <br />$ 1,000,000 <br />INSURER F: <br />X COMMERCIAL GENERAL LIABILITY <br />19 OCCUR <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 />INSR <br />SUBR <br />MD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYV <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />19 OCCUR <br />I <br />CP20100507-05 <br />04/01/15 <br />04/01/16 <br />PREMSESO DAMAGETRENTE ante). <br />a occurCLAIMS-MADE <br />$ 100,000 <br />$ <br />MED EXP(Any one person) <br />PERSONAL& ADV INJURY <br />$ 1,000,000 <br />Reviewed b <br />i. <br />I <br />GENERAL AGGREGATE <br />$ 10, 000, 000 <br />y � <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMPIOP AGG <br />$ 1, 000, 000 <br />II— PGLICY PRG- <br />ECT I LOC <br />1/ <br />G <br />1 <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />— -- <br />Silvia Cuev <br />o <br />COMBINED SINGLE LIMIT <br />Ea accltlent <br />$ <br />BODILY INJURY (Par person) <br />$ <br />AOSCHEDULED <br />AUTOS AUTOS <br />PRCSA/AdmiS <br />n. <br />BODILY INJURY (Par accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident____ <br />_ <br />$ <br />NON -OWNED <br />HIRED AUTOS _ AUTOS <br />I <br />$ <br />I <br />UMBRELLA LIAR <br />XOCCUR <br />EACH OCCURRENCE <br />$ 4,000,000 <br />A <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />ELP0010135-05 <br />04/01/15 <br />04/01/16 <br />AGGREGATE <br />$ 4,000,000 <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS LIABILITYTORY <br />WC STATU- OTH- <br />LIMITS <br />E.L. EACH ROOT DENT <br />$ <br />ANY PROPRIETORIPARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />N/A <br />'"—'---'"'-- <br />EL. DISEASE -EA EMPLOY <br />$ <br />(MandatoryinNH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requlred) <br />ADDITIONAL INSURED WITH REPSECTS TO THE OPERATIONS OF THE NAMED INSURED ONLY: <br />PAJARITO, LLC, MR. FRANK CHAVES, CITY OF SANTA ANA. <br />FOR THE DATES: 4/29/15 THROUGH 5/04/15 <br />PAJARITO, LLP <br />FRANK CHAVES <br />P.O. BOX 11412 <br />SANTA ANA, CA 92711 <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 PROLISIONS. <br />AR rinhtc <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />
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