CHRISTIANSEN AMUSEMENT, INC. 3 - 2015

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DATE(MMIDDPrYYY) AL CERTIFICATE OF LIABILITY INSURANCE 3/30/2015 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: Joanne Manion _.. __. __ Arthur J. Gallagher Risk Management Services, Inc. AI°"N E. 425-454-3386 IAA No)425-451-3716 777 108th Ave NE, #200 E-MAIL Bellevue WA 98004 ADDRESS__ _ INSURER(S)AFFORDINGCOVERAGE NAIC# INSURER A:Amerlcan States InsuranceCompany 19704 INSURED CHRIAMU-01 INSURERS: Christiansen Amusements, Inc. INSURER C: P. O. BOX 997 INSURER O: Escondido, CA 92033-0997 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 17775,147 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 ADDL SUER, POLICY EFF POLICY EXP LTR TYPE OF INSURANCE "SR MD POLICY NUMBER UMMIDDFOOOO (MMIDD"YYI LIMITS GENERAL LIABILITY EACH OCCURRENCE'. --- DAMAGE TO RENTED _ .COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS MADE _ OCCUR MED EXP (Any one person) PERSONAL&AOV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ PRO- $ POLICY'. jEC LOC A AUTOMOBILE LIABILITY 01CI56248640 4/1/2015 4/1/2016 (Ea aacltleDtll LE IMIT ' $1000,000 _ 'X ANY AUTO BODILY INJURY (Per person) I$ ALL OWNED 'SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS _ INON-OWNED X X PROPERTY DAMAGE HIRED AUTOS .AUTOS (Per accident) I$ $ UMBRELLA LIAR OCCUR Reviewed EACH OCCURRENCE $ _ — eel .. __.. EXCESS LIAR CLAIMS -MADE '`t. I AGGREGATE $ DED RETE NTION5 $ WORKERS COMPENSATION WC STATU- OTH- __. .TORY LIMITS -----EB_ ANDEMPLOYERS'LIABILITY YIN p oo r11 `Io uevas ANY PROPRIETOR/PARTNER/EXECUTIVE❑'NIA SIIVka EXCLUDED? OFFICER/MEMBERandaton _EL EACH ACCIDENT $ NH) atoryln NH) r[V J/'1 /"�l.t PRCSA/Admm. EL DISEASE EAEMPLOVEEI$ _ If describe under ns, -DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The City of Santa Ana, its officers, employees, agents and representatives and Fiesta de Carnival are included as additional insureds but only as respects the operation of the named insured per policy terms and conditions per form CA7110 0307. For all Christiansen Amusement events during the period 4/1/2015 - 4/1/16 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Robert Carroll 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 USA © 1988-2010 ACORD CORPORATION. All riahts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD