FIESTA DE CARNIVAL (A-2015-188)-2015

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Clienf#t 158 PAULMAUR ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD YYYY) a11n2o15 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). PRODUCER Haas & Wilkerson Insurance 4300 Shawnee Mission Parkway Fairway, KS 66265 913432 -4400 - CO A NAME: PAIHCDNEd Ext:913432.4400 AIC No: E -MAL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER e; Star Insu ranter Company 16023 Paul Maurer dha Paul Maurer Shows; Paul Maurer Shows LLC 16081 Warren Lane INSURER C: AOCCUR ��P.ENCE 'PREMISS Ea oawr ante MED EXP(Any one person) INSURER D $Excluded $1,000,000 Huntington Beach, CA 92649 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LTR TYPE OF INSURANCE ABDLY o POLICY NUMBER MMIDON MMMOY/YEYYY - LIMITS A GENERAL LIABILITY G20496496 4/ 011201504101 /201q EACH _$1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR AOCCUR ��P.ENCE 'PREMISS Ea oawr ante MED EXP(Any one person) $100000 $Excluded $1,000,000 PERSONAL& ADV INJURY $2,000090 GENERAL AGGREGATE- GEN'L AGGREGATE LIMIT APPLIES PER: $2,000,000 (PRODUCTS- COMP /OP AGG $ POUCV PECI FXI LOC A AUTOMOBILE LIABILITY H08133268 21051'2015 _ 02/051201d CEO MBMEEDISINGLE OMIT $1,000,000 $ ANY ALTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS Jx BODILY I (Per accident) $ $ NON -OWNED HIRED AUTOS AUTOS rx PROPERTY RA MA Per.odco,m _ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ $ EXCESS LIAR CLAIMS -MADE : AGGREGATE DED RErEN'rION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICEWMEMTOIIEXCTUDEDEXECUTIVE= NIA WC0568554 1/01/2015 01101/2016 X i WC STATU- I OTH- .LIMEY E. L. EACH ACCIDENT $1,000,000 $1,000,000 (Mandatory in NH) E.L DISEASE- EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $1,000,000 _ ed �y•. DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (Adach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured: City of Santa Ana, it's officers, agents, employees, representatives and S volunteers, and Fiesta de Carnival.; Event Dates: Cesar Chavez Park GUeva SEE ATTACHED ADDITIONAL INSURED AND NON - CONTRIBUTORY ENDORSEMENTS 5�w�`d I Pd'('( 0 Workers' Compensation coverage applies to the statutory requirements of the state of Cali la. RcsP P City of Santa Ana, Parks, Recreation & Community Services Agency 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2010/05) 1 oil #S210502/M210499 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 Em 01988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SALAK