CHRISTIANSEN AMUSEMENTS, INC. 4 - 2016

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A� O➢ CERTIFICATE OF LIABILITY INSURANCE 4/15/2 MMI DNWY) 16 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 PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 777 108th Ave NE, #200 3ellevue WA 98004 INSURED Christiansen Amusements, Inc. P. 0. Box 997 Escondido, CA 92033-0997 CHRIAMU-01 W", NAME: Bobb�al�Ole —T PHONE 'FAX iAAl,_act 425-45.1-3_716 _ E-MAIL Bobby _ YWalpole@ajg com _ INSURERS) AFFORDING COVERAGE NAIC# INSURER A:Amerlcan States Insurance Company 119712 INSURER C: rnvcoAncc rCPTICIrATe k1I mnPeP. r4R94ARnA oevlelnsl w Isno co. 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 IADDLSUBR'1 - - LTR TYPE OF INSURANCE IINSD WVD POLICY NUMBER POLICY EFF POLICY EXP - MMIDDIYYVY MMIDDIYVVY LIMITS -- GENERAL LIABILITY EACH OCCURRENCE - r L CLAIMS- �' DAMAGE TO RENTED i _ �'i. MADE OCCUR _ 1 �. PREMISES (Ea occurrence $ _ MED EXP (Any one persa —- PERSONAL &ADV INJURY I$ _ _ IGEN'LAGGREGATELIMITAPPLIESPER GENERAL AGGREGATE $ Imo_ ET LOC JC $ _.._. PRODUCTS - OTHER: $ A AUTOMOBILE LIABILITY - ! IOIC15624865 14/1/2016 14/1/2017 $ CO,MBINEDSINL GL-1,000,000 (Ea can '�I X ANY AUTO !1 BODILY INJURY (Per person) ' ALL OVMdED �, SCHEDULED AUTOS 'AUTOS BODILY INJURY (Per acmtle )tti X HIRED AUTOS X INOTOSWNED PROPERTY DAMAGE -- $ ! Per accltlent)__ UMBRELLA LIAB OCCUR ''1 EACH OCCUR_RENCE.. $ EXCESS LIAR CLAIMS -MADE! _ AGGREGATE_ $ $ DEO RETENTION$' - WORKERS COMPENSATION I' OE STATUTE L ER AND EMPLOYERS' LIABILITY PIN _ ANYCERIMEMBEREXCLUDED? CUTIVE E.L.EACH ACCIDENT $ OFFI(Mandator EMBER EXCLUDED? ❑ N/All - , IMantlatory in NH)and E.L. DISEASE - EA EMPLOYEE' $ 1DIf yes,RIPTI -- �DESCRIPTIONOFOPERATIONSbelow DESCRIPTION OF I E. L. DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be summed if more space is required) ��{{ The City of Santa Ana, its officers, employees, agents and representatives and Fiesta de Carnival are included as additiods but only as respects the operation of the named insured per policy terms and conditions per form CA7110 0307. \A City of Santa Ana Attn: Robert Carroll 20 Civic Center Plaza Santa Ana CA 92701 USA 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 t& -% A�du, rn PPn PATInM All rinhl� re�e...n.l ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD