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SOUTSHO-02 JHERNANDEZ <br />A CERTIFICATE OF LIABILITY INSURANCE DATE <br />412012016 MMVDIRYYYYl <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement On this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement($). <br />PROOUCER LiCBnse # OB48084 I <br />CONTACT <br />Wraith, Scarlett & Randolph Insurance Services, Inc. PHONE (5301862.9151 FAX Noe (5301882"8452 <br />___.- —, le,c n,,. a.e. <br />INSURER{S)AFFORDING COVERAGE NAICa <br />INSURER A:State Compensation Insurance Fund '35076 <br />INSURED INSURERS: <br />Southland Shows Inc & Christiansen Amusements Inc, INSURER c : <br />Stacy Brown <br />PO Box 997 [ INSURERD:, <br />Escondido, CA 92033 INSURER E _ <br />OVERAGES 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 DOCUMENTWITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />GENL AGGREGATE LIMIT APPLIES PER', <br />POLICY _! JEOT _ LOC <br />OTHER:_ <br />AUTOMOBILE LIARLITY <br />ANY AUTO <br />-1 AUAU TOS OS I,I SCHEDULED <br />AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />I UMBRELLA UAB r OCCUR <br />EXCESS LIAB yCLAIMS <br />DED RETENTIONS <br />EACH OFENCE <br />$ <br />�6ACCUR <br />MAGE TO RENTED <br />(PREMISES <br />MED EXP (Any ons gerson)$ _.._ _.. <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE i$ <br />'PRODUCTS-COMP/OPAGG '$ <br />i COMBINED SINGLE LIMIT <br />_(Ed accident)_ $ <br />BODILY INJURY (Per person)) <br />.._ <br />BODILY INJURY (Per acc,denp,S <br />Ali .PROPERTY DAMAGE " ---- <br />C_ $ <br />Per accldenn i <br />h8 <br />EACH OCCURRENCE _ _(S <br />.!AGGREGATE 'S <br />WORKERS COMPENSATIONSTATUTE I ER�� <br />Me EMPLOYERS' LIABILITY . <br />A ANY PROPRIETORMARTNSWEXECUTIVE yJ-NA 910795415 ".08/0112015,98/0'112915 E.L. EACH ACCIDENT $ 1 <br />OFFIC BRIM EMBER PROW DEO? <br />(Mandatory In NH) E.L. DISEASE_ EA EMPLOYEE '.$ _ 1 <br />Lfgas 'peo+ribe undni' <br />E.L. DISEASE - POLICY LIMIT $ 1 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required14gV' ' <br />Evidence of Insurance related to all Southland Show & Christiansen Amusements events between 4120118a �-81�� <br />Ye A <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN <br />20 Civic Center Plaza <br />Santa Ana, CA 92701-4058 ---- <br />AUTHORIZED REPRESENTATIVE <br />61988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />