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CHRIS23 OP ID: JU <br />...._ CERTIFICATE OF LIABILITY INSURANCE <br />DATe(MMIDDIYYYY) <br />09105!2016 <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 1S 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 ondorsemenl s . <br />PRODUCER <br />Wraith, Scarlett 48084 Randolph <br />his. Sarv., Inc 0848084 <br />622 Main Street <br />Woodland, CA 95695 <br />Craig Huft <br />CONTACT <br />NAME: Craig HUft <br />_ <br />wnoM2 FAX <br />tArc. ae. Ean; 530-662-9181 ..�� No)_ 530.662-6452 <br />EMAIL -----"'—"--'---"'__. <br />..ADDRESS _Crai�his WSrinS.COm <br />INSURER(S(APFOROING COVERAGE �_ <br />NAIL# <br />wsuRERA,State Compensation Insurance <br />35076 <br />INSURED Christiansen Amusements <br />Stacy Brown <br />P.O. Box 997 <br />INSURERS: <br />_.. _..---- —---- —..—.— <br />_..--- <br />_INSURERC_._-� <br />Escondido, CIA 92033 <br />INSURER D: <br />INSURER E <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS 15 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 />T <br />TYPE OF INSURANCEXD'BL <br />SUBR <br />_.__. POLICY NUMBER <br />MM/YY <br />/YY--� <br />M U /O�i^tT <br />LIMITS <br />Santa Ana, CA 92701-4058 <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />CLAIMS -MADE ❑ OCCURPREMISES <br />AVA?Ec T0'RrRTrff"—"-.".___..._._....._.___..._.__. <br />Ea occurrence <br />PERSONAL&ADV INJURY <br />$ <br />GENII. AGGREGATE LIMIT APPLIES PER: <br />' POI.ICYujEC7 ` LOC <br />GENERAL AGGREGATE$ <br />-_—.__._—.--...._..-..._ <br />PRODUCTS-COMP/OP AGG <br />...___..... _......................... <br />S <br />S <br />OTHER' <br />AUTOMOBILE <br />_., <br />LIABILITY <br />COMBINED SINGLELIMI r <br />LEa acutlertlJ <br />S <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />—__ <br />ALL OWNED vSCHEDULED <br />AUTOS _ AUTOS <br />..-. NON -OWNED <br />HIREDAUTOS ALTOS <br />BODILY INJURY(Per aendent) <br />PROPERTY (3Ah1i10E ...`� <br />._ <br />5 <br />..5 __..._.....___.__..._ <br />S <br />RELLA LIAR OCCUR <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />$ <br />ESSLIABCLAIMS-MADE. <br />1D'ED=PETeNTK)N <br />S <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNEEffXECUTIVE YIN <br />OFFICERIMBMBER EXCLUDED? <br />(Mandatory In NH) <br />N/A <br />910796416 <br />08/01/2016 <br />08/01/2017 <br />X PER 041 - <br />STATUTC-, ER <br />..._ <br />EL. EACH ACCIDENT <br />1,()06,060 <br />_ <br />E.L. DISEASE - EA EMPLOYEE <br />—$ <br />$ 1,000,000 <br />Ues, describe under <br />SCRIPTION OF OPERATIONS below <br />-- <br />E.LOISEASE-POLICYLIMIT <br />-'—"— <br />$ 1,060,060 <br />DESCRIPTION OF OPERATIONS ILOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, maybe atnulsed it more space is required)nn <br />Evidence of Insurance related to all Christiansen Amusements events between V,���� <br />8/1/16 - 8JS/17, PO �% � <br />�r <br />CERTIFICATE HOLDER CANCELLATION <br />CITYSA3 <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 PROVISIONS. <br />City of Santa Ana <br />20 Civic Center Plaza <br />AUTNORiZEO REPRESENTATIVE <br />Santa Ana, CA 92701-4058 <br />ACORD 25 (2014/09) <br />O 1988.2814 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />