CHRISTIANSEN AMUSEMENT, INC. (2)

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r':rrxfASy 6CERT�FICATE OF LIABILITY INSURANCE HATE IMMIDUIYYVY) 4/18/2017 THIS. CERTIFICATE IS 6SUED 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER Arthur J, Gallagher Risk Management Services, Inc. 777 108th Ave NE, #200 Bellevue WA 98004 CONTACT NAME: Bobby Walpole PHONE I FAX (AIG,1d%,I, 425-586-1006 Arc„N425-451-3716 - E-MAIL Bobby 01IRESs______ INSURERS) AFFORDING COVERAGE NAIC p_ INSURER A:American States Insurance Company D 19712 INSURED CHRIAMU-01 INSURER B: INSURERC: Christiansen Amusements, Inc. Escondido, CA92033-0997 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 2063720831 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. INS.',, LTR TYPEOFINSURANCE POLICY EFF POLICY EXP _ INSOI WVDI POLICY NUMBER '.MMIDDIYYYY '.MMIDO/YYYY LIMITS COMMERCIAL GENERAL LIABILITY � --,- CLAIMS -MADE J OCCUR EACH OCCURRENCE _ I$ DAMAGE DAMAGE T��_ 1 PREMISES (Ea, occunencel ^ I$ 1 IIII MED EXP (Anyone person) $ J :PERSONAL &ADV INJURY I$ - GEN'L AGGREGATE LIMIT APPLIES PER PRO - 1 liJECT '__,I LOC : GENERAL AGGREGATE $ __ PRODUCTS-COMPIOPAGG $ HPOLICY OTHER: 101 14/1/2018 A AUTOMOBILE LIABILITY CI5624865-6 114/1/2o17 .COMBINED BINGL $ . (Ea accident _ _ 1,000_,000 X IANY AUTO - BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON,OVJNED X AUTOS ONLY X 1 ,_ 1 AUTOS ONLY a BODILY INJURY ci Peracdent $ ( ) PROPERTY DAMAGE 1 (Peraccident $ S UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE 11 �� .,�� I! EACIT"CCU RRENCE $ _ AGGREGATE $ DED RETENTION$ ____ WORKERS COMPENSATION I -AND VERS' LIABILITY YIN ' G� j, I PER OTT - - I E.L. EACH ACCIDENT $ PROPRIE nRIPARTNEMEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑INIA (MandatoryIn NH) If yes des. be der DESCRIPTION OF OPERATIONS below ` _ V,(� \A,4.? i �� DISEASE - EA EMPLOYEE $ 1 E.L. DISEASE -POLICY LIMIT $ DESCRIPTION RIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORDI 101, Additional Remarks Schedule, may be attached 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. IGP/4140 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 @ 1988-2015 ACORD ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD