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Client#: 158 A^^rvn PAULMAUR 4"t`ewriul CrtiK 1 11-K ATE OF LIABILITY INSURANCE I DATE(M%DOIYWY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER' THIS CERTIFICATE DOES NOTAFFIRMATIVELYO INSURANCE 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(los) 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 holdsr in lieu of such endorsement(s), PRODUCER pN ACT Haas & Wilkerson Insurance NAME: u,N 4300 Shawnee Mission Parkway . 1913 432.4400a.MAIL A/O No: Fairway, KS 66205 ADD -SS: 913432.4400 INSURER(9) AFFORDING COVERAGE NAICN INSURED INSURERA:ACE American Insurance Company 22667 Paul Maurer dba INSUREPi State National Insurance Compel 12831 Paul Maurer Shows INSURER C: 16081 Warren Lane INSURERD: Huntington Beach, CA 92649 INSURERE; —�— INSURERP:. COVERAGES rFRTICIrATc sn m.esva. _ 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 CONTRACTOR OTHER DOCUMENT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED WITH RESPECT TO WHICH THIS HEREIN AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IS SUBJECT TO ALL THE TERMS, $EXCLUSIONS LTRR TYPEOF INSURANCE NRSUER POLICY NUMBER MM// EPF MMIDO/YYY LIMITS A GENERAL LIABILITY G20496496 4/01/2018 041011201H X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $1 000 ppp CLAIMS -MADE OCCUR DAIiAAIGSE TO RENTEp pREM ES IEa occurcence) _ 000000 , _ MED EXP (Any one person $Excluded - "—" PERSONAL S ADV INJURY $11000,000 GENT AGGREOATE LIMIT APPLIES PER: v _ GENERAL AGGREGATE s2,000,00D POLICY JECa X LOG PRODUCTS-COMP/OP AGG $2,000,000 A AUTOMOBILELIABILITY H08133268 2/p5/2018 02/05/201 § COMBINED SIN LE LIMIT Ea eccitlent $1'000,000 ANY AUTO ALL OWNED X SCH50ULED BODILY INJURY (Par person) s AUTOS AUTOS X HIREDAUTOS X NON -OWNED BODILY INJURY (Per acdaent) $ —� AUTOS PROPERTYDAMAGE $ $ UMBRELLA LIAB OCCUR _ `-- LXCE89 LIAR CLAIMS -MADE EACH OGCURRENCE $ AGGREGATE § OEO RE'rENT10N$ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 11011201801101/ �j C'N OTH- $ ANYGppOpYIN OYFIMEMBER EXCLUDED? NIA iNFA0568554 EL. EACH ACCIDENT $1,000,000 (Mandatory, in NH) E.LDISEASE-EA EMPLOYEE $1 000000 If yes, describe under DESCRIPTION OF OPERATIONS below _ EL. DISEASE POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, it more space is required) Additional Insureds: City of Santa Ana, Its officers, agents, employees, representatives and ��11 Volunteers, and Fiesta de Carnival. SEE ATTACHED ADDITIONAL INSURED AND NON-CONTRIBUTORY ENDORSEMENTS Workers' Compensation coverage applies to the statutory requirements of the state of Californiy DFRTIFI(:ATP NM 119G _ City of Santa Ana, Parks, Recreation & Community Services Agency 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE O&�CRIBED @l�ij�)'IE"dg BE CANCELLED BEFORE THE EXPIRATION DATE T EREOP, N ICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) 1 of 1 #S3378191M337818 A""UPIL) cUKVUKA TION. All rights reserved. The ACORD name and logo are registered marks of ACORD SALAK