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HomeMy WebLinkAboutO ENTERTAINMENT, INC. 4ACity of Santa Ana Clerk of the Council AGREEMENT TERMINATION 2011-JM 29 PM 4: 50 Please complete this form when the attached agreement is no longer in effect. Return form to the Clerk of the Council Office (M-30). (ITY OF SANTA ANA Call 647-6520 if you have any questions. CLERK OF COUNCII The agreement with No. �� A '�� ����� t) �� was completed on �r� l(' and final payment has been made. Department: 1 Phone/Eat.: 5 TYJ Signature: c� �Dk ;QAJIP4 CSO Date: �D—,dd � Ly- Revised 12-07-07 ON 1ILE INSURANCE NOT R GEED WORK MAYOT OOUNCIL CLERK FIRST AMENDMENT TO NON-EXCLUSIVE AGREEMENT TO PROVIDE nc�TF.; y-2y�1� CARNIVALS AT CITY PARKS wr A-2009-017-001 THIS AMENDMENT is entered into this 1 st day of March, 2010, by between O Entertainment (hereinafter "Operator"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City"). RECITALS: A. The parties entered. into Agreement A-2009-1/, (the "Agreement") by which g� Operator has conducted carnivals in City parks. O � [� V' B. In accordance with the terms and conditions of the Agreement, the parties wish to U renew the Agreement for a one-year period and to revise the Schedule of Events. WHEREFORE, in consideration of the covenants contained in the Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this First Amendment, the parties agree as follows: Section 3. FEES/DEPOSITS/PERMITS/LICENSES is amended to set forth the dates and fees for the 2010 carnivals as follows: Park Jerome Dates March 12-14 Revenue 1 a�,250 L Jerome — ---- August 13-15 ------ $7,000 $15,250 2. Section 5, TERM shall be amended to extend the term through December 31, 2010. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to Recreation Services Agreement on the date and year first written above. ATTEST: ARIA D. HUIZ,rR Clerk of the Council CITY OF SANTA ANA DAVID N. REAM City :Manager APPROVED AS TO FORM: RECOMMENDED FOR APPROVAL: GERARDO MOUET Executive Director Parks, Recreation and Community Services Agency PROVIDER (J 0 i Q .FEB-25-2010 THU 04.55 PSI FAX NO. 407 645 2810 P. 01 CERTIFICATE OF INSURANCE RODIICI R: DATE ISSUED: OV06MO9 COMPANY: LESTRR KALMANSON AGENCY, INC. 1000A t EkTAIN VNDEKWfJTMkS A►I' LLOYD'S/ P.U. BOX 94m LONDON MAITLAND FL 327Q4•QX101i PH: (407) 645.5000 P(ILICY NUMBER: NCMOUM FAX: (407) 643-U10 AbOD INSURED O ENTERTAINMENT, INC. C/Q ROY HASSUTT 539 Z BIXBY ROAD # 59 LONG RUCK CA 908W ROVE, FOR TM POLICY PFRIOD INAiCATWJ NO N(S) OF ANY MNTFtACT (* OTHER DO CI#NW t MAY PERTAIN. THE INSURANCE AMRDED IX 9, EXCLUSIONS AND/OR CONUITUONS OF SUCH BY ANY PAID CLAIMS. OW25/24ff9 05I23/Mio 0=0 DAYS AT 12:01 A.M..t a T ANDARD TDa) 'I(S) OR SMMAYBE fC£ TO ALL Y HAVE REM IL CLAIMS MADE 1.1 ERPRODUC1sAQ0KEGA"Fi+: W. X OWNERS, LANDLORDS & IT%NANTS P)M"4 A ADV_ INIIiIM $-0- EACH OCCUlkRENCE: S 1,000,000.00 ftMO DAM; 05I25/'I0% FIRE DAAfAG8 (ANY ONE FMkE): S-0- p6TAILTmENT Or PARKS & RECREATION ISIARB HEREBY ADDSO AS ADDITIONAL INSUREDS ONLY AS THEIR WTERE.STS MAY APPEAR 1N RESPECTS TO THE OPSRATiON(S) P'ERFORMC05 BY THE NAMED INSURED ANDIOR "S amn-OYEE(S) ONLY. CaTRICATEVA 1D ONLY WfTH ATTACHED AM "A FOR DESCRIPTIDN QF UA431TM COW-RAGS(S) AIFFURDED. EVENT: SANIA ANA FIESTA DAYS EVENT DATL(S): MARCH 9 14 2010 (PATES INC LUD9 SETUP AND TAKE DOWN) LOCATION; MOMS RARK, 726 S. CENTER Sr, SAWA ANA, CA THUS CGR"M— CA S IS 1WI33D Ag A MATTER OF INFORMATION OKY AND CON NO WAITS UPON THE CBKMCATX HOLDERJUS CER791CATII DOES NOT AMEND, W=ND OR ALTER TiM COVERAGEM AFT'ORDrd) BY'I'NE POLICY(S)USTSI? MOLD ANY Ob THE ABO'VS DES=ft BD POMY(S) BE CANCBLLr.D W-O-RE THS rmmAirioN DATE TMREOF, rft ISSUING COMPANY WILL MAIL jL DAYS' 1NR T HNOTICS To TfIE CERTIFICATSHOLDER NAMED SELOW. CEIiTWICATE UIOL= / ADDITIONAL INSIMED(S): AUT1IORM SENT/IT1VE, CITY OF SAN'TA ANA PPRO TO FORM 20 CIVIC (ENTER PI.A2A SANTA ANA. CA R2701 JOS W. ET ER MAILED TO. CITY OF SAWA ANA PA?XS, RECRPAT(ON, Ci Y A R Y AND COMMUNITY SERVICES AGENCY ATTN-. EDITHA SANTL4NO P.O. box 1"s M 23 SANTAANA. ,CA P701 FAX: 714-571.4266 X -. WTaISL NIPIlf 8UDlNT FEB-p5-2010 THU 04,55'PH FAX NO. 407 645 2810 p, 02 D D I T 1 0 N A L I N S U R E D " B -LnJ.Z ZWUVKQ7L'L%CJl ', ZV'lAA;'rlVl.'; 3/VZ/4U, FVP-MZ A CAK'r Va' AT 12:01 A.M. LOCAL STANDARD TI' POLICY NO: NCH08466 APP VED M ISSUED TO: 0 ENTERTAINMENT, INC. AGENCY LESTER KAL)+iANSOP AGENCY INC, / MAITLAND� ER ATTORNNEY ISSUED BY: 100t CERTAIN UNDERWRITERS AT LLOYD'S / LONDON IN CONSIDERATION OF'Tr'lU PREMIUM CHARGED, IT IS HEREBY AGREED AND ONDERSTOOD THAT SUCH ADDITIONAL INSUREDS) IS / ARE HEREBY ADDED TO THIS POLICY, &/OR BY SUSSMOENT CEftTIFICATE(S) OF INSURANCE ISSUED BY LESTER KALMANSON AGENCY, INC. WILL BE ADDED ONLY AS THEIR INTERESTS MAY APPEAR. IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THE POLICY FOR BODILY INJURY AND PROPERTY DAVlAGE LIABILITY SHALL ALSO -APPLY TO EACH INTEREST NMP PER CZRTIFICATE(S) OF INSURANCE ISSUED, AS AN INSURED, BUT ONLY IN RESPECTS TO LIABILITY ARISING OUT OF THE DESIGNATED PREMISES OF THE NAMED INSURED OR OPERATION#S) PERFORMED BY OR FOR THE NAMED INSURED, THE INCLUSION OF SUCH ADDITIONAL INTERESTS) SHATZ NOT, OPERATE TO INCREASE THE COMPANY'S STATED LIMITS OF LIABILITY. IT IS AGREED THAT, I'8 THIS POLICY IS ISSUED TO A FIDUCIARY, THE INSURANCE AFFORDED BY THIS ENDORSEMNT SHALL 140T APPLY TO ANY EXECUTIVE OFFICER ©R EMPLOYEE WITH RESPECT TO INJURY OR TO SICKNESS, DISEASE OR DEATH OF ANOTHER EXECUTIVE OFFICER OR EMPLOYEE OF THE SAME EMPLOYER INJURED IN THE COURSE OF SUCH EMPLOYMENT. IT IS FURTHER AGREED THAT " 30" DAYS NOTICE OF CANCELLATION WILL BE GIVEN TO THE ADDITIONAL INSURED(S) IN THE EVENT OF CANCELLATION OF THIS POLICY, UNLESS OTHERWISE STATED, ADDITIONAL INSUREL^: A) THE CITY OF SANTA ANNA, ITS OFFICERS, AGENTS, AND EMPLOYEES C) THE DEPARTMENT OF PARKS & RECREATION. SANTA ANA, CALIFORNIA EVENT DATES): MA6 E 08 - 16, 2010 EVENT. SANTA ANA FIESTA DAPS EVENT LOCATION: JERONE PARK, 726 S. CENTER STREET, SANTA ANA, CA WARRANTED; ANY AND ALL ADDITIONAL INSURED'S ADDED TO THIS POLICY BY CERTIFICATE OF INSURANCE OR BY ENDORSEMENT, AS STATED ABOVE, ARE ADDED ON ONLY AS THEIR INTEREST MAY APPEAR IN RESPECTS TO THE OPERATION(S) &/OR ACTIVITY(S) PERFORMED &/OR PROVIDED BY TKE NA.14ED INSURSD(S) &/OR IT'S EMPLOYEES) ONLY, AND FOR WHICH LIABILITY COVERAGE IS AFFORDED &/OR P R E M I U M C H A R G E D IN CONSIDERATION OF THE PRENSUR CHARGED, THE ABOVE ADDITIONAL INSURED IS ADDED TO & MADE A PART OF THIS POLICY FOR THE STATED EVENT DATE(S) ONLY OR UNTIL EXPIRATION OF THE POLICY PERIOD ONLY. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNC ED. E N D0 R S E M'E N T N U M B E R r 2/25/10 X WNTS AUTHORIZED EP KALMANSON (PG-1�-9/05-PS4-P-SD-AD-S) LESTER t4ALNi O AGENCY INC. FEB-25-2010 THU 04:58 PH FAX NO, 407 645 2810 P. 03 C L A : M S M A 0 E A D 1) E N 0 U M F 0 R 0 ENTERTAINMENT INC C/O ROY HASSETT --------- ------------------------------------------------- ----------- I ------ AGENCY: LEMP KAWANSOV AGENCY INC. P.O. BOX 940008 MAITLAND, FLORIDA - U.S.A. PH: 407-645-5000 FAX: 407-645-2810 ----------------------------------------------------------------------------- POLICY PERIOD/TERM: 05/25/09 To 05/2$/10 TERM: ANNUAL (12:01 AM Loc;AI, STANDARD TIME) ----------------------------------------------------------------------------- POLICY NUMBER: NCM 08466 ----------------------------------------------------------------------------- DE$CRIPTION OF CLAIMS MADE LIABILITY INSURANCE COVERAGES) AFFORDED. ---------------------------------------------------------------------- A) SPECTATOR LIABILITY COVERAGE IS AFFORDED FOR THE SUPPLYING OF VARIOUS CONTRACTED TALENT(S) / ACT($) BY THE NAMED INSURED 6/OR THEIR EMPLOYEE(S) TO PERFORM AT VARIOUS CONTRACTED (USA) LOCATIONS ONLY WHILE UNDER THE DIRECT CONTROL/SUPERVISION OF THE NAMED INSURED &/OR THEIR EMPLOYEE'S ONLY. ---------------------------------------------------------------- — ------------------- B) PREMISES LIAVILITY COVERAGE IS AFFORDED FOR THE NAMED INSURED'S EVENT PLANNING &/Oft COORDINATED BUSINESS FOR VARIOUS CONTRACTED ACTIVITY(S) &/OR OPERATIONS) FOR CONSIDERATION PROVIDED BY THE NAMED INSURED j./OK THEIR EMPLOYES(S) WHILE AT VARIOUS CONTRACTED (USA) LOCATIONS ONLY WHILE UNDER THE DIRECT CONTROL/SUPERVISION Of THE NAMED INSURED 9/OR THEIR EMPLOYEE'S ONLY. --------------------------------------------------------------------------------- C) PP=SES--LIABILITY COVERAGE IS - AFFORDED - TO INCLUDE THE SET-UP, USE &/OR TAKE DOWN OF THE NAMED INSURED'S OWED SOMPKENT TO BE USED 114 CONJUNCTION WITH THE NAMED INSURED'S COMMERCIAL CONTRACTED TALENT(S) / ACT(S) OPERATIONW / ACTIVITY(S) ONLY, WHILE AT VARIOUS CONTRACTED (USA) LOCATION$ ONLY WHILE UNDER THE DIRECT CONTROL/SUPERVISION OF THE NAMED INSURED &/OR THEIR EMPLOYEE'S ONLY. ------------------------ M----W ---------------------------- w ------------------- POLICY CONDITIONS: 1) ANIMAL TALENT ACT(S) / SHOWS) ARE SPECIFICALLY EXCLUDED UNLESS OTHERWISE ENDORSED HERETO AND AN ADDITIONAL PREorum IS CHARGED. 2) ANY/ALL VONDOR($) / CONCESSIONAIRE(S) 6/OR CONTRACTED TALENT(S) PROVIDED BY THE NAMED INSURED MUST PROVIDE A CERTIFICATE OF INSURANCE THROUGH AN ACCEPTABLE CARRIER, WITH NZN114UH LIMITS OF $1, 000, 000 - 00 PER OCCURRENCE AGGREGATE NAMING: 0 ENTERTAXNMINT, INC. AS AN ADDITIONAL INSURED. 3) NAMED INSURED IS TO MUNTAIN A SEPARATE WRITTEN AGREEMENT WITH ALL TALENT(S) (TALENT AGENTS) 4/OR WITH ALL CLIENTS) &/OR VENUE(S) 4) THIS POLICY WILL BE EXCESS OVER ANY otHFjL VALID &/OR COLLECTABLE LIABILITY INSURANCE POLICY(S) APPLICABLf. FOR ALL CONTPAMR(S) / TALENT(S) UNLESS OTHERWISE STATED fi/OR ENDORSED HERETO. 5) LIABILITY COVERAGE 18 SVFCtFICALLY EXCLUDED MR ANY PYROTECHNICS. 6) WORKER'S COMPENSATION / EMPLOYER'S LIABILITY CQVERAQS IS SPECIFICALLY EXCLUDED FROM THIS POLICY FOR ANY INJURY TO ANY EMPLOYEE(S) &/OR INDEPENDENT CONTRACTOR(S) &/OR VOLONTEEK($). 71 LIABILITY COVERAGE IS SPECIFICALLY EXCLUDED FOR ANY EXOTIC ANIMALS. PAGE2 OF 2 ----------------------------------------------------------------- �ADOENDUM DATE ACORN CERTIFICATE OF LIABILITY INSURANCE 05/24/20 PRODUCER (425)454-3386 FAX (425)451-3716 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 367 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bellevue, WA 98009-0367 INSURED Christiansen Amusements, Inc. Southland Shows, Inc. P. 0. Box 997 Escondido, CA 92033-0997 CnVGRA/A2FR INSURERS AFFORDING COVERAGE I NAIC # INSURERA: General Insurance Co of America INSURER B: INSURER C: INSURER D: INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTED $ tmMERCIALO CLAIMS MADE ❑ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO 24CC2779361 04/01/2010 04/01/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ I ANY AUTO EAP 0 TO �7 EA ACC $ $ AUTO ONLY AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR a CLAIMS MADE 10 J ATT �-{E .Y AGGREGATE $ $ DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND WC STACRY 'MTU- OTH- ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUT!VF E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The City of Santa Ana, its officers, employees, agents and representatives are included as additional insureds but only as respects the operation of the named insued per policy terms and conditions. RE: 4th of July Carnival at Delhi Park Event Dates: June 28 - July 7, 2010 City of Santa Ana Attn: Robert Carroll 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL KNIMOOM MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, >�c xxac�x��c>I�xaecxx KK*XXcXxJ(IkNKi4O(drM Kl )tXXMJilil6i0EMlf*Xla XMXXXXXXXXXXX AUTHORIZED REPRESENTATIVE Dave Harman/JOANNE ACORD 25 (2001/08) ©ACORD CORPORATION 1988 •"' REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS COMMERCIAL AUTO CA 71 10 03 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. EXTENDED CANCELLATION CONDITION Paragraph 2.b. of the CANCELLATION Common Policy Condition is replaced by the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. TEMPORARY SUBSTITUTE AUTO — PHYSICAL DAMAGE COVERAGE Under paragraph C. — CERTAIN TRAILERS, MO- BILE EQUIPMENT AND TEMPORARY SUBSTITUTE AUTOS of SECTION 1 — COVERED AUTOS, the following is added: If Physical Damage coverage is provided by this Cov- erage Form, then you have coverage for: Any "auto" you do not own while used with the per- mission of its owner as a temporary substitute for a covered "auto" you own that is out of service be- cause of its breakdown, repair, servicing, "loss" or destruction. BROAD FORM NAMED INSURED SECTION II — LIABILITY COVERAGE — A.I. WHO IS AN INSURED provision is amended by the addition of the following: d. Any business entity newly acquired or formed by you during the policy period provided you own 50% or more of the business entity and the business entity is not separately insured for Business Auto Coverage. Coverage is extended up to a maximum of 180 days following acquisi- tion or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. BLANKET ADDITIONAL INSURED SECTION II — LIABILITY COVERAGE — A.1. WHO IS AN INSURED provision is amended by the addition of the following: e. Any person or organization for whom you are re- quired by an "insured contract" to provide insur- ance is an "insured", subject to the following additional provisions: (1) The "insured contract" must be in effect during the policy period shown in the Decla- rations, and must have been executed prior to the "bodily injury" or "property damage". (2) This person or organization is an "insured" only to the extent you are liable due to your ongoing operations for that insured, whether the work is performed by you or for you, and only to the extent you are held liable for an "accident" occurring while a covered "auto" is being driven by you or one of your em- ployees. (3) There is no coverage provided to this person or organization for "bodily injury" to its em- ployees, nor for "property damage" to its property. (4) Coverage for this person or organization shall be limited to the extent of your negli- gence or fault according to the applicable principles of comparative negligence or fault. (5) The defense of any claim or "suit" must be tendered by this person or organization as soon as practicable to all other insurers which potentially provide insurance for such claim or "suit". Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1997 CA 71 10 03 07 Page 1 of 6 EP lu rAA - p W Ri 00 1/003 RODUCIM, DATE -ISSUED; 03/oWoll LESTER KALMAWSON AGENCY, INC CONVANY! P-0. BOX 9400M 100ya CERT-AZNUNIXRWklTMATLL0YlD'S/ MAITLAND, PL 3.1754-M Pft' (407) 645-SM POLICY NUMMt; CLCM00494 �=�Xt�mt; 7C� FAX; (407) 64s-2a Ia L 0 EMRTANMEM, OrC. CAD ROY HASSWIT 539 & BDMY ROAD 9 59 LONG BEAM CA 90907 043no10 1 mwlo I I MIUM DAYS AT 11,01 A.hL �� STANDARD T" .,,E) ED ABOVE FOR THE p0=pdY+W7 MEN ISSUED TO THE INSURED Of ANY COMMACT OR DMMATM NOT wniWANDING ANY AEQUMU6NT. IWWS) OR TO OIL MAY PERTALN. OIM DOCUKENT WITH KESP= To WMC" MS CMTMCATEM MAY BE TW MLMMCE AYFO*MM By THE POL'CYFJ DESCIRMM HERM IS SIT TOALL TERMS"!XCLfJS'oNS ANYOR COMXnONS OP SUCH POiXIES. LWTS OF ijAa=T SHOwK MAY 14AVE gW UCED BY ANY PAM CLAIMS. %=4LAL AUUKEGATE, 21- CLAW MADE =s Lrharzb PRODUCT3 AOMEOATE- $.&, A OWMS, LAJ0L0$D6 & TENA.W,9 PIOLSONAL & ADV. INAW! $46 R-FTR0 DATE. 01--ZW2006 F-AC14 WaMMCE, s t000.000.00 PM DAMAGE (ANY ONE $-0- MWENTATIM WARE IMMY Al)DW AS ADDIMONAL RMREDS ONLY AS THM WMMVTS MAY APPEAR RESIOECTS To THE OMOPERATION(S) PERFORMEbgy THE NAWW DM(AW A14WOR EIR EMPW-t EF%S) Y, EVM4"P SANTA AMA FWSTA DAYS EVENT DATE(S): MARCH 772 -198, 2011 (DATES INCLUM SETLYP ANM TAKE Do" LOCATION; JIMOW PARX. 726 S- COMR SL SANTA AX--i, CA gm,3'-Zv-t lfl-IE IN ViSLIEDAS A MATTER Of ON UNLY AND CONFERS NO RIGHTS ;UV,'TmE CMILTWICATE HOLD THIS CERTMCATE DNS NOT AMEND, MCMD OR ALTER THE COVERAG315(s) AFFORM BY THE POUCY(S) LLg= par&' HOLIDER / QTY OF SANTA ATRIA 20 CWC CENTER PLA_7A $ANTA ANA. CA 92701 AS St' I SLCC�,� �'jLy Atifr FAX; 714-571-4261 WoncE To THE CIRTm6ii'H-0, -9ELow'. CO/TO 3E)Vd 1969960Z9S To:zo Tloz/OT/co 03/04/2011 18.1E FAIL lllcc xL Yaagtti "„ THIS EpTTX7mErdzw caMCES YOUR POLICY. FLLFASE ftM IT { AT 12:01 A.M. LOCAL ETANDARD TIME } POLICY NO: CLCM09463 ISSUED TO: 0 rNTE'q.TAINkENT, INC. AGENCY : LESTf R Kf.URMNSON AGENCY INC. / MAITLAND, M. ISSUED SY: ? 001i CERTAIN UtOgRWRITERS AT LLOYD' S / LOWN IN c?NSIL?F.f1mrm OF TEE PT{SMi(3t4 3753E7, _ IT is HERSBY AGREED AND UNDEASTOO D TI A'T SUCH ADDZTIOM INSDREQ (S) IS / ARE NUEST ADDED TO THIS POLICY, do/►JR BY SU@SE=14T CEATIVIC.?TF(5) OF INSURANCE ISSUED BY LESTER ZhUMANSGN A(;ZNCY, INC. WILL SE AZ)09C1 ONLY AS THEM INTERESTS MAY APPEAR. IT IS AGREED THAT SUCH INS 7MNC AS IS AFFDADED BY TIE POLICY FOR BODILY INJURY AND PROPERTY DA)MGE LIABILITY SfiP.I,I, ALSO APPLY TO ZAC11 INTEREST NAMED PER CZRTXE7TCATE (S) or I'C vRANUE mum, AS AN n4sanD, BUT ONLY IN RP..SPE. S TO LIABILITY ARISING CC ? OF THE DESIGNATED PROMISES OF THE itiiiAZEP INSURED OR OPMTION (S) PERrORMED BY OR FOR THE NAMED INSURED, THE INCLUSION OP SUCH ADDITIONAL INTEREST(S) SHALL NOT OPERATE TO INCREASE THE COMPANY'S STATSD LIMITS OF LIABILITY. IT IS AGREED THAT, IF THIS POLICY IS ISSOM TO A FIDUCIARY, Tn SNSUR tCE ?AFFORDED BY THIS ENDORSr'WNT SHALL NOT APPLY TO ANY EXECUTIVE OFFICER OR EMPLOYEE WITS RESPECT TO IN«T(TRY OR TO SICMESS, DISEASE OR DEATH OF MOTHER EXECUTIVE OFFICER OR EMPLOYEE OF THE 3A"rSE PtOYEfc INJMED IN THE COURSE OF SUCH EMP'L`f,-MSNT, IT IS FORTHER AGREED THAT " 030 DAYS NOTICE OF CANCILILFiTION WILL BE GTV.r*,l To THX ADOITZONAL INSO'MD(S) ZN THE ZVENT OF CANCELLATION OF THIS POLICY, (1WI FSS OTHSRWISE STATED. ADDITIONAL INSORE ; TH CITY' OF SANTA lam, I_'S OPTICERS, MMTS, A EMPLOYEES; AGENTS. AND REPRESENTATIVES EVENT DATE(S). AACR 07 - 15, 2011 EVENT LOGATIOX: JEROME PARK, 726 S. CENTER, 9T2EET, SANTR ANA, CA WARMNTED: 77 ANU AI,L ADDITIONAL INSUREDS A OED TO TiiaS POLZCY by cv�RTIFTCAT"E OF INSCT'FtAwr- OR E1Y ENDORSEMENT, AS STATED ABOVE, ARE ADDED ON OWC ,Y AS THEIR 1IMPIST MAY ALPIPW IN RESPECTS TO TaZ 0921R.TION(S) &/OR ACTIVITY(S) PERPOft3ED &/Oft PROV-1DED BY THE NAMED INSCREP(S) &/OR tT'S ftPLOYEE(S) ONLY, AND FOR WHICH LIABILITY COV'ERAU IS AFFORDED &/OR SCE(H=311) HERET AND/OR HERETO. P R F M i U M C H A R G E D 19 CONSIDERTION CIE THE ?R"IW CHARVED, THE RB E AD77713m I1titsNEF IS ADDED TO & MADE A PART OF THIS POLICY FOR THE S'1`XTP.17 EVENT DATE (S) ONLY OR UNTIL EXPIRATION OF THE POLICY PERIOD CSWLY. ALL METER TEP-48 AND CONDITIONS OP THIS POLICY REMAT EN D 0 R S EMENT N UmB11vk 22 3/04/11 X ZP" 1 i IIrG-3- $/05-&Sd-P-s�-ats�a J AT -ER XALMA*tSOV Al'ZNCY INC. Vv EO/ZO 39Vd 196996VZ99 IO:ZO TTOZ/OI/£O