Laserfiche WebLink
EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br /> CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Alliant Insurance Services City of Santa Ana <br />P.O. Box28323 20 Civic Center Plaza, M-28 <br />Santa Ana, CA 92799-8323 P.0. Box 1988 <br />(949) 660-8163 Santa Aha, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Kathy Armas <br /> Martial <br /> Arts <br /> TYPE: <br />9 Corte Pasillo DATE(S): January 20 - June 30, 2004 <br />San Clemente, CA 92673 LOCATION: Lawn Bowling Center <br /> <br />This is to certify that the policies of insurance listed below have been issued to thc insured named above for the policy period <br />indicated. Notwithstanding any requirements, terms or conditions 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 />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2004 EXPIRATION: JANUARY 1, 2005 <br /> <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Opexations 1,000,000 <br />Personal & Advertising lnju~ 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br /> <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. <br />"Who is insured" is amended to include, as an insured, thc person or organization shown in this schedule, but only with respect to liability ahsing out oftbe <br />ownership, maintenance or useoftbepremisesusedbythenamedinsurcd(cventholder). This insurance docs not apply to: Any "occurrcnce" which takesplace <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancel]cd before thc expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insurers listed. <br /> <br />AUTHORIZED REPRESENTATIVE: F~'~~ <br />DATE ISSUED: January 20, 2004 <br /> <br /> <br />