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DOHRMANN, DIXIE 1
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DOHRMANN, DIXIE 1
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Entry Properties
Last modified
3/31/2015 2:36:47 PM
Creation date
3/28/2005 8:09:26 AM
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Template:
Contracts
Company Name
Dixie Dohrmann
Contract #
N-2005-017
Agency
Parks, Recreation, & Community Services
Expiration Date
12/31/2005
Insurance Exp Date
1/1/2006
Destruction Year
2010
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<br />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 LIABll.ITY PROGRAM <br /> <br />PRODUCER: PUBUC ENTITY (ADDITIONAL INSURED) <br />Driver Alliapt Insurance Services CUy o~ San;ta. AM <br />P. O. Box 28323 20 C~v~e C~nt~ Plaza, M-28 <br />Santa Ana, CA 92799,8323 Sa.n.ta Al'la, CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENf HOLDER): EVENT INFORMATION: <br />V~Ue. VohJuna.I'lYl TYPE: I vu, .tJr.u.c..t.i.o I'la..t - Cfta. M.6 <br />tJ - dJJ05 - 0/1 DATE(S): 2/07/0';-6/30/05 <br /> LOCATION: LawYl BO~l'lg Ce.nte.tt <br />This is 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 requirements, terms or conditions of any conlIllct 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: OSSEPIOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL UAB]UTY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General A_Ie Limit $ 2,000,000 <br />Products 8< Completed Operations 1,000,000 <br />Personal 8< Advertising Injury ],000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Darnase (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <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. the person or organization shown in this schedule, but on)y with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insun::d (event holder). This insurance does not apply to: Any "occunence" which takes place <br />aftertbc: event holder ceases t1)'be a tenant in thatnremises. <br /> OTHER ADDITIONAL INSUREDS <br /> APPROVED AS TO FORM , <br /> \ .//7. <br /> / -y., " -' <br /> / '1 au -. <br />CANCELLATION' Assistant City Attfrney <br />Should the above described policy to cancc:lled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTI:lORlZED REPRESENTATIVE: <br /> <br />V;f~ <br /> <br />DATE ISSUED: <br /> <br />2/07/05 <br />
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