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RIVERA, SALOMON 1a
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RIVERA, SALOMON 1a
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Entry Properties
Last modified
5/21/2015 12:05:46 PM
Creation date
3/28/2005 9:57:45 AM
Metadata
Fields
Template:
Contracts
Company Name
Salomon Rivera
Contract #
N-2004-033-01
Expiration Date
12/31/2005
Insurance Exp Date
1/1/2007
Destruction Year
2011
Notes
Amends N-2004-033 Amended by N-2004-033-02, A-2006-263, -01, -02, -03, -04
Document Relationships
RIVERA, SALOMON 1
(Amends)
Path:
\Contracts / Agreements\ INACTIVE CONTRACTS (Originals Destroyed)\Q-R (INACTIVE)
RIVERA, SALOMON 1b
(Amended By)
Path:
\Contracts / Agreements\ INACTIVE CONTRACTS (Originals Destroyed)\Q-R (INACTIVE)
RIVERA, SALOMON 1c
(Amended By)
Path:
\Contracts / Agreements\ INACTIVE CONTRACTS (Originals Destroyed)\Q-R (INACTIVE)
RIVERA, SALOMON 1d
(Amended By)
Path:
\Contracts / Agreements\ INACTIVE CONTRACTS (Originals Destroyed)\Q-R (INACTIVE)
RIVERA, SALOMON 1e
(Amended By)
Path:
\Contracts / Agreements\ INACTIVE CONTRACTS (Originals Destroyed)\Q-R (INACTIVE)
RIVERA, SALOMON 1f
(Amended By)
Path:
\Contracts / Agreements\ INACTIVE CONTRACTS (Originals Destroyed)\Q-R (INACTIVE)
RIVERA, SALOMON 1g
(Amended By)
Path:
\Contracts / Agreements\ INACTIVE CONTRACTS (Originals Destroyed)\Q-R (INACTIVE)
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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br />N -a,90 -l- 03 3 <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />t'f<ODl10ER: <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver A7liant Ilu'waace Services <br />City of Santa Ana <br />4.Box2 &323 <br />20 Civic Canter Plaza, M -28 <br />Santa Ana, CA 92799 -8323 <br />P.O. Box 1988 <br />S98`li -81(13 <br />Santa Ana, CA 92702 <br />License No: (]L 36661 <br />ti.yM> D INSURED (EVENT HOLDER): <br />EVENT WPORlvLA WN: <br />S:r.e.r,Ir,esl. ii's.va�.n.FL <br />TYPE: <br />709 S. Parton StAeet <br />_'Dance <br />DATE(5): 7US- <br />Santa Ana, CA 92701 <br />_ <br />LOCATION- 4Anua t?ruoR .e P.na <br />IL's Is to certify that the policies of bormance listed below have bom raved to the insured named above for the policy period <br />indicated. Notwithstanding any regoirem lds, temp or conditions of ary contract or other dacument with respect to wlnch this <br />certificate nay be issued or may pertain, the insurance afforded by the policies described herein is subject to all the tents, <br />exclusions and conditions of such pohmes. Limits shown may Lave been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEPI000OOI <br />MASTER POLICY DATES: EFFEC'T'IVE; JANUARY 1, 2004 EXPIRATION: JANUARY 1, 2005 <br />COMMERCIAL GENERAL LIABILITY <br />Gmcni Appcpple Lirfil. <br />OCCURRFNcf FORM T)Et)11C1'mLfi: NONE <br />i 2 'Mo <br />P'Woci] @ I;;nmpleted th, avilOnY 1030.0w <br />1> cal 1L Advemama I j�Y I,Wkwo <br />P=h Occtontwc Lin:il 1,addaito <br />fire 6amibt IAnY One Fire! .5oxw <br />5lniiril Pay,re:nis (:4ny Gnc Persunl 0oaa <br />n.:4 oI` inwmncr a1gkY sellal}iciY tq eat'h tl'CIFI nnutpil b UIIS ^ -- <br />y Polity fi lffa"P&MlPali']. 01 LSfftd l'0f 1fn3 CYeN. <br />\tihG N IOUII W' 1]'�:nC11110110 inelulk, as y Wwmd, dlC pgapt Vf bLyllfliufm $110" is alit w A`dnl5 but only With mpm m lubillty L sjna Out of the <br />)4iW(a Yp, madlttlWlGf! ]Yt LLEk Ot dNe pYlYritY1 of W Lry the iml]ed iTSV1Y�t (evalr M7derl• Tltit rwasliee dou non a Wy lo: Any p1wr <br />'rl (C! ItK event. hohiY cOYft9 10 � 0 iplani T tltarpmnvs. <br />OTHER ADDITIONAL INSUREDS —' <br />LAtir- .klLUbL.N. 3hMwld the abo t dt ribed policy tr, cancelled Wble na expiration date thereof, The ifauiea cargaey will mail 30days witW notice to the <br />cern8ale holder rid addiwnui lands Us" <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 4107104 <br />
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