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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 />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />City of Santa Ana <br />Driver Alliant Insurance Services in conjunction with <br />20 Civic Center Plaza, M -28 <br />Apex Insurance Services <br />Santa Ana, CA 92701 <br />P. O. Box 28323 <br />Santa Ana, CA 92799 -8323 <br />(949) 660 -8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Salomon Rivera A) ..33 <br />TYPE: Salsa Classes <br />709 S. Parton Street <br />DATES <br />O January 1 - December 31, 2006 <br />Santa Ana, CA 92701 <br />LOCATION: Southwest Senior Center <br />N— �CO�l— c33 —c.,Z <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 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: 04SEPI00o001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2006 EXPIRATION: JANUARY 1, 2007 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit 52,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury 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 />The limits or 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 only with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place <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 cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: <br />Ltsl1 <br />
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