Laserfiche WebLink
<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE 01" INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDmONAL INSURED) <br />Driver Alliant Insurance Services Cay on San-ta. Ana <br />P. O. Box 28323 20 C.i.v.i.c. Cel!.tvr. Plaza, M-28 <br />Santa Ana, CA 92799-8323 Sal'lta Ana., CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOIDER): EVENT INFORMAPJON: <br />Jane;(: Sc.hvunvr. TYPE: .(.(/.no CR.a.6 <I eA <br />34 Bwbane Way DATE(S): ~/UIIU4 - IZ/jljU4 <br />Iltv.i.l'le, CA 92612 LOCATION: Vcvu.OM Lo c.a..tc.o M <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, lenns or conditiollS 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 descnbed hcrein is subject to all the terms, <br />exclusions and coodi lions of such policies. Limits shown may have been reduced by paid c1ain1S. <br />It,",SURANCE CARRIER: EVlIlISton Insurance Company <br />MASTER POLICY NUMBER: 04SEPlOOOOOl <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2004 EXPIRATION: JANUARY 1,2005 <br />COMM ERClAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />0en..aI A&grepte Limit S 2,1lOO,OOO <br />Products &. Completed Operations 1.000,000 <br />Personal & Advertising lnjury 1,000.000 <br />Each Occurrence Limit ],000.000 <br />Fire Damage {Any One Fire) 50,000 <br />Medical Payrnc;nts (Any One P<<son) 5.000 <br />The limitsQfinsu~ncc apply sepantely 10 each event il1JUred by tbispPIicy lIS if; separate pcljcy ofin5urancc has been wued for that ~cnt. <br />"Who is. insured" is anlQ1l,!cd 10 in~Judc. as an insurr:d,lhc person or organization sboWtl in thCi schedule, bul only wilh respect to liability arising out aflhl: <br />ownersbip, mainlCnance or use arthc prc:miSCi used by the named insured (event holder). This inslIAncc does not apply to: An)' '''occurrence'' which takes place <br />after the event hoklcr ceases 10 be a tenant in that premises. <br /> o TIlER ADDITIONAL INSUREDS <br />CANCFI I A TION: Should the above described policy to cancelled before the expiration date thereof, the: issuil18 conlj)JlllY will mai130 d.ays written notice 10 the <br />certificate holder and additional insureds listed. <br /> <br />DATE ISSUED: <br /> <br />AUTHORlZED REPRESENTATIVE: ~-t~ <br /> <br />4/"/04 ~i n <br />r ,/'-1f.-J!\f :fly <br /> <br />(v1J <br />