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<br />/V.2 [}[}.If- D6:,[)-D2 <br /> <br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2007-13 <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 />- --- - - --- - City <>f-Santa AWL <br /> -- - ---- <br /> Alliant Insurance Services, Inc. in cOrUunction with 20 Civic Center Plaza, M-28 <br /> Apex Insurance Services Santa Ana, CA 92701 <br /> P. O. Box 6450 <br /> Newport Beach, CA 92658 <br /> (949) 660-8163 <br /> License No: OC 36861 <br /> NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br /> Janet Schermer TYPE: Music Class - Piano <br /> 34 Brisbane Way DATE(S): 02/27/07 - 12131/07 <br /> Irvine, CA 92612 LOCATION: Corbin Senior Center <br /> "Liouor Liability after 2am 0 <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 /> certi1kale 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: 04SEPIOOOOOI <br /> MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2007 EXPIRATION: JANUARY 1,2008 <br /> COMMERCIAL GENERAL UABILlTY OCCURRENCE FORM DEDUCTIBLE: NONE <br /> Genet>! Aggregate Umil $ 2,000,000 <br /> Products & Completed Operations 1.000,000 <br /> Personal & Advertising Injury 1,000,000 <br /> Each Occurrence Umit 1,000,000 <br /> Fire Damage (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 /> . <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: AIly "occurrence" which takes place <br /> after the event holder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL fNSUREDS <br /> CANCEL! AnON: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days W"fitten notice to (he <br /> certificate holder and additional insureds listed. <br /> <br />~~~ <br /> <br />-' AUTHORIZED REPRESENTATIVE: <br /> <br />DATE ISSUED: Februarv 27.2007 <br />Generated by Risk Management Division by: &> J~ Yl7 ~"~r1~ <br /> <br />