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M ~2ooy-ioz- 02 <br />EVANSTON 1NSTIRANCE COMPANY <br />CERTIFICATE NO.: - <br />CERTIFICATE OR INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />YRODUCDR: PUBLIC ENTITY (ADDITIONAL INSURED) <br />~ City of Santa Ana <br />Driver Alliant lnsuranee Services in conjunction with 20 Civic Center Plaza, M-28 <br />Apex Insurance Services 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): EVENT INFORMATION: <br />Braulio Mendez TYPE: Music (Guitar) Classes <br />2313 S. Rene Drive DATE(S): June -December 2006 <br />Santa Ana, CA 92704 LOCATION: EI Salvador Community Center <br />', This is to ccfify that the politics of insurance listed below have been issued to the insured named above for the policy period <br />~,i indicated. Notwithstanding any requirements, terms or conditions Of any contract or other document with respect to which this <br />ccrti ficatc may be issued or may pertaiq the insurance afforded by the policies described herein is subject to al] the temts, <br />'I exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />u INSURANCF. CARRiH:R: F,vanstnn insurance Company <br />(i MASTER POLJCY NUMRRR- 04SF.PI000OOI <br /> <br />I. MASTER POLICY llA'PES: EFFECTIVE: JANUARY I, 2006 EXPIRATION: JANUARY 1, 2007 <br />COMMERCIAL GEDIERAL LIAPIL['CY OCCORRLTICP FORM UF.000II[3l.!•;: NCNL' <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal .~ Advrstising Injury 1,000,000 <br />~ Paeh Occurrence Limit I,OOQOW <br />Fire Damage (! ,y Oue Firc) 50,000 <br />~~ Medwal Payments (Any Onc Person) 5,000 <br />i <br />The lunits of insurance apply separately to each evaa immrAl 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 Duly with mspeet to liability arising nut of the <br />ownership,maintenance or use ofthe premises usedbythe named insured(eventholder}This insuaucedees notapplyto-Any"occurtenee'which takes place <br /> <br />~~ after the event holder ceases W be a [enaut in that remises. <br />f OTHER ADDITIONAL INSUREDS <br />_- <br />I~ <br />] <br />ii <br />- - <br />I <br />CANCELLATION: Should the above described policy to cancelled before [hc expiration date thereof, the issuing oompany will mail 30 days wriaen notice m the <br />certificate holder and additional insureds listed. <br />~~~~ <br />,rr~zt~,,,,>,~ ~; r~ ~~~zM <br />~- AUTHORIZED REPRESENTATIVE: - <br />DATE ISSUED: Mav 31 2006 _ _ - ~- ~ err SCtL S6aedv <br />Asvxtent City Attariey <br />