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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2007-06 <br /> <br />/' "'~, '" ,; (," 01 <br /> <br />()l/!{/n <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 of Santa Ana <br />Alliant Insurance Services, Inc. in conjunction 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 />Marlene Shaw TYPE: Bellv Dando!! <br />14446 Pimlico Road DATE(S): 01/22107 - 12131107 <br />Westminster, CA 92683 LOCATION: Sa"'ado Ceoter <br /> --Liquor Liability after 2am 0 <br />This is to certify that the policies of insurance listed below have been issued to dle insured named above for the policy period <br />indicated. Notwithstanding any requirements, terms or conditions of any contract or odJer 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 aU the terms, <br />. exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. . <br />INSURANCE CARRlER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEP 100000 1 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2007 EXPIRATION: JANUARY 1,2008 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NO"E <br />G...... Aggt<g>Ic limit $ 2,000.000 <br />ProdUds &: CompIek:d Opcratioos 1,000,000 <br />Personal &: Adwnising IlIjury t ,000,000 <br />Each OCCUlTeIlce Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />1bc Jimits of insurance appJy separ81dy to each cvent insured by tJlis policy as if a separate policy of insurance has been issued lor Ihat 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 oul of the <br />ownership. maintenance or use of the premises used by Ute named insured (event holder). This insurance does not apply to: Any "occurrence" which tak.es place <br />after the event holder ceases to be a tenant in Ihat prenlise.s. <br /> OTHER ADDITIONAL INSUREDS <br />CANCEU.ATrON' Should the above described policy to cancelled before the expiration dale thereot~ the i.ssulng company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />4~~ <br /> <br />, AUTHORIZED REPRESENTATIVE: <br /> <br />.0" <br /> <br />'. DATE ISSUED: January 22, 2007 <br /> <br />!; Generated by Risk Management Division by: <br /> <br />L~ ~- A- /?7r:/~~~ <br />}' <br /> <br />