SEHUAME, RUDY R. 1c - Laserfiche WebLink

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N-aoo�,-oaq --03 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2008-05 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM AUTHORIZED REPRESENTATIVE: DATE ISSUED: PUBLIC ENTII1' (ADDITIONAL INSURED) PRODUCER: City of Santa Ana Alliam Insurance Services, Inc. in conjunction with 20 Civic Center Plaza, M-28 Apex Insurance Services Santa Ana, CA 92701 P. O. Box 6450 Newport Beach, CA 92658 (949)660-8135 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Rudy Sehuame TYPE: Karate Class 2424 W. First Street, Space 133 DATE(S): _January 2008 —December 2008 Santa Ana, CA 92703 LOCATION: Santa nits Park Center *Liquor Yes ❑ No N Liabihty **Liquor Liability after 12 am ends before 2 am This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER Evanston Insurance Company MASTER POLICY NUMBER: 04SEP100000I-4 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2008 EXPIRATION: JANUARY 1, 2009 COMMERCIAL GENERAL LIABILITY OCCIIRRENCEFORM DEDUCTIBLE; NONE Geneml Aggregate Limit $2,000,000 Produces & Completed Operations 100.000 Personal & Advertising Injury 1.000,00 Each Occurrence Limit 1.000,000 Fire Damage (Any One Fitt) 50,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000.000 The limits of insurance apply separately to each event insured by this policy 0 if a separate policy of ionmoce has been issued for thel event. "Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, butonly with respect to liability arising out of the ownership, maintenance or use of the Premises used by the named it and (evmt holder). This imus n a does not apply m: Any "occurrence" which talm Place after the event holder ceases to be a tenant in that promises. OT1D;R ADDITIONAL INSUREDS CANCEL LAT(ON: Should the above described policy to cancelled before the expiration date thereof, the issuing company anll mail 30 days written notice to the certificate bottler and additional insureds listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: