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EVANSTON II~'SURANCE COMPANY <br />CERTIFICATE NO.: 2009-02 <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br /> City of Santa Ana <br />Alliant Insurance Services, Inc. in conjunction with 20 Civic Center Plaza <br />Apex Insurance Services Santa Ana, CA 92701 <br />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />{949)660-8135 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Janet Schermer TYPE: Music (Piano) <br />34 Brisbane Way DATE(S): Jan. 5 -Dec. 31 <br />CA 92612 <br />Irvine LOCATION: Corbin Senior Center <br />, *Liquor Liability Yes ^ No ^ <br /> **Li uor Liabilit after 12 am ends before 2 am ^ <br />This is to cerfify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, Leans or conditions of any contract or other document with respect to which this <br />certificate maybe 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: 04SEP1000001-5 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPD2ATION: JANUARY 1, 2010 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />Gettetal Aggregam Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising htjury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Paynuttts (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />The limits of insurance apply separately to each even[ insured by ibis policy as if a separate policy of insurance haz been issued for that event. <br />"Who is insured" is amended to include, az an insm~ed, the person or organization shown in this schedule, but only with respect iD liability arising out of the <br />ownership, maintenance or use of [he premises used by [he named insured (event holder). This insurance does not apply to: Any "occutrenw" which ta`ses place <br />after the event holder ceases [o be a tenant in drat premises. <br />OTHER ADDITIONAL INSUREDS <br /> <br />CANCELLATION: Should the above described policy m cancelled before the expiration date thereof, the issuing company will trail 30 days written notice [o the <br />certificate holder and additional insureds listed. <br />,r~uo~ <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 5 2009 ~~ 'T <br />