ROBLES, DENISE 1B - 2009 - Laserfiche WebLink

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i:VANSTON INSURANCE COMPANY CERTIFICATE NO.: 2009 -05A CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) City of Santa Ana dliant Insurance Services, Inc. in conjunction with 20 Civic Center Plaza apex Insurance Services Santa Ana, CA 92701 P t). Box 6450 Pyewport Beach, CA 92658 (949) 660 -8135 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Denise Robles TYPE: Aerobics 10672 Claussen Street DATE(S): Jan. 5 - Dec. 31 Garden Grove, CA 92840 LOCATION: Salgado Center *Liquor Liability Yes ❑ No - - - -- ["Liquor Liability after 12 amends 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 i adicated. 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 -5 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: JANUARY 1, 2010 ( OMMERCIAL GENERAL LIABILITY general Aggregate Limit $ 2,000,000 OCCURRENCE FORM DEDUCTIBLE: NONE Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence Limit 1,000,000 Eire Damage (Any One Fire) 50,000 !Medical Payments (Any One Person) 5000 Liquor Liability (If purchased) 1,000,000 1 he 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. 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 ., wvership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place I .i aer the event holder ceases to be a tenant in that premises. i OTHER ADDITIONAL INSUREDS Hortencia Nunez I i AWL'Ll ATION Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the : mificatc holder and additional insureds listed. :.LII'HWIZED REPRESENTATIVE: I IATE ISSUED: February 27 2009