SEHUAME, RUDY R. 1e - Laserfiche WebLink

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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2010 -003 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services 20 Civic Center Plaza P. 0. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Rudy Sehuame TYPE: Karate 2424 W. First Street, Space 133 DATE(S): 1/7/10 - 12/18/10 Santa Ana, CA 92703 LOCATION: Santa Anita Park "Liquor Liability Yes ❑ No kt "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: 10SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2010 EXPIRATION: JANUARY 1, 2011 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $ 2,000,000 Products& Completed Operations 1,000,000 O FORM pS Personal& Advertising Injury 1,000,000 N�PViOVED Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments One Person) 5,000 (Any JOSEPH Liquor Liability (If purchased) 11000,000 TTO NEY C The limits of insurance apply separately to each event insured by this policy as if a separa icy of insurance has been issued for that event. "Who is insured" is amended m include, as an insured, the person or organisation shown in this schedule, but only with respect to liability arising out of Ore ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: 11a �� DATE ISSUED: January 7, 2010 by Briza Morales W