Laserfiche WebLink
EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO,:101D012 <br />CERTIFICATE OFINSURANCE <br />dINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS, <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITION ALINSURED) <br />AlLantInsurance Services, far. inconjunction with <br />City of Santa Ads <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. 0, Box 6430 <br />Saofe Ana, CA 92701 <br />Newport Beach, CA 926H <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Healthy <br />TYPE: BabvsilOna <br />Attn: Alicia Donald <br />DATE)5f, 02/03/10 —12171110 <br />20892 Sadmaker Circle <br />LOCATION: LawnbowlineCenter <br />HuntinglonBeach ,CA92643 <br />'InquraLiabllity YesE No® <br />*OLiquor Liability ader12amends before 2am� <br />This is to col that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicated. NorwhIstanding any tequ r memos, termsor conditions of any contract or other document with respectto which this <br />ceHfirars may be issued or may pertain, the insurance afforded by the policies described hi 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 lnsumuceCompany <br />MASTER POLICY NUMBER: IOSEPICCOODI <br />MASTER POLICY DATES EFFECTIVE: JANUARY I, 2010 EXPIRATION: JANUARY I, 2011 <br />LOMMERCIALOURALLVE R <br />Good Agl ban suoogo <br />0.WRRENCEFORM <br />D®UCP®LE NONE <br />Prduds&CumpldelUpetadens I,CIq,Wo <br />Pmsor'H dAdv¢ilisioglnjury I,CO3,Wo <br />Eazhkeumoc¢Limil I,Mq,Wo <br />FiorDamage(AnyM[m)) N,Opo <br />Madicalpayments (Any One Pusoa) $,No <br />Liquor Liability (If purchased) I'il <br />Thelun anerrumuapply separately in ad v eloarlrymispoliicy5sfaMoakpoliryafinwmnceRS bera earied for tua6ml. <br />'Wac iairnmsd,isemeaddtoiaeludy a a aninsurerflepuwn ororganiulien shmm in Ibis Sohval but only And moor toliahili cnsingoNOPOe <br />oxnmhip, maislmameoros¢ofd¢premis¢sosd hylhenamd'msuai(evenituldm), risaxmmcedcesnotapplym', Arty"==vj" whi"crplme <br />after re everholdecesmenoreaanan a@zl pmmism. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLUNN Should lheabove owned policy hemacelldheforclhemplrelieadalmhermf,(be mongcompanyvin and 30 days man aniceln no <br />coofilele holder and ddidorel insuds liad. <br />AUTHORIZED REPRESENTATIVE: � � Pw"'wr <br />DATEISSUED: Februarv7.2010 BriraMoreles <br />