MAYNE, VIRGINA G. 6B - 2010 - Laserfiche WebLink

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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2010-002 CERTIFICATE OF 1NSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL 1SURED) Alliant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services 20 Civic Center Plaza P. O. Box 6450 - Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Virgina Mayne TYPE: Self Improvement 1601 E. Avalon Ave. DATE(S): 1/7/10-12/18/10 Santa Ana, CA 92705 LOCATION: Santa Ana WORK Center *Liquor Liability Yes EJ No -Liquor Liability after 12 am ends efore 2 am Q 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: IOSF-Pl000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2010 EXPIRATION: JANUARY 1, 2011 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Ag~gregate Limit S2,000,000 Products o Completed Operations 1,000,000 Personal Advertising Injury 1,000,000 Each Occurrence Limit 1,000,000 Fire Damage (Any.Ona Fire) 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 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 ofthe 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 thatpremises. OTHER ADDITIONAL INSUREDS D j3y$ L 1SA E. gTORCK Assistant City Attorney 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: ci DATE ISSUED: January 7 .2010 by Briza Moraleusyi n