ARCEO, BLANCA E. 1A - 2011 - Laserfiche WebLink

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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012-11 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM 1PRODUCER 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 64,50 Newport Beach, CA 92658 Santa Ana, CA 92701 License No: CC" 36861 . ..... . . ............... . NAMED INSURED (EVENT HOLDER): . . .... ..... . .... EVENT INFORMATION: Blanca Arceo TYPE: Dance (various) 2022 W. Alco Ave. DATE(S): 01/03/12 —12/31/12 Santa Ana, CA 92703 LOCATION. Jerome and Southwest Senior Centers w_ CX- : c *Liquor Liability Yes E] No E **Liquor Liabili after 12 am ends before 2 am I ty El This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies). INSURANCE CARRIER- Evanston Insurance Company MASTER POLICY NUMBER: 12SEPI00000I MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTrBLE: NONE General Aggregate Limit $2,000,000 Products & Completed Operations 1,000,000 Personai & Advertising Injury 1,000,000 Each Occurrence Limit 1,000,()00 Fire Damage (Any One Fiie) 100,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased F S1,000,0001 S3,000,000 El $2,000,000/$2,00,0,000 The limit,,, of insurance apply separate lly to each event insured by this policy as if 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 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 Q_AN_C,ELLAJI0N: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy _provisions, r-7 AUTI-IORIZED REPRESENTATIVE: DATE ISSUED: — 01/03112 b Briza-Moralcs