ROBLES, DENISE 1D - 2011 - Laserfiche WebLink

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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012-19 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM ROD P ODUC PUBLIC ENTITY (ADDITIONAL INSURED) Alliant insurance Services, Inc. in conjunction with City of Santa Ana Insurance Apex Apex Services p 20 Civic Center Plaza P. 0. Box 6450 Santa Ana, CA 92701 Newport I Newport Beach, CA 92.658 License No: CDC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Denise Robles TYPE: —Aerobics 1664 W. Cindy Lane, Apt. D D DATE(S): 01/26112 —12/31/12 Anaheim, CA 92803 LOCATION: Salgado Community Center *Liquor Liability Yes ❑ No 15� "Liquor Liability after 12 am ends before 2 am 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 bolder. 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: 12SEP100000l MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 ]EXPIRATION: JANUARY 1, 2013 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE, NONE General Aggregate Limit $2,000,000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence Limit 1,000,0010 Fire Damage (Any One Fire) 100,0010 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased $1,000,000/$3,000,000 El $2,000,00032,000,000 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 o,fthe 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. OTIJER ADDITIONAL INSUREDS Hortencia Nunez CANCE1126.110A Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions, P-11011 Iffil A DATE ISSUED: 01126/12 by Ibiza Morales