ARCEO, BLANCA E. 1B - 2012 - Laserfiche WebLink

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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012 -11 CERTIFICATE OF INSURANCE 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. O. Box 6450 Newport Beach, CA 92658 Santa Ana, CA 92701 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Blanca Arceo TYPE: Dance (variousl 2022 W. Alco Ave. DATE(S): 01/03/12 — 12/31/12 Santa Ana, CA 92703 LOCATION: Jerome and Southwest Senior Centers _ ` 1 /� ' �� J �� *Liquor Liability Yes � No N ��, * *Li uor Liabili after 12 am ends before 2 am Q 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 [he terms, exclusions and conditions of such policy(ies). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 12SEP1000001 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 8c Completed Operations 1,000,000 Personal 8c Advertising Injury 1,000,000 Each Occurrence Limit 1,000,000 �gl�xc i � � � A S ,�_� �'�Ul� j'yy Fire Damage (Any One Fire) 100,000 Medical Payments (Any One Person) 5,000 �' � Liquor Liability (If purchased) t,000,000 _ -- Optional Limits Purchased Laura __ St;tt Sheerly -- 0 $1,000,000/$3,000,000 ns��sta rt CiI y � I t � � r �� Q $2,000,000/$2,000,000 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 of the ownershiq maintenance or use of the premises used by the named insured (even[ holder). This insurance does no[ apply [o: 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, notice will be delivered in accordance with the policy rovisions. �� /I ilh� AUTHORIZED REPRESENTATIVE: DATE ISSUED: 01/03/12 by Briza Morales t� l t5 [ 12 S Ar�L.�jc3 --- Cly 1 t