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RIVERA, SALOMON 2A - 2012
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RIVERA, SALOMON 2A - 2012
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Last modified
7/7/2016 2:32:57 PM
Creation date
7/16/2012 2:58:10 PM
Metadata
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Template:
Contracts
Company Name
RIVERA, SALOMON
Contract #
N-2011-134-001
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Expiration Date
12/31/2013
Insurance Exp Date
12/31/2013
Destruction Year
2018
Notes
Amends N-2011-134
Document Relationships
RIVERA, SALOMON 2 - 2011
(Amends)
Path:
\Contracts / Agreements\_PENDING FOLDER\READY TO DESTROY IN 2018
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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2013 -20 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. in conjunction with <br />City of Santa Ana i <br />�! <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. O. Box 6450 <br />Santa Ana, CA 92701 '� <br />Newport Beach, CA 92658 <br />'�. <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Salomon Rivera <br />TYPE: Dance <br />709 S. Parton Street <br />DATE(S): 01/17/13 — 12/31/13 <br />Santa Ana, CA 92701 <br />LOCATION: Southwest Senior Center <br />N _ �� �,�_ `-alb --� � � <br />*Liquor Liability Yes � No <br />* *Li uor Liabilit after 12 am ends before 2 am <br />This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy <br />period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This <br />certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not <br />constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance <br />described herein is subject to all the terms, exclusions and conditions of such policy(ies). <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: SEP41011 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2013 EXPIRATION: JANUARY 1, 2014 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products 8c Completed Operations 1,000,000 <br />Personal 8c Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 100,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) l,000,000 <br />Optional Limits Purchased <br />� $1,000,000/$3,000,000 <br />p $2,000,000/$2,000,000 <br />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. <br />"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 <br />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 <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy be cancelled before [he expiration date thereof, notice will be delivered in accordance with the policy <br />rovisions. <br />O �_ <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: <br />
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