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DAVIS, LAVERNE 3 -2015
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DAVIS, LAVERNE 3 -2015
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Last modified
3/25/2020 9:33:08 AM
Creation date
4/22/2015 1:21:19 PM
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Contracts
Company Name
DAVIS, LAVERNE
Contract #
N-2015-048
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Expiration Date
6/30/2017
Insurance Exp Date
12/31/2017
Destruction Year
2022
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EVANSTON FNSURANCE COMPANY <br />CERTIFICATE NO.: 2016-1.9 <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 <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. 0. Box 6450 <br />Santa Ana, CA 92.701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Laverne Davis <br />'TYPE: Dance <br />2221 Lowell Street ,�� <br />( <br />DATE(S): 01/07/16— 12/31/16 <br />Santa Ana, CA 92707 �� <br />LOCATION: El Salvador Center & Santa Anita Center <br />*Liquor Liability Yes ❑ No N <br />"Liquor Liability 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. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless <br />amended as described in Special. Conditions. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: SEP41.020 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2016 EXPIRATION: JANUA.RY 1, 2017. <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DE I3UCTIRLE NONE <br />General Aggregate Limit S 2,000,000 <br />Products & Completed Operations 1,000,000 SPECIAL. CONDITIONS: <br />Personal & Advertising hllury 1,000,000 The following endorsements attached to <br />Each Occurrence [,unit 1,000,000 the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 100,000 Certificate Of Insurance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (if purchased) 1,000,000 <br />Optional Limits Purchased - , <br />st'000,0001S3,000,000 P <br />[] $2,000,0001$2,000,000 <br />Darnage `Ta Property (If purchased) <br />ICI <br />The limits of insurance apply separately to each event insured by this policy as ife separate po 4' insurance has 'been issued for that event. <br />OTHER ADDITIONAL INSUREDS <br />CA.NCFlJ.,ATION: Should the above described Policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />revisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 7 2016 by Briza Morales <br />
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