Laserfiche WebLink
EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 6357-07406334078526 <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 />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Khai Hoang <br />TYPE: Dance Various <br />14401 Poplar <br />DATE(S): 06i24i2015-12F3ei20-15 12 31 15 <br />Tustin, CA92780 <br />LOCATION: Southwest Senior Center <br />*Liquor Liability Yeso No • <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: SEP41017 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2015 EXPIRATION: JANUARY 1, 2016 <br />COMMERCIAL GENERAL LIABILITY General <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />SPECIAL CONDITIONS: <br />Personal & Advertising Injury 1,000,000 <br />The following endorsements attached to <br />Each Occurrence Limit 1,000,000 <br />the Master Policy do not apply to this <br />Damage To Promises Rented To You (Any One Premises) 100,000 <br />Certificate OfInsrrrance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />d <br />El$1,000,000/$3,000,000 <br />v\eke VI <br />Re l <br />11 $2,000,00052,000,000 <br />Property Damage (If purchased) <br />No Property Damage Coverage <br />u eA <br />The limits of insurance apply separately to each event insured by this policy as if a separate polidp9 . ranoe has been issued for that event. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATEISSUED: 06/24/2015 Revised 6/26/15 B.M. <br />