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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2007-22 <br /> <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br /> PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br /> City of Santa Ana <br /> Alliant Insurance Services, Inc. in conjunction with 20 Civic Ccntcr Plaza, M-28 <br /> Apex Insurance Services Santa Ana, CA 92701 <br /> P. O. Box 6450 <br /> Newport Beach, CA 92658 <br /> (949) 660.8163 <br /> License No: OC 36861 <br /> NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br /> Andrea D. Sinclair TYPE: Health and Fitness <br /> 950 W. 17st Street #C DA TE(S): Mav - December 2007 <br /> Santa Ana, CA 92706 LOCATION: Senior Center and Lawn Bowlin!! <br /> ..Liquor Liability afier 2am 0 <br /> This is to certi/)' that the policies of insurance listed below have been issued to thc insured named above for the policy period <br /> indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this <br /> certificate may be issued or may pertain, the insurance afforded by the policies described hcrein is subject to all the terms, <br /> exclusions and conditions of sucb policies. Limits shown may have been rcduced by paid claims. <br /> INSURANCE CARRIER: Evanston Insurance Company <br /> MASTER POLICY NUMBER: 04SEP100000 I <br /> . MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2007 EXPIRATION: JANUARY 1,2008 <br /> 'COM'>!ERCIAL GENERAL LIABILITY OCCURRENCE fORM DEDl;crmr.E. />iONE <br /> General Aggregate Limit $ 2.000.000 <br /> Products & Completed Operations 1,000,000 <br />,_Personal & Advertising Injury I.OOD,OOO <br />: Each Occurrence Limit 1,000,000 <br />, Fire Damage (f\ny One Fire) 50,000 <br /> Medical Payments (Any One Person) 5.000 <br /> The limits of insurance apply separately to each event insured by this policy as if a sepafllte policy;)f 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 msuranco;:: does not apply to: Any .'occurrence" which takes place <br /> after the event holder ceases to he a tenant in that premises <br /> OTHER ADDITIONAL INSUREDS ' . , ,"JV LU AS TO FORM <br /> ---~~ <br />, l,c:.LJLj Su!. Sheedy <br /> -\.c-'i~l.:~;1l Cily Attorney <br />on <br />I' <br />I CANCELLATIO:-J: Should the above described policy to cancelled before the expIration dale thcn:of th;: issuing company will mail 30 days written notice (() the <br />: certificate holder and additional insureds listed. <br /> <br />~;Z~ <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />,DATE ISSUED: May 7. 2007 <br /> <br />~ ~.;~. <br /> <br />"Generated by Risk Management Division by: <br />