Laserfiche WebLink
EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2017-01 <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. O. Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMET) INSURED (EVENT HOLDER): <br />EVENTINFORMATION: <br />Terry Subandhi <br />TYPE: Badminton <br />14862 Coletta Place <br />DATE(S): 01/01/17 — 12/31/17 <br />Westminster, CA 92683 <br />LOCATION: SalVado Center <br />C, i Le <br />*Liquor lity Yes [] No Z <br />"Liquor LiaLiabibility 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 bolder) for the policy <br />period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ics) unless <br />amended as described in Special Conditions. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: SEP41023 <br />MASTER POLICY DATES,-. EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />BCE: UCTIBLE: NONE, <br />General Agg.regate Limil S 2,00,000 <br />Products & Completed Oponations, 1,000,000 <br />SPECIAL CONDITIONS: <br />Personal & Advertising Injury i,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 />Dafnagc'l'o Promises Rented To You (Any One Premises) I <br />Certificate Of hmtrance: <br />Mv.dical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) i MUM <br />Optional Limits Purchased <br />R $1,000,00053,000,000 <br />M $2,000,00052,000,000 <br />Damage To Property (If purchased) <br />The limits of insurance apply separately to each event insared by this policy as i f a separate policy of insurance 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 he delivered in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: <br />M <br />