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N-2018-006-01 <br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2018-22 <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 />NAMED INSURED (EVENT FIOLDER): <br />EVENT INFORMATION: <br />Sonia Miskulin- Academy of International Dance <br />TYPE: Dance <br />2019 S. Main Street <br />DATE(S): VO4/18— 12/31/18 <br />Santa Ana, CA 92707) <br />LOCATION: Jerome, Salgado & EI Salvador Center <br />*Liquor Liability Yes ❑ No <br />"Liquor Liability after 12 am ends before 2 am El <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: SEP41026 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2018 EXPIRATION: JANUARY I, 20 t9 <br />COMMERCIAL. GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General 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 L,000,000 <br />the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 100,000 <br />Certilicate Of Insurance: <br />Medical Payments (Any One Person) 5,000 <br />MEGL643 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />❑ $1,000,000/$3,000,000 <br />❑ $2,000,000/52,000,000 <br />Damage To Property (If purchased) <br />The limits or insurance apply separately to each event insured by this policy as ifa separate policy of insurance has been issued for that event. <br />OTHER ADDITIONAL INSUREDS <br />Donald Sevilla <br />Chaye Jackson <br />CANCELLATIOM Should the above described policy be cancelled before the expiration date thereof, notice will be delivered I1'ao-kUrnce with the pol' <br />rovisions. <br />Yv <br />AUTHORIZED REPRESENTATIVE.: <br />DATE ISSUED: <br />