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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2019-21 <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 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Santiago Bauitista <br />TYPE: Martial Arts <br />2043 S. Birch St, <br />DATE(S): 01/01/2019-12/31/2019 <br />Santa Ana, CA 92707 <br />LOCATION: Memorial Park, El Salvador Park, <br />Saleado Community Center <br />*Liquor Liability Yes ❑ No <br />**Li uor Liabilit after l2 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: SEP41028 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2019 EXPIRATION: JANUARY 1, 2020 <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 t,000,000 <br />the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 100,000 <br />Certificate 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 />1-1 $1,000,000/53,000,000 <br />❑ $2,000,000/$2,000,000 <br />Damage To Property (If purchased) <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued For that event, <br />OTHER ADDITIONAL INSUREDS <br />Justin Unsworth <br />Clelia Mouser <br />Jesus Bauitista <br />Peter Mangosin <br />t <br />n <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be deliveree 9Cclr d e h the licy <br />provisions, <br />AUTHORIZED REPRESENTATIVE:.._ n__ .® <br />DATE ISSUED: <br />0 / <br />