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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2019-08 <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 Ann <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 HOLDER): <br />EVENT INFORMATION: <br />Karin Morales Ocampo <br />TYPE: Ballet <br />9772 Santiago Blvd <br />'I-)--ac , <br />DATE(S): 01/01/2019-12/31/2019 <br />-- o-1, 3� <br />Villa Park, CA 92867 <br />LOCATION: Santa Anita ;enter <br />_ <br />*Liquor Liability Yes EE 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: SEP41028 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 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 L000,0oo <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 />❑ $1,000,0003,000,000 <br />E] $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 />C{�,N��,FLL1bT[ON Should the above described policy be cancelled before the expiration date thereof, notice wilt be delivered in accordance with the policy <br />rovisioru. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: <br />t#<� xfy �tl <br />o <br />V IJ <br />