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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2009-01 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOML'�� EVENTS. SEPARATEBILITY APPAM TIONS FOR NOMINEE EVENTS. AL F Apex Insurance Services P. O. Box 6450 Newport Beach, CA 92658 (949) 660-8135 r iernse No: OC 36861 } City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 NAMED INSURED (EVENT 11]1.ubx): TYPE: Dance - Salsa Salomon Rivera , a00(� _ o�(p3, DATE(S): Jan. 5- Dee.31 — 709 S. Parton Street LOCATION: Southwest Senior Center Santa Ana, CA 92701 *Liquor Liability Yes ❑ No ❑ err : ,, r T iahility after 12 am ends before 2 am ❑ d to the insured named above for the policy Period This is to certify that the poliane ref uirements, tinsurance teerms orted low have been conditions of any econtract other document with respect to which this indicated Notwithstanding y 4 policies described herein is subject to all the terms, certificate may be issued or may may pertain, the insurance afforded by P exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEP 100000I-5 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: jANUARY 1, 2010 OCCURRENCE FORM DEDUCTIBLE: NONE COMMERCIAL GENERAL LIABILITY g 2 000.000 General Aggregate Limit I,000,c00 Products &Completed Operations I (g0,000 personal & Advertising Injury 1 10,000 000,000 Each Occu cnee Limit Fire Damage (Any One Fire) Medical payments (Any One person) 5,000 1,000,OOo Liquor Liability (If purchased) The limits of insurance apply separately to e¢ch event insured by this Policy as if a separate policy of insurance has beer[ rssueo ror uur vvult organization shown in this schedule, but only with respect y occurre¢Ce" which tikes Place liability arising out of the "Who is insured" is amended to include, as an insured, the Person or oes not apply to: Any ownership, maintenance or use of the premisesen used by the named insured (event holder). This Insurance d" alter the event holder ceases to be a CANCELLATION: ATION: Should the above described policy to ="tied before the Wimdon date thereof, the issuingcompmyw'ill marl 30 days written notice to the ..,,---- ,._,,,._."A 4AA!6�..l insureds listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: