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EVANSTON INSURANCE CoMpoy <br />CERTIFICATE NO.: 2009-08 _ 1 D <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: <br />Aliiant Insurance Services, Inc. in conjunction with <br />Apex Insurance Services <br />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />(949)660-8135 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />Brauiio Mendez <br />7151/2 E. Fifth Street <br />Santa Ana, CA 92701 <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />EVENT INFORMATION: <br />TYPE: <br />Piano <br />DATE(S): <br />Jan. 12 - Dec. 31 <br />LOCATION: <br />Senior Center <br />*Liquor Liability <br />Yes Q No ❑ <br />**Liquor Liability <br />after 12 am ends before 2 am F^ <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEP100000I-5 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: JANUARY 1, 2010 <br />COMMERCIAL GENERAL LIABILITY <br />General Aggregate Limit <br />Products & Completed Operations <br />Personal & Advertising Injury <br />Each Occurrence Limit <br />Fire Damage (Any One Fire) <br />Medical Payments (Any One Person) <br />Liquor Liability (If purchased) <br />$ 2,000,000 OCCURRENCE FORM <br />1,000,000 <br />1,000,000 <br />I1000,000 <br />50,000 <br />5,000 <br />1,000,000 <br />The limits of insurance apply separately m each event insured by this policy as if a separate <br />DEDUCTIBLE: NONE <br />of insurance has been issued for that event. <br />"Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability. arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: aseAny "occurrence" which takes place <br />after the event holder ceases to be a tenant in that nremicA. <br />OTBER ADDITIONAL INSUREDS <br />CANCELLATION• Should the above described policy to cancelled before the expiration date thereof, the issuing corripany will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 1,) ->nno �./ - <br />