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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 634590922457527507 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />A ieuflusue.'m coujundiou with <br />City of Sat Alla <br />Apex Iusurallce Semius <br />P, 0. Box 64fD <br />Newporl Beach, CA 9265S <br />Licence No:OC 16861 <br />NAMED INSURED (EVENTHOLDERp <br />EVENTINFORMATIONI <br />NydiE Duran <br />TYPE Dene (Various) <br />2033 Harvard <br />DATE(S): D10012 120012 <br />Saida Ana, DA 92794 <br />LOCATION, Memoriatand date Arta <br />Liebuiry YesE Not <br />ulLi <br />ucquor <br />r Uabili Sher l2 am ends before 2 am� <br />This is to cenify thatfhe pol nes of insurancelisted below have been issued to the insured named above for the policy period <br />indicated, NoromhoandieS arty requiremenu, terms or conditions of any contract or other document with respectto which this <br />Wifcalemay be issued or may percein, the insuranceaRnrd¢d by the pollcits described herein is subject Mall the terms, <br />exclusions and conditions of such policies. Lit shown may have hom orbroedby paid cla'Dns, <br />IHSURANCECARRIER. EreralmtosumoteCumwoy <br />MASTERPOLICY NUMBER, 12SEPIONNI <br />MASTER POLICY DATES, EFFECTIVE. January01,2012 E%pIRATION: January ot, 2019 <br />COMM ERN L GFISORkL LIA81UTY <br />XC11MCFORM <br />DFAUCUBI.E, NONE <br />(knurl AagmgnoLimil r2ook0 <br />Endows &ca tmd)oromi ,ON,0 <br />Pemr®I&Advmisln mum I,ga <br />Ed caunaaatdair i3Oq,ND <br />Fire Demate(My One firs) >D,NO <br />Mdical Paymone(Any One Emil a,NO <br />Liquor Lielty (if pmeentd) <br />Theliminsofiotumnmapply sgpmldylomdwmtlmi6yurooliryuifaupmmepdigot,u,arzhmhsmusmd frouremo <br />'Who itnwrd"ismvndd to lodAt is an insured, the prmi oruqueadonshown m m;sdsduly but adywm m;w mlldillryrat tutor lhis <br />ownership me= nl ox of the piu5d by k famed lmwd ltvw[moF)Im9hWrm[Ydoes no aNy l0L0'xitLMF¢"wM[h nom pNm <br />On ttKEIMI IWderemses c he a boast initi, pwism <br />OTHER ADDITIONAL INSUREDS <br />CBNCE IATIOR Should the aMrcdust Pchrybomrat reSNdeapiretimdmeNwLMisminpmmprow1l mail 30dos mun rates be lM <br />wittiest holder md rid suadiomfdsluded . <br />AUTHORIZED REPRESENTATIVE <br />DATE ISSUED: <br />