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EVANSTON INSUFZANCE COMPANY <br />CERTIFICATE NO.: 634274904998208327 <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <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 />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Pat Hurley <br />TYPE: Music <br />14920 Minneola Ct. <br />DATE(S): 0'1/05/20'11 - 06/29/20't1 <br />Tustin, CA 92780 <br />LOCATION: EI Salvador Center <br />'t�/ �/� � <br />—� � � `i <br />*Liquor Liability Yes � No <br />p �/� <br />* *Li uor Liabili after 12 am ends before 2 am <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: 1'ISEP'100000'I <br />MASTER POLICY DATES: EFFECTIVE: January 01, 20'1'1 EXPIRATION: January 01, 20'12 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limi[ $ 2,000,000 <br />� <br />Products 8c. Completed Operations 1,000,000 <br />Personal � Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />AP C•�/ <br />TO FORM <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy ns <br />or t at 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 azising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does no[ apply [o: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION Should the above described policy be cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />�� � <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED <br />