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EVANSTCN MSURANCE COMPANY <br />csHTIPICATBNO.: 2011.01 <br />CERTIFICATE OTINSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliarl Inmrance Services, Inc. m eunjunelio With <br />City of Santa Ana <br />Apex lasurarraServices <br />20Civiu Center Plaza <br />P.O. Box 6430 <br />Newpadeeach,CA926H <br />Santa Ana, CA 92701 <br />License No; OC 36861 <br />NAMED INSURED (EVENT NOLDERG <br />EVENT INFORMATION, <br />Patrick Hurley <br />TYPE Music <br />14910 Mil Court <br />DATE(S) 01104112- 12131112 <br />Tustla,CA 92180 <br />LOCATIOM. III Sall Center <br />,��� _��� ��� <br />"Liquor Liability Ye l] No® <br />"LiuorLiabili a0erl2ameodsbefom2am0 <br />This is to ceMiry $9 the insurance policy It below has I= issued to We above irsumd named (evert holder) for the polloy <br />period indicated, TM1Is cenifinele Ishsutdas a maker afinfortnmion only and canfrcr no rights upon the ceA'thoaW lodm. This <br />conifcete does rotafffrmadvelyornegsiively ammd, extend or alterthc coverage afforded by the pollry listed aid IARs not <br />con9imte acentmct between Ae'mswance car ier, amhorieed represermlive, prad uwllfcereho der Tha insmana <br />desc{3ed heminlssubjrctfo ell0e leans, exclusions and conditions of nook pollcy(ies), <br />INSURANCE CARRIER , Evanston Inswanoe Company <br />MASTER POLICY NI!MBER. 12SCPI000D01 <br />MASTER POLICYHATFS, EPPECTIVE: IANUARY I,?012 E %PIRATIONaANUARY I, 2017 <br />CINJ,M1aA(1ALCENFPAIUABIIfIY <br />CCCIIPAFNCIfoRM <br />DEf1UCImlG'. hA]NF <br />Cmml Ag�pWS Wmii g7,rW,W4 <br />Holum @amVlwd 6ySnpars I,Wr,gq <br />Penora &AdMivq(nlury I,IXNI,ga <br />Fuh Qnmaxe lira it I,�,000 <br />Via CtmsW(MyquP'�rtl IWWO <br />Medwl Poymmu(Aryq¢Pnmrl S,Wa <br />Liquor Cmbiiry (Ifpurehaaed) boar,Wr <br />OpnomlWmitcPorcGased <br />0 sl,000,�oP2,NOO,oao <br />o s�aoo,oDOrst,a000ao <br />'Welimi¢rfimunrz I sg2rtRlyloeshheveol ir�6yrda litysifasryvmep�li ¢yoYirswuiataz6ar'usuel fw Wl¢vmL <br />"Who irvivod "isunwdd la uWudq osaninwW, IhopmoowmpW�Wiiwrhown to Ws xMdul4WioolywiNrtsryvl WliahillrynlsurgouloPlhe <br />oxnmhip, mvourcrseoruceofiheprcmittsu�hyNenamod imwed(wmi kldnl Thuinnuarttd«sraapplym'. Hoy "ceeertma "uAlrhukmNva <br />Wirttlkevem Mderoaf etWhtalmmtl inAalpmrirte <br />OTHER ADDITIOeaLtNSUaeDs <br />VENLIId➢CN" mauldJ�¢ horedouriMd{ aliry6erenoelh -0hdomtre¢epva�ioodmcthpro[ noon :�nllPoddivendlo�mdmreu�AWpoliq <br />onfiom. <br />RUTHORIZED REPRFSENTATIVP., <br />DATE ISSl1ED, IJI III by Brian Morales <br />