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EVANSTONINSURANCEWMPANY <br />CERTIFICATE NO; 2010 -009 <br />CERTIFICATE OPINSURANCE <br />NOMINEE EVENTS, <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER PUBLIC ENITTY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. inoonjonctlonwith City of Santa An <br />Apex lnsurance5¢ruicea 20 Civic Center Plaza <br />P, 0. Box 6450 Santa Ana, CA 41101 <br />Nt;WBeach,CA92W <br />License No :OC6861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />RaymundoSoarez TYPE: MarlialAra <br />6I0S.TownseodStreet DATE(S), 01-1211840 <br />SantaAaa,CA 92107 LOCATION, BI Salvador RecreatianCenter <br />'Liquor Liability Yes 0 Nog <br />"Liquor Liability afler12amendsbefom2am� <br />Ttdsistoc¢rtf that the policies of casumm listcd below have ban issued to the insured iscomed above for the Policy Period <br />md'rcaleti. Notwithstanding any ioquiremmits, zins or coashtions; ofiraymnaitt or otherdoescricertwincresitNtt which this <br />ceNfieafemayb¢ isouedoruaypeAam the vmmance afforded by 0m poEcfcs dasmbedherenia aubjectro dltmte <br />, tns, <br />ezcluaions and conditions of such policies , Lint shown may have been rodo¢¢Ahypaid claims, <br />INSURANCE CARRIER, Evmstonlnsmanne Company <br />MASTER POLICY NUMBBR: IOSBPIWOWI <br />MASTDRPOLICYDATBS: DRRECf[VE, IANUARY 1, 2010 EXPHiA7)ON: ]ANUARY 1, 20(1 <br />CGMMERCIALOEN6PALLNBI11Tti' CCCUPAENCEFORId DE �, NON5 <br />Gmu9 A�f¢ppklimil S2,W0,000 <br />Prcdmk @CampktedOpoati ®a I,RO,000 PPROVE I <br />Personal &Ativ¢rfisinglnjury I,Wa,a00 <br />Fa�O¢4mimoelilrtit I,Wa,WO <br />Fir¢Gurug¢(MyOn¢Pla) fs,OW <br />Mctlmal Paym¢nn (AnyonoPwsoa) JOSEP W f CNER <br />LiquorLiebiEty(Ifpurehased) I,oao,xa RNEY <br />C A <br />iiulimisofinsuaneoapptya¢ puaklymunhnmlmmnrtlhyd�'epollryuf RpolicyePiraurmceHshomiwe7lulMte rmt <br />" WhOnP9alt> I° t90ASp�mOelYtlC, B69A' WOr� ,(hEpERM @er$IAiAIIOnfiiOWLRI (nlf 9ehCdYIE,NIIMIy!NI�IffpGtm �IheIryN910gnWOf � <br />mmersh' ry, mtink¢ aon¢ rua¢ fN¢ pnmis¢ rus¢ tlhylhtaammiiwmd (ermtholtltt).'ITiainsuMadocn¢I Upplyto, Any "aeurtmcd'whicM1kkuplan <br />afln Ae ennl Mkvuus m h¢ r I¢nmt m tlsl pamiuf. <br />OTHBRADDYf10NALINSUREDS <br />N TIN'. ShouldthobovedwnlelpoPcyheca7rdledtrl melhoupinamdelathn¢ o(f o¢ iwingmoryaaywill mai170tlaytwnlRnnadamlM1e <br />¢udfnak holds end eMtlirma imm�tls 16ktl. <br />AUTHORIZEII REPAESENTATNE: �� <br />DATEISSUED: Ienuarv12010 by BnzaMmales�wv <br />AUTHORIZEII REPAESENTATNE: �� <br />DATEISSUED: Ienuarv12010 by BnzaMmales�wv <br />