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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2011-09 <br />CERTIFICATE INSURANCE COVERAGE EXCLUDED FOR NOMINEE EVENTS SEEOSEPARATE APPLICATI�I 7811 P?4 M EVENTS. <br />SPECIAL EVENT LIABILITY PROGR <br />AfflTY it n num <br />PRODUCER <br />PUBLIC ENTITY ( ONAL; INSUMCUL <br />Alliant Insurance Services, Inc. in conjunction with <br />City of Santa Ana <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. O. Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Maria Corona Ca)r-->o` t`-lCf—, <br />TYPE: Dance <br />12172 Haster St, Apt. A <br />DATE(S): 01/19/11 — 12/31/11 <br />Garden Grove, CA 92840 <br />LOCATION: Memorial Center <br />\ ��O`O <br />`V —" <br />*Liquor Liabil ty Yes 0 No <br />**Li uor Liability after 12 am ends before 2 am <br />This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy <br />period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This <br />certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not <br />constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance <br />described herein is subject to all the terms, exclusions and conditions of such policy(ies). <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 11SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 <br />C'OM M E -RC'IAL CiENFRAI. LIA1311-I"1-Y <br />OC'C'LIRRENC'1'_ FORM <br />DED(1C'T1[31JC, NON], <br />General Aggregate Limit S2,000,000 <br />Products & C'omplcted Operations 1,000,000 <br />Personal & Advertising lniury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One 1'erson) 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 ifa separate policy 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 ofthe <br />o.vnership, maintenance or use of the premises used by the named insured (event holder). this insurance docs not apply to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCFLLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />provisions_ Every effort will be made to deliver 30 days written notice to the certificate holder and additional insureci(s) listed. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 19, 2011 by Briza Morales <br />