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EVANSTONMSURANCECOMP.ANY <br />CERTIFICATE NO,: 2011.09A <br />CERTIFICATE OF LNSL'RANCE <br />COVERAGE EXCLUDED FOR NOMINEE EVENTS SEE SEPARATE,APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LRBILITY PROGRAM <br />INSUREDI <br />W61WrwvMxJVIN, [no onconlunmonwtm City ofSamaAna <br />AptXlnsurance Smices 20 CMIc Cotter Rim <br />P.O. Box 6430 Santa Ana, CA 92101 <br />Newport Beach, CA 92638 <br />Lome No: OC 3061 <br />mare aurum TYPE: _ Dana <br />12112 Hasler Sl, Apt. A DATE(St _91)19111—INEII <br />Garden Grove, CA 92840 art 10C..00N: la idCeott <br />i�C>IC�'Clo 'LiquolLiatLiry Yes] Noz <br />TNs is to ctnd". at the insurance polity Iced helowhas been issued to the above insured wed (event holder) for the policy <br />period Indicsi TNs cenlBaate is issued as amatter of information only sod owthre no 69hu;mthe eeAiRove holder. This <br />oaniRnate does notaflirmatively or negsdNely anterd, eprnd m alttrthe coverage afforded h de poRry l'uud and it does not <br />mnsurneamnkaabetweenthe 'waaraneecarrier, auttonmdrtInne maove,prodncerendctnili areholder. The ioswaeee <br />dwibed herein lssnEieettoall tM1ttema,tnlusiom and coaditiomofsmh policy ies), <br />INSURANCE CARRIER Emlon Inevance Company <br />MASTER POLICY N17GER: 1I01000001 <br />MASTER POLICY DATFS: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 <br />DDUCTMU NONE <br />Liability <br />'m Uisuhalul5hilooly w.ih;tsp�Iw2aSVdyuiuoparro(!k <br />usN Eplxoweaiso�(nmtNiltlal mswamueGaorgpppAm. My"oz�rno¢"xhi�OkaNst <br />Noemi Corona <br />Chihiro Sano <br />eetiaWillin Miywin mdatxiul deptliry <br />AUTHORZEDREPRESENTATIVE: /a/� 'f <br />D.ATEISSUED: Lai 192011 byBotaMomhs Revised 1I14/11 B M <br />