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EVANSTONNSUANCECOMPANY <br />CERTIFICATE NO.: 201203 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alllanr Insurance Services, Inc. in conjunpiom wilt <br />Cityof Santa Ana <br />Ape. Bervices <br />20 Civic Center Plana <br />, 430 <br />P 0. Box66450 <br />Newport Beach, CA 92658 <br />Sante Ana, CA 92701 <br />License No, GO 36861 <br />NAMED INSURED (EVENT HOLDER), <br />EV ENT INFORMATION, <br />Geraldine Valeom <br />TYPE, 4NmoasBcs <br />13100Chapmaa Ave, Apt 3.108 <br />_ <br />DATES), 0IM3M - 12131112 <br />Garden GrovgCA9290 <br />LOCATION: Jerome Center <br />aUquor Llan ny Yes No� <br />sate <br />aOr Llatlll ader 12 an Enda before 2 amQ <br />This is to eer(il&Be names policy listed below has been Issued 10 Be above m oled named(eysm holder) for the polky <br />period indicated, This ou iboatels issued as a menu ofinformetion only and confers no rights upon the cenifmam holder. This <br />c¢nifumW does Rot15matively ornegmively amem,, extend or alterBe coveageaffordedby thepofrry listed and it does not <br />consthutea contact beNem JI Ince, courier, auBonaed represenmtive, Producer and ceAlfrau holder The 'mswame <br />desodI ed herein is subject luau the trams, esclusfoarand coodhioos of suchpolicy(ies). <br />INSURANCE CARRIER: Evanslon Inures ceCompany <br />MASTER POLICY NUMBER: I2SEPI000001 <br />MASTER POLICY DATES EFFECTIVE, JANUARY I, 2013 EXPIRATION JANUARY 1, 2013 <br />COMMFBCMLGENEeAUMIIAY <br />OCCUP,pENCEFORM <br />D00BLE', NONE <br />OmaalAggrtpl¢LHit s2,coo,000 <br />Pmduna&Completed Oparms WIN <br />&mmo1&Adverrun2 MIM' 1o1,W0 <br />W0mwanmLimit I,Cotow <br />Pim CmmnnlAgOneFirQ Icoo <br />kill hymn iAny One N mnl 5,OM <br />Liquor Liability(Ifpurchased) I'Catoo <br />Optioual Llmlts Purchased <br />p 311000500NS2, KOOO <br />p s2,oBB,00Mtt,too,ddB <br />7,klimioofimaarra lyupwmly lamnhrnnlioru�d hy91spO0ryu dasrpmle olLyofioswmxxhuGrn issxdfmctmreml. <br />"wMif NsuIBI"EnmtrdedNlRJndr man NfW04 nrtpttimuml�i¢IlmlamMNlhb3ef.<uah,FWmNxllhlfapMlln lahflfymEingoN nTNe <br />o�gstdp,mdmererxmuixoflM pmni>vusd lrylhen¢metlimurcn(r+mIMNnJ 1Nsiw�rmadoaogapplyN My'oawmce'xhi0 &kaplue <br />Oar me ma haloes cm to aaa mmlmNG ermb 1xS. <br />OTHER ADDITIONAL INSUREDS <br />CAfKLIAH4LC' Should dtbndwWpd ybemcled 6dmebeupiran aae$=v nonce mllI bedalNemtlnouarimwa$mepNiq <br />ovuions <br />AUTHORIZED REPRESENTATIVE: <br />DATEISSUED•, 12f20111 by Bnze Moales <br />