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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012-06 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City Of Santa Ana Apex Insurance Services 20 CIVIC CenteC Plaza P. O. Box 6450 Santa Ana CA 92701 Newport Beach, CA 92658 , License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Manuel Ortega TYPE: Music 5708 W. First Street #C ?//- O ? ? DATE(S): 01/03/12 - 12/31/12 Santa Ana, CA 92703 /Y ? LOCATION: Santa Ana Police Athletic 8c Activity Lea ue SA PAAL *Liquor Liability Yes No **Li uor Liabilit after 12 am ends before 2 am This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. This certificate is issued as a matter of information only and confers no rights upon [he certificate holder. This certificate does not affirmatively or negatively amend, extend or alter the coverage afforded F,/ the policy listed and it does not constitute a contract between [he insurance carrier, authorized representative, producer and certificate holder. The insurance described herein is subject to all the terms, exclusions and conditions of such po!ic_?'9es). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 12SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM t)EIJUCTIB LE' NONE General Aggregate Limit $ 2,000,000 Products 8e Completed Operations 1,000,000 Personal a4c Advertising Injury 1,000,000 Each Occurrence Li mi[ 1,000,000 Fire Damage (Any One Fire) 100,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) l,ooo,ooo Optional Limits Purchased Q $1,000,000/$3,000,000 Q $2,000,000/$2,000,000 The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for [hat event. "Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect [o liability arising oul of the ownership, maintenance or use of the premises used by [he named insured (event holder). This insurance does not apply lo: Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should [he above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy rovisions. ?? e AUTHORIZED REPRESENTATIVE: DATE ISSUED: 12/21/11 by Briza Morales