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E VAN STON INSURANCE COMPANY <br />CERTIFICATE NO.: 2012-15 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />.............. ---- - - <br />PRODUCER PUBLIC ENTITY (ADDITIONAL. INSURED) <br />Alliant Insurance §ervices, Inc. in conjunction with City of Santa Ana <br />Apex Insurance Services 20 Civic Center Plaza <br />P. 0. Box 6450 Santa Ana CA 92701 <br />Newport Beach, CA 92658 , <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): T_VER�15NFOK TF <br />Maria Ruiz TYPE: Preschool / Dayeare <br />2814 Waverly Ave. DATE(S): 01/09/12-12/31/12 <br />Santa Ana, CA 92705 LOCATION: Corbin Center <br />­ao *Liquor Liability Yes [I No 5� <br />"Liquor <br />Liability after 12 am ends before 2 am El <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: 12SEPIOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION. JANUARY 1, 2013 <br />COMMERCIAL GENERAL LIABILITY OCCURRFNCFFORM DE1AJCTT]3LF: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Darnage (Any One Fire) 100,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />F $1,000,00053,000,000 <br />E] $2,000,000/52,000,000 <br />The limits of insurance apply separately to each event insured by this policy as if a 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 of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance dm not apply to-, Any "mcui-rence' which takes place <br />after the event holder ceases to be a tenant in that premises, <br />OTHER ADDiTIONAL INSUREDS <br />QMKF.U,A11QN.; Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />provisions, <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED- —0 1/05/12 by Briza Morales <br />