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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2012-08 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. an conjunction with <br />City of Santa Ana <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. 0. Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />L icense No: OC 36861. <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMAT[W <br />Rudy Sehuarne TYPE: Martial Ats <br />2424 W. First Street, #133 DATE(S): 01103112 —12131112 <br />LOCATION: Santa Anita Center <br />, <br />Santa Ana, Cr" 9270�3 <br />*Liquor Liability Yes [I N o Z <br />cx�) C <br />(1z "Liquor Liabilit after 12 am ends before 2 am El <br />_y <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: 12SEPI00000I <br />MASTER POLICY DATES: EFFECTIVE. JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 <br />COMMERCIAL GENERAL LIABILUY OCCURRENCE FORM DEDUCIIBLE: 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 Damage (Any One Fire) 100,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) I,000,000 <br />Optional Limits Purchased <br />F-1 simmoo/smoomoo <br />[:] $2,000,00052,000,000 <br />The limits of insurance apply separately to each event insured by this Policy as if 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 vMh respect to liability arising out of the <br />ownership, maintenance or use ofthe premises used by the named insured (event holder). 'rhis insurance does not apply w Any "occurrence" which takes place <br />after the event holder ceases to be a tenant, in that premises <br />OTHER ADDITIONAL INSUREDS <br />.CAN. Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />provisions, <br />MU # as 1013 VA 10 011 R 0 2 R 1 W; 12 V 611 W; I <br />DATE ISSUED:­ O L/Q-1/1 2 by-Briza Morales . ............... .. . __ .. . ....... ­_ <br />