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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012-16 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 Center Plaza P. O. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Maria Vigil TYPE: Zomba 308 Columbia Street DATE(S): 01/05/12 — 12/31/12 Newport Beach, CA 92663 _ LOCATION: to Liquor Liability Yes No M • *Liquor Liability 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 the certificate holder. This certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies). INSURANCE CARR ER: Evanston Insurance Company MASTER POLICY NUMBER: 12SEPI000OOI MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 C00AM 3tCIAL GENERAL LIABIL Y OCCURRENCE FORM DIDUCf1B1.E1 NONE Gened Aggregate Limit S2,000.000 Products A Completed Operations 1.000,000 Personal R Advertising htiury 1.000.000 Each Occurrence limit 1,000,000 Fire Da—aw (Arty One Fire) 100.000 Medical Payments (Any Onx Person) 5,000 Liquor Liability (If purchased) 1.000.000 Optional Limits Purchased 0 S1,"0.000/S3,000.0" S2,000,0"/S2,000,0" The limits of inataartca to each event insured by this policyas if a separate policy ofinsurance has been issued for that event- - Anis unsnued" 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 ovvnersltip, mainteinanee or use of the premises used by the named insured (event holder). This ituuranee does not apply to: Any "oonu anon which takes place after the event holder ceases to be a tenant in that its. OTHER ADDITIONAL INSUREDS CANOE L. TIOM Should the above desenlxnd policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy wroviions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 01/05/12 by Brio Morales