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E'VANS"FON INSURANCE CONBANY <br />CERTIFICATE NO.: 2011 -43 <br />N -2010- 056 -001 <br />CERTIFICATE OF INSURANCE <br />COVERAGE EXCLUDED FOR NOMINEE EVENTS SEE SEPARATE APPLICATIONS FOR NOA4INEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />Apex hsurance Services <br />P. O. Box 6450 <br />Newport I3each, CA 92658 <br />License No: OC 36861 <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />NAMED INSURED (EVENT HOLDER): <br />HVENT INFORMATION: <br />Delma Sehuame <br />TYPE: Al•t Class <br />2424 �v. first Stt•eet #133 <br />DATE( =): 07/14/11 — 12/3i/I1 <br />Santa Ana, CA 92703 <br />LOCATION: L<'1 Saivactor Center and Lo an Center <br />=`Liquor Liability Yes No <br />" *Li leer Liabilif after 12 atn ends before 2 am � <br />This is to certify that the insurance policy listed below has bean 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 aniettd, extend or alter the coverage afforded by the policy listed and it does ttot <br />constihtfe a contract between the insurance can-ier, authorized representative, producer and certificate holder_ The insurance <br />described hereilt is subject fo all the terms, exclusions and conditions of such poIicy(ics). <br />INSURANCE CARRIER: Evanston Insurance Company <br />1�lASTER POLICY NUMBER: l ISEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 <br />COMMERCIAL GENERAL LiAE3ELITY <br />OCCURRENCLr FORM <br />UEDUCTIQLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Pruducts � Completed Operations 1,000,000 <br />Personal 8 Advcrtisl+tg Injury 1,000,000 <br />Each Occurrence Lindt 1,000,000 <br />Fire Daiaaga (Any Ona Fire) 50,000 <br />Medical Payments (Auy One Person) 5,000 <br />Liquor Liability (If purchased) t.000.000 <br />71to limits otinsutan<o apply separately [o cads avant insured by this policy as if a sepatala policy ofinsurance has beet[ issued for [hat evatt. <br />^Who is insured" is amrnded to Include, as an insured, the person or organization shown in this schedut0. but Doty with re=peat to liability arising out of the <br />oaynership, meintetwnce or use of the premises used by the nanxd insured (avant holder). Phis insurance does not apply [o: Any "occurren <e" which takes placa <br />after the avert }molder ceases to ba a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCEI,LATLON: Should Eha above described if olicy he cancelled before the a <piralion data tltercof, notice avi11 be delivered !n nacordance with the policy <br />rovlstons. Eve eflbr[ ♦viii be made to dativcr 30 da written notica to the certificate holder and additional insureds Iisted. <br />AUTHORIZED REPRESENTATIVE: �� � c� <br />DATE ISSUED: 07/14/2011 by Briza Morales A PPIZ(J V J✓� A� 1 O �t' (,)1� NI <br />_._..� —_. �.i.,aur��S tt S edy - -- <br />,,,�t:[nt City Attorney <br />