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EVANSTON INSURANCE COMPANY <br />CERTIFICATENO.:20H -05 <br />SPECIAL EVENT LIABILITY P1lOCRAN <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliaotlnsurance Servl ¢rs,]no,ineonjunekwith <br />City of Santa Ana <br />Apex Insurance Smius <br />20Civie Center Plaza <br />P.O. Box 6450 <br />Newport Beach, CA 9269 <br />Santa Ana, CA 92701 <br />Liaenst No: OC36MI <br />NAMED INSURED (EVENT HOLDERj: <br />EVENT INFORMATION: <br />Salomon Raven <br />TYPE; Banos (Verious) <br />109 S, Parson Street <br />DATE(S): 01103112 —IWL12 <br />Santa Ana, CA 92101 <br />LOCATION: SourhwestSeolar Center <br />'Liquor Liability Ys0 No® <br />"Liquor JAIhx afltr 12 am ends before amp <br />This is to ceAifythat the insurance policy Bred blow has been Issued to the above insured named (event holder) for the polity <br />penod indiosled, Thiscerifleate is'ssued asa made of'mformation only end confers no no upon thecedjflcafe holder This <br />utljAW dos not aflirmmively or negah'vely emceQ extend or alter Ne ooverage offended bylhepollcy listed and it dos not <br />oonsthute acontract between Aemamanu runs, aofeori9 reprsutetive, pmduurend ralifiosla holder. Tfie insurance <br />dsuihtd Iream is subject mill Ihetarms, ezolusians and oondilianaof such palloy(ies). <br />INS URANCECAl1RIER: Evanston lnsumnu Company <br />MASTER POLICY NUMBER, LSEPIO0000I <br />MASTER POLICY BATES, ERFECTIVE: JANUARY f 2012 E %PIRATION, IANUARY 1,2017 <br />COM1dhHaCW.OENEMLw1aIUiY <br />OCCURaENCEFOPM <br />aIaOC➢B6F NOM <br />Cmoil A�egax gmii fl,l'�,Wo <br />Prtdum@GmplddOgnsnoox I,IXI,WB <br />Pamotl &Ad�misioglojury I,NO,WJ <br />FsdO¢wo,aLimii I,NO,a'NI <br />firt0amagelAmOnFua ICO,Wa <br />MttliW Byrt�ls[My0m Posoo3 S,%gJ <br />Liquor6iebiliry )IlpurcMaed) Imo,� <br />Optlanel Llmlta Purchased <br />0 s6hho,ohms3,ohh,00h <br />� 92,hh6,ohoa2,000,000 <br />itslimiboaNswarseupplys Iomohavmlirsr�ayNopelirymd'amwwe Iiryoflru�iwmtluaxnlwoffmNal arrni. <br />" Wtmisirawe f "uemtrddroircludgp¢nuuwel,th¢pmm ormgmimticn�hown to Nis wh�IgMiiooly�nihrcpatlo liaElliry¢nsingoNA�k <br />w�ne�igmurAtra�ttormeoPlN pmcise w�CyWoamadiwirtd[< umlMNerl 'Nipiosuramedoo�omapplym'. Any "xunma "xAiA mknplue <br />BflQ NLEIMt ARdtlLWS30 eta Rnmlp N�RmtleA <br />OTNER ABDITIONAL INSURFAS <br />S'Al'CELLA➢Ph" ShouldnsafercCc�ielgOliry k�xdled 6�fineNeerylMioodai ¢Ih¢renf,mri¢cwllMddlvaud ioamdsrc�x7Anapolq <br />nsiwu <br />AUTHORIZED REPRESENTATIVE: <br />DATB ISSUFA, I?Dtlll by Brig Mamles <br />