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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 634617167686074954 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. in conjunction with <br />Clty of Santa Ana <br />Apex Insurance Services <br />P. o. sox 64s0 N- 2011 -161 <br />Newport Beach, CA 926s8 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Sandra Ramirez <br />T'ypE: Dance (Various) <br />7877 San Rafael Drive <br />DATE(S): 0'1/09/20'12 - 09/28/20'12 <br />Buena Park, CA 90620 <br />LOCATION: EI Salvador Center <br />*Liquor Liability Yes � No Q <br />* *Li uor Liabili after 12 am ends before 2 am Q <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: '12SEP'100000'I <br />MASTER POLICY DATES: EFFECTIVE: January 01, 20'12 EXPIRATION: January 01, 20'13 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTffiLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products 8c Completed Operations 1,000,000 <br />Personal 8c Advertising Injury 1,000,000 <br />Each Occurrence Limit ],000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <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 [he <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUI2'�p$'] {(� V j;'1, AS TO F'OFZM <br />Jackie Campos <br />–_ — <br />�!'�� <br />t�ra sett sl edy <br />„�,tz; nt City ttonicy <br />CANCELLATION Should the above described policy be cancelled before the expiration date thereof, the issuing company wil I mail 30 days written notice to the <br />certiFcate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: �� � c� <br />DATE ISSUED: 0'1/09/20"12 <br />