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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.. 2012 -12 <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 />City Of Santa Ana <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />Santa Ana, CA 92701 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Daniel Ramirez <br />TYPE: Dance lvariousl <br />13901 Fernwood Drive <br />DATE(S): 01/03/12 — 12/31/12 <br />Garden Grove, CA 92843 <br />LOCATION: Jerome Center <br />�d � �'"' � � 1 <br />*Liquor Liability Yes � No <br />* *Li <br />uor Liabili after 12 am ends before 2 am <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 aiiirmatively 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: 12SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />Grneral Aggregate Limit $ 2,000,000 <br />Products � Completed Operations 1,000,000 <br />Personal Bc Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />APPR <br />�]� A� ,r,� 1 "UjEZM <br />Fire Damage (Any One Fire) 100,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />_ <br />Optional Limits Purchased <br />aura Sr!t Siiecdy <br />� $1,000,000/$3,000,000 <br />As <br />istarx[ City Attorney° <br />D $2,000,000 /$2,000,000 <br />The limits of insurance apply separately to each event insured by this policy as iFa 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, bu[ only with respect to liability azising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). ibis insurance does not apply to: Any "occurrence" which [ekes place <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />Maryella Ramirez <br />Denys Diaz <br />AN r r gTION� Should the above described policy be cancelled before [he expiration date thereof, notice will be delivered in accordance with the policy <br />rovisions. <br />�� � e <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 01/03/12 by Briza Morales <br />