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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012 -15 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 Newport Beach, CA 92658 Santa Ana, CA 92701 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Maria Ruiz TYPE: Preschool / Daycare 2814 Waverly Ave. DATE(S): 01/09/12 — 12/31/12 Santa Ana, CA 92705 * OCATION: Corbin Center u , _ i � Liquor Liability Yes 0 No N i_i \ * *Li uor Liabili after 12 am ends before 2 am 0 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 CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 12SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE Genera( Aggregate Limit $ 2,000,000 Products 8c Completed Operations 1,000,000 Personal 8c Advertising Injury 1,00Q000 Each occurrence Limit l,000,000 APi'IZf_3Vf -:1 /\� 'I't ") I�O�M Fire Damage (Any One Fire) 100,000 - Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased --- - - - - -- - -- - -- - - - -� $1,000,000/$3,000,000 Laurz� S.;tt Si,e�dy $2,000,000/$2,000,000 Asatsla�� City !All�rncy The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for [hat event. "Who is insured" is amended to include, as an insured, the person or organization shown in [his schedule, but only with respect to liability arising out of ilte ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply [o: Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CAN ATION� Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy rovisions. f --�- -� �� c! AUTHORIZED REPRESENTATIVE: DATE ISSUED: 01/05/12 by Briza Morales