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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2013 -30 <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 />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />* *Liquor Liability after 12 am ends before 2 am ❑ <br />License No: OC 36861 <br />period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Rodolfo Sehuame <br />TYPE: Bu- Jvutsu (Martial Art1 <br />1000 Pine Avenue, Apt. 120 <br />DATE(S): April 16, 2013 — December 31, 2013 <br />Redlands, CA 92373 / ,(l_oe 00 0//11 <br />V <br />LOCATION: Santa Anita Center <br />*Liquor Liability Yes ❑ No <br />* *Liquor Liability 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 affirmatively 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: SEP41011 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2013 EXPIRATION: JANUARY 1, 2014 <br />COMMERCIAL GENERAL LIABILFFY <br />OCCURRENCEFORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Aire Damage (Any One Fire) 100,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />❑ $1,000,000/$3,000,000 <br />❑ $2,000,000/$2,000,000 <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 the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any `occurrence" which hakes place <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy be cancelled before the expiation date thereof, notice will be delivered in accordance with the policy <br />provisions, <br />/ C -- <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: April 16, 2013 by Briza Morales <br />