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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.- 2014.17 <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 />License No: OC.36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Lora Wilson <br />TYPE: Dance <br />1918 E. 19`b Street <br />DATE(S): 01/08114 — 12/31/14 <br />Santa Ana, CA 92705 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes ❑ No X <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: SEP41014 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2014 EXPIRATION: JANUARY 1, 2015 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRFNCEFORM <br />DEDUCTIBLE: NONE. <br />Goneral. 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 />Eire Damage (Any One Fire) 100,000 <br />Medical .Payments ':(Any One Person) 5,000 <br />Liquor Liability (If purchased) 11000;000 <br />Optional Limits Purchased <br />❑ $1,000,000/$3,000;000 <br />❑ $2,000,000/$2,000;000 <br />Property Damage (If purchased) <br />❑ Limit $50,400 Deductible $500 <br />Limit $100,000 Deductible $1,000 <br />The limits of insurance apply separately to each event insured by this policy as if aseparme policy of insurance -hes been issued for that event <br />"Who is insured" is amended to Include, as au insured; the person ororganiution shmnni in this schedule, but only with respect to liability arising outol'the <br />ownership, maintenance or use of the premises: used by the named insured (event bolder). This insurance does not apply to: Any "occunence "which takes Phase <br />after the event holder ceases to be tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />Carmen Whitener <br />CANCELLATION: Should tare above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance withthe:policy <br />Provisions. <br />AUTHORIZED REPRESENTATIVE; <br />DATE ISSUED: January 8 2014 by Briza Morales <br />