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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.. 2014-12 <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. 0. 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 />Gracila Hernandez <br />TYPE: Sewing <br />280 W. Carriage Drive, #D <br />DATE(S): 01/06/14-12/31/14 <br />Santa Ana, CA 92707 <br />LOCATION: Southwest t15 Center <br />,i <br />*Liquor Liability Yes❑ No <br />"Liquor Liability after 12 am ends before 2 am El <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 andcertificate holder, The insurance <br />described herein is subject to all the terms, exclusions and conditions of suchpolicy(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 />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products &.Completed Operations 1,000,D00. <br />Personal& Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,900 <br />Dice Damage .(Any One .Fire) 100;000 <br />Medical payments (Any One Person) 51000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />❑ $1,000,000/53,000,000 <br />El $2,000,0002,000,000 <br />Property Damage (If purchased) <br />Q Limit $50,000 Deductible $500 <br />❑ Limit $100,000Deductible $1,000 <br />The limits or 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,. asan insured,the.person or, organization shown in this schedule, but only with respect to liability arising outofthe <br />ownership; maintenance or use of the premises used by the named insured (event holder). This Insurance does not apply to: Any "occurnence" which takes 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 expiration date thereof, notice will be delivcred in accordance with the. policy ! <br />rovisions, <br />A, <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: β€” January 6, 2014 by Briza Morales <br />