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EVANSTON INSURANCE COMPANY CERTIFICATE NO.; 2014-11 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Allita t Insurance Services, Inc, in conjunction with City of Santa Ana Apex Insurance Services 20 Civic Center Plaza P. O. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT BOLDER): EVENT INFORMATION: Felice Illccagla TYPE: Self Improvement 3436 S. Taurus Lane DATE(S): 01/06/14 —12/31/14 Santa Ann, CA 92704 LOCATION: Sandi! Lawn Bowline Clubhouse ! Q — *Liquor Liability Yes No o—ocl fD **Liquor Liability after 12 am ends before 2 am ❑ 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 loos not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not constitute.a contract between She insurance carrier, authorized representative, producer and certificate holder. The insurance described herein is subject to all the terms; exclusions and conditions of such policy(les). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: SEP41014 MASTER POLICY DATES; EFFECTIVE: JANUARY 1, 2014 EXPIRATION: JANUARY 1, 2015 .COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $.2;000,000 Products & Completed Operations 1;000,000 Personal :& Advertising tnjury 1,000,000 Each Occurrence Limit 1;000,000 Fire Damage (Any One Fire) 100,000 Medical Payments (Any One Parson) 5,000 Liquor Liability (Ifpurchased) 1,000,000 Optional Limits Purchased ❑ $1,000;000/53,000;000 ❑ $2,000,00052;000;000 Prop�Ierty Damage (If purchased) LJ 'Limit $50,000 Deductible $500 ❑ Limit $100,000 Deductible $1,000 The limitsof insurance apply separately to each event insured by this policy as ire separate policy of insurance hesbeen issued for that event. "Who is insured" is amended to include, men insured, the person or organization shown in this schedule, but only with respect to liability arising outof the ownership, maintenance or use ofthe premises usedby the named insured (event holder). This insurance does not apply for Any `occurrence" which takes place :atter the event holder ceases to be o tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy be cancelled before the expiration date thereof,notice will be delivered in accordance withthe policy tovisions. r�- AUTHORIZED REPRESENTATIVE; DATE ISSUED; January 6. 2014 by prize Morales