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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.; 2015-17 <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. 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 />Salomon Rivera <br />TYPE: Dance <br />709 S. Parton Street <br />DATE(S): February 3, 2015 — December 31, 2015 <br />Santa Ana, CA 92701 <br />LOCATION: Southwest Senior Center <br />—Rot " <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. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless <br />amended as described in Special Conditions, <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: SEP41017 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2015 EXPIRATION: JANUARY 1, 2016 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDl1C'nBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />SPECIAL CONDITIONS: <br />The following endorsements attached to <br />Each Occurrence Limit 1,000,000 <br />the Master Polley do not apply to this <br />Damage'ro Premises Rented To You (Any One Premises) 100,000 <br />Certificate Of Insurance: <br />Medical Payments (Any One Person) 3,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />® $1,000,000/53,000,000 <br />❑ $2,000,000/$2,000,000 <br />Damage To Property (if purchased) <br />'rhe limits of insurance apply separately to each event insured by this policy as its separate policy of insurance tins been issued for that event <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />reVI5lUna. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: February 3, 2015 by Briza Morales <br />