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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2016-25 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT IAABL1.ITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Set -vices, 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 />Martin Torres <br />TYPE: Martial Arts <br />12692 Ranchero Way <br />DATE(S): 01/20/16 — 12/31/16 <br />Garden Grove, CA 92843 <br />LOCATION: Jerome Center <br />ik <br />*Liquor Liability Yes [:1 No <br />"Liquor Liability after 12 am ends before 2 am L] <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(ics) unless <br />amended as described in Special Conditions. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: SEP41020 <br />MASTF R POLICY DATES: EFFECTIVE: JANUARY 1, 2016 EXPIRATION: JANUARY 1, 2017 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM DEDUCTIBLE- NONE <br />General Aggregate Limit 2,000,000 <br />Products & Cornpleted Operations 1,000,000 <br />SPLCIAL CONDITIONS. <br />Personal & Advertising Injury 1,000,00() <br />The following endorsements attached to <br />Each Occurrence Limit 1,000.000 <br />the Master Policy do not apply to this <br />Damage To Premises Rented To YOU (Any One Premises) 100,000 <br />Certificate Of Insurance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (if purchased) 1,000.000 <br />1"6 \A <br />Optional Limits Purchased <br />F-1$1,000,00053,000,000 <br />v0\ /A <br />F1$2,000,00052,000,000 <br />Darnage To Property (if put -chased) <br />The limits 01'insurance apply separately tea each event insured by this policy as if@ separate policy of insurance hasN -issued for that event. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION Should the above described policy be cancelled before the expiration date thereof, notice Nvill be delivered in accordance with the policy <br />provisions. <br />aa, <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: — January 20�, 2016..by Briza Morales <br />