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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2014 -05 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Allfant 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 No: 42658 <br />License No: OC 36861 f lr -- <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Manual Ortega <br />TYPE: Music <br />5108 W. First Street, #C <br />DATE(S): 01/01/14 - 12/31/14 <br />Santa Ana, CA 92703 <br />LOCATION: Santa Ana Police Athletic & Asedylty <br />League (SAPAAL'1 <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. 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 />OCCURRENCEFORM <br />DEDUCTIBLE; NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury I,000,000 <br />Each Occurrence Limit 1,000,000 <br />Elm Damage (Any One Fire) 100,000 <br />Medical Paymcnnts(Any One Person) 5,000 <br />PROVED A <br />S TO FORM <br />Liquor Liability (If purchased) 11000,000 <br />Optional Limits Purchased <br />n <br />1� •. <br />(� <br />❑ $1,000,0001$3,000,000 <br />❑ $2,000,00052,000,000 <br />Lama A. <br />Rossini <br />Property Damage (If purchased) <br />Assistant Citi <br />Attorney <br />❑ Limit $50,000 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 a separate policy of ansumnce has been issued for that event. <br />"Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out ofthe <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to; Any "ocourrenec" wdilch takes place <br />after the event holder ceases to be a Conant in that preouses. <br />OTHER ADDITIONAL INSUREDS <br />CANCEL A'rr(1N, should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />rovisinne, <br />r <br />AUTHORIZED REPRESENTATIVE; <br />DATE ISSUED: December 18.2013 by Briza Morales <br />