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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 6359-05284817137707 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBL.IC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. in con.iUnCtiOn With <br />City of Santa Ana <br />Apex Insurance Services <br />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />License No�, OC 36861 <br />NAMED INSURED (EVENT HOI,,,DER): <br />EVENTINFORMATION: <br />Sonia Miskulin- Academy of International Dance <br />TYPE: Ballet <br />2025 S Main St <br />DATE(S): 02/1312016 - 12/3112016 <br />Santa Ana, CA 92707 -3LO � S-- <br />LOCATION: Jerome and Salgado Centers <br />*LiqUorLiability Yeso No <br />"Liquor Liability after 12 am ends before 2 am E] <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: SEP41020 <br />MASTER POLICY DATES: EFFECTIVE: January 01, 2016 EXPIRATION: January 01, 2017 <br />COMMERCIAL GENERAL LIABILITY General <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />Aggregate Linia $2,000,000 <br />Products & Completed Operations 1,000,000 <br />SPECIAL CONDITIONS; <br />Personal & Advertising 111JUry, I ,000,000 <br />The following endorsernen ts attached to <br />Each Occurrence Linul 1,00(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 put -chased) 1,000,000 <br />Optional Limits Purchased <br />F-1 $1,000,0001$3,000,000 <br />F $2,000,00052,000,000 <br />Property Damage (if purchased) <br />No Property Damage Coverage <br />The limits of insurance apply separately to each event insured by this policy as if separate policy of insurance has been issued for that event <br />OTHER ADDITIONAL INSUREDS <br />CANCFLl.,A_FlW Should the above described policy lie cmicelled before the expiration date thereof, notTee will he delivered in accordance with the policy <br />provisions <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 02/0812016 <br />