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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 201.6-01 <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. 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 />Blanca Arceo L . ; <br />TYPE: Z"111ba <br />2833 N. Bristol Street, Apt. 589 <br />DATE(S): 01/01/16 — 1.2/31/16 <br />Santa Ana, CA 92706 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes ❑ No ❑ <br />"Liquor I..,iability 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: SEP41.020 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2016 EXPIRATION: JANUARY 1, 2017 <br />COMMERCIAL GENERAL. LIABILITY <br />OCCURRENU FORM <br />DEDUCTIBLL NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed. Operations 1,0m,0CIt1 <br />SPECIAL.. CONDITIONS: <br />Personal rxt Advertising; Injury I„000,000 <br />The fo➢lowing endorsements attached to <br />Each Occurrence Limit 1,000,000 <br />the Master Policy do not apply to this <br />Damage "po Premises RentedTO YOU (Any Otte Premises) 100,000 <br />Certificate Of h1suraneer. <br />Medical Payments (Any One Person') 5,000} <br />Liquor Liability (If purchased) 1,000.000 <br />Optional Limits Purchased <br />� <br />❑ $1,000,000/53,000,000 <br />❑ $2,000,00052,000,000 <br />,w <br />xj ' <br />Damage To Property (If purchased) <br />.� a <br />\ <br />T, <br />S\X , <br />'Fhe limits ©r insurance apply separately to each event insured by this policy as if a separate policy or insurance has been issued Ibr that event. <br />OTHER ADDITIONAL INSUREDS <br />Silvia Salgado <br />CANCLLLATION. Should the ;Above described policy be cancelled berme the expiration date thereof, notice wvill be delivered in accordance �vit'h the policy <br />provisions. <br />AUTHORIZED REPRESFWATIVE: <br />DATE ISSUED: December 15 201.5.by Briza Morales <br />