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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 20I6-24 <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 (EVENTHOLDER): <br />EVENT INFORMATION: <br />Baldwin Torres C <br />° <br />TYPE: Martial Arts <br />12692 Ranchero Way <br />DATE(S): 01/20/16—12/3I/16 <br />Garden Grove, CA 92843 <br />LOCATION: Garfield Center <br />*Liquor Liability Yes ❑ No <br />1_,**UqUor'LiabiIity 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 terns, exclLlsiolts and conditions of such policy(ies) unless <br />arnended as described in Special Conditions. <br />INSURANCE CARRIER: Evanston. Insurance Company <br />MASTER POLICY NUMBER: SEP41020 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2016 EXPIRATION: JANUARY 1, 2017 <br />COMMERCIAI, GENERAL LIABILITY OCCURRENCE: FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2„000,000 <br />Products & Completed operations i'000,000 SPECIAL CONDITIONS: <br />Personal $t Advertising Injury 1,000,000 The following endorsements attached to <br />Each Occurrence Limit 1,000,,009 the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any one premises) 100,000 CertllltatC Of h1suraulce. <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) I,000,000 <br />OptionQa+l Lryimitts� Puntt-c0hjyase/�Q(l�0 <br />W <br />(1 $2,OOO,00062,000,000 <br />Damage To Property (If purchased) / <br />The lnnatS of in3urance apply separately to each event insured by this policy as if a separate po of insurauroce s ed for that event. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above, described policy be cancelled bellore the expiration date thereof, notice will be delivered in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 20, 2016 by Briza Morales <br />