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E"VANSTON INSURANCE COMPANY <br />CERTIFICATE; NO.: 2017-35 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENTLIABILITY 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 />Karma Morales <br />TYPE: Ballet <br />9772 Santiago Blvd <br />DATE(S): 03/01/17 — 12/31/17 <br />Villa. Park, CA 92867 <br />LOCATION: Santanita Park <br />➢"°' 's ��� <br />*Liquor Liability Yes ❑ No E <br />"Liquor Liability after 12 am ends before 2 am El <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: SEP41023 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: 1ANUARY 1, 2018 <br />COMMERCIAL. GENERAL LIABILFFY <br />OCCURRENCE FORM <br />DEDCIC71BLE: NONE <br />General Aggregate Limit S 2,000,000 <br />Products & Completed Operations 1,000,000 <br />SPECIAL CONDITIONS: <br />Personal & Advertising Injury 1,000,000 <br />The following endorsements anached to <br />Fach Occurrence Limit I ,000,000 <br />the Master Policy do not appiy to this <br />Damage To Premises Rented To You (Ally One Premises) 100,000 <br />Certificate Of Insurance: <br />Medical Payment's (Any One Person) 5,000 <br />b <br />Liquor Liability (If purchased) I'mo,000 <br />Optional Limits Purchased <br />❑ $1,000,000/$3,000,000 <br />~ v0 <br />�� <br />I <br />td�� <br />❑ $2,000,000/$2,000,000 <br />Damage To Property (if purchased) <br />The limits ofinsurance apply separately to each event insured by this policy as if a separate policy o ". surance hae ri itssued for that event. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />rovisio s. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: March 1, 2017 By Stella Fajardo <br />