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EVANS'TON INSURANCE COMPANY <br />CERTIFICATE NO.: 2016-21 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />1P1 ODUCER <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, 0, 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 />Maria Maddock <br />TYPE: Dance <br />3050 S. Bristol Street, Unit 613 14- <br />DATE(S): 01/07/16 — 12131/16 <br />Santa Ana, CA 92704 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes [] No Z <br />**Liquor Liability after 12 am ends before 2 amE] <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 1, 2016 EXPIRATION: JANUARY 1, 2017 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $2,000,000 <br />Products & Completed Operations 1,000,000 <br />SPECIAL CONDITIONS: <br />Personal & Advertising 111JUry 1,000,000 <br />The folloAring endorsements attached to <br />Each Occurrence Limit l,00(),000 <br />the Master Policy do not apply to this <br />DarnageTo Premises Rented To YOU (Any One Premises) t 00,000 <br />Certil-wate Of Insurance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (if purchased) 1,000,000 <br />000' <br />Optional Limits Purchased <br />❑ $1,000,0001$3,000,000 <br />❑ S2,000,00052,000,000 <br />Darnage To Property (if purchased) <br />The limits of inWrance apply separately to each event insured by this policy as if separate policy Yf 111SLIT-anCe has been issued for that event. <br />, _ ....... .... ... , ".. <br />OTHER ADDITIONAL INSUREDS <br />Luisa Flores <br />Nadine Velastegui <br />Silvia Salgado <br />Melody Gonzalez <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice "ill be delivered in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: — January,,7, 2016.by Briza Morales <br />