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EVANSTON INSURANCE C O /IPANY <br />CERTIFICATE NO.: 2016-27 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Service,,;, Inc. in conJunction with <br />City of Santa Ana <br />Apex Insurance Services <br />20Civic Center Plaza <br />P. 0, Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 3686I <br />NAMED INSURED (EVENT EOLDEFt): <br />EVENT INFORMATION: <br />Santiago Bautista <br />TYPE: Martial Arts <br />1523 W. Sixth Street . ;�. . <br />� � '� � <br />DATE(S): 08/23/16 — 12/31/1.6 <br />LOCATION: PI Salvador & Salgado Center <br />Santa Ana, CA 92703 C <br />Memorial, <br />*Liquor Liability Yes ❑ No Z <br />"Liquor LiabilitX after l2 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 ail the terms, exclusions and conditions of such policy(ies) unless <br />amended as described in Special Conditions. <br />INSURANCE CARRIER: Evanston Insurance Company <br />INIASTER POLICY NUMBER: SEP41020 <br />INIASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2016 EXPIRATION: JANUARY 1, 2017 <br />CCOMMERCI,lL GENERAL LI.ABRATY OCCURRENCE F( RNI [DEDUCTIBLE: NON[ <br />General AgIregate Limit S 2,000,000 <br />�„, <br />Products & Completed Operations 1,000,000 ed SPECtr\9:. CONDITIONS: <br />i� <br />Personal & Advertisin."Injury 1,0 lj, i The rollowirhg endorsernens attached to <br />Each 0K,xaTre;nce Limit 1,0 . 00 the iMaster Policy do not apply to this <br />Damage To Premises Renard To 4'ou (Any One Prenlises) 100,000 Certificate 01'Insurance: <br />Medical Paynents (Any One Person) 5,0 <br />Liquor Liability (If purchased)ni ou <br />Optional Lunits Purchased }~ " <br />P❑1 S1,000,000/53,000,000 <br />❑ $2,000,000/$2,000,000 PGC S ta <br />�cs//j <br />Damage To Property (If purchased) <br />ec eat'Ofl <br />H1C l rnllts of insurance apply separately to CaCh event inStired by this policy is if a separate policy orinsurance has been ➢ssued lot, that event. <br />OTHER ADDITIONAL INSUREDS <br />Justin Unsworth <br />Pete Nlangosing <br />Jesus Bautista <br />Nlario Rivera <br />Jose Lopez <br />CLVvjCF-[.LAT ION: Should did above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the pokey <br />provisions. <br />AUTHORIZED IU?RESENTATIVE: <br />DATE ISSUED: Aulrust 23, 2016_by_BrizaMorales,__ -- <br />