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EVANS"CON INSURANCE COMPANY <br />CERTIFICATE NO.: 2016-04 <br />CERTIFICATE OF INSURANCE <br />SPECIAL. EVENT LIABILITY PROGRAM <br />PRODUCER. <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Instnance Services, Inc. in conjunction with <br />City of'Snnta Ann <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 />Kevin Dalrymple -- <br />TYPE: ,ludo <br />5.547 San Juan Drive <br />DATE(S): 01/01/16—12/31/16 <br />Orange, CA 92869 <br />LOCATION: Southwest Senior Center <br />*Liquor Liability Yes ❑ No <br />"Liquor Liability 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) unICSS <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, OL+NFRAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE. NONF <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />SPECIAL CONDI'l IONS: <br />Personal & Advertising hrjury 1,000,000 <br />The tolowing endorsements attached to <br />Faeh OeCURCaeC Limit 1,000.000 <br />the Master Policy de not apply nothis <br />Dumugc'fo Premises Rented'fo You (Any One Premiscs) 100,000 <br />C'ortiticale Of lnstn ince. <br />Medical Payments (Any One Flown) 5,000 <br />Liquor Liability (Irpurehased) 1,00rt,000 <br />° <br />�.i <br />Optional Limits Purchased <br />7 <br />�2,a o 00052,000,000 <br />El <br />Damage To Property (if purchased) <br />c <br />a$ <br />'fhe limits of insurance apply separately to each event insured by this policy as if a separate policy imnce e rep r that event. <br />OTHER ADDITIONAL INSUREDS Q <br />CANCELLATION. ATION Should the above described policy be cancelled before ate expiration date thereof, notice will be delivered in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: December IS 2015 by Biiza Mot -ales <br />