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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2016-12 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />ACliant 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 Ann, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Michael Zapata <br />TYPE: Martial Arts <br />208 W. Willcen Way <br />DATE(S): 01/01/16-12/31/16 <br />Anaheim, CA 92802 <br />LOCATION: Santa Anita and Garfield Centers <br />*Liquor Liability Yes ❑ No N <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) unless <br />amended as described in Special Conditions. <br />INSURANCE CARRIER: Evanston insurance Company <br />MASTER POLICY NUNIBER; SEP41020 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 20t6 EXPIRATION: JANUARY 1, 2017 <br />COMMERCIAL CENERAL LLABILrfY <br />OCCURREN'CBFORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1.,000,000 <br />SPECIAL, CONDITIONS: <br />Personal & Advertising Injury 1,000,000 <br />The following endorsements attached to <br />Each Occurrence Limit 1,000,000 <br />the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 10o,000 <br />Certificate Of Insurance: <br />Medical Payments (Any One Person) 5,00D <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />$1,000,000/$3,000,000 <br />❑ $2,000,000/$2,000,000 <br />Damage To Property (If purchased) <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of Insurance has been issued for that evon <br />OTHER ADDITIONAL INSUREDS <br />Geraldine Valencia <br />Flor Hernandez <br />CANCELLAT[OM Should the above described be cancelled before the expiration date thereof, Ir" in <br />policy notice will elfvarad vr✓Ith the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: December 22, 2015 by Prize Morales <br />