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EVANS'r0N INSURANCE COMPANY <br />CERTIFICATE NO.: 201.7-05 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT L,IABILITV PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. in conjunction with <br />City of Santa Agra <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 FIOLDER); <br />EVENT INFORMATION: <br />Michael Zapata <br />'TYPE: Martial. Arts <br />940 W Chapman, Suite 100 <br />DATE(S): 1/01/17— 12/31/17 <br />Orange, CA 92868 <br />LOCATION: Garfield Center <br />*Liquor Liability Yes ❑ No <br />**Liquor Liability after 12 am ends before 2 am ❑ <br />'I"his 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: SEP41.023 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />(,eneral Aggregate Limit S 2,000,000 <br />Products & Completed. Operations 1,000,000 <br />SPECIAL CONDITIONS: <br />Personal & Advertising Injury 1,000,0oo <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 (Arty One Premises) 100,000 <br />Certificate Of Insurance: <br />Medical Payments (Airy One Person) 5,000 <br />Liquor Liability (cif purchased) 1,000,000 <br />Optional Limits Purchased. <br />❑ $1,000,00013,000,000 <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 event. <br />OTHER ADDITIONAL INSUREDS <br />Gerald ineValencia <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: f <br />DATE ISSUED: <br />rF�t( <br />