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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2017-19 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />1PRODUCER <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. 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 />Vessica Campos <br />TYPE: Dance <br />7082 Senway Drive, Apt. 5 <br />DATE(S): 01/04/17 — 12/31/17 <br />Westminster, CA 92683 <br />LOCATION: Memorial Center <br />*Liquor Liability YesE] NoZ <br />**Lisuor Liability after 12 am ends before 2 am ❑ <br />'Phis 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: SEP41023 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCEFORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit �S 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'] o Premises Rented To You (Any One Premises) 100,000 <br />Certificate OfInsurance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (if purchased) 1,000,000 <br />Optional Limits Purchased <br />F-1 $ 1,000,000/S3,000,000 <br />F-1 $2,000,000/S2,000,000 <br />Damage To Property (if purchased) <br />,Net <br />The limits Of insurance apply separately to each event insured by this policy as ifa <br />separate policy ofjEAy�aAheq4g <br />orAjjevent. <br />OTHER ADDITIONAL IN9ffkDS CS <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: <br />DATE ISSUED: January 4, 2017 by Stella Faiardo <br />