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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2017-15 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />11PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. in conjunction with City of Santa Ana <br />Apex Insurance Services 20 Civic Center Plaza <br />P. 0. Box 6450 Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Jorge Higuera <br />TYPE: Self Defense <br />PO Box 10521 <br />DATE(S): 01/01/17 — 12/31/17 <br />Santa Ana, CA 92711 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes El No <br />**Liquor Liability after 12 any ends before 2 am El <br />This is to certify that the insurance policy listed below has been iSSLIed 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 (JENERAL LIAMLITY <br />OCCURRENCE FORM <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 Umi( 1'000'01}0 <br />the Master Policy do not apply to this <br />Damaoe To Premises 1tcnted'to You (Any One Promises) 100,000 <br />Certificate Of Insurance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability [,000,000 <br />(If purchased) <br />Optional Limits Purchased <br />M $1,000,00053,000,000 <br />7 $2,000,00052,000,000 <br />Damage To Property (if purchased) <br />The limits of insurance apply separately to each event insured by tbis policy as if separate policy of insurance WiRY*i'issued for that event. <br />OTHER ADDITIONAL INSUREDS <br />Kevin Le <br />Ernesto De La Torre <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: December 27, 2016 By Stella Faiardo <br />