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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 636213739645871736 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL. INSURED) <br />Alliant Insurance Services, Inc. in conjunction with <br />City of Santa Arta <br />Apex Insurance Services <br />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />- — — —- --- — <br />--- --- -- ------- -- -- — - — -- -- .. . ........... . <br />Lfccnse No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Alvin W Tsang <br />TYPE: Meetings (Inside) <br />8000 4th St. Avenue #321 <br />DATE(S): 02/25/2017 <br />Brooklyn, IVY 11209 <br />LOCATION: Santa Ana Public Library <br />*Liquor Liability Yes No(D <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 NUMBER: SEP41023 <br />MASTER POLICY DATES: EFFECTIVE: January 01, 2017 EXPIRATION: January 01, 2018 <br />COMMERCIAL GENERAL LIABILITY General <br />OCCURRENCE FORM <br />DEDUCURLE: NONE <br />Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,0w <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) 100,000 <br />Certificate Of Insurance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />❑ $1,000,0001$3,000,000 <br />❑ $2,000,000/$2,000,000V <br />.� <br />Property Damage (If purchased) <br />No Property Damage Coveragerj <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has be th ch . <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />rov isions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 01/30/2017 <br />