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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2017-24 <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 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 />Baldwin Torres <br />TYPE: Martial Arts <br />12692 Ranchero Way <br />DATE(S): 01/20117-12/31/17 <br />Garden Grove, CA 92843 <br />LOCATION: Garfield Center <br />'Liquor Liability Yes ❑ No <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 1, 2017 EXPIRATION: JANUARY 1, 2018 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />Geneml 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 Ptmises) 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 />❑ $1,000,000/53,000,000 <br />❑ $2,000,000/52,000,000 <br />Damage To Property <br />by <br />(If purchased) <br />R <br />viewed <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of insumace has been issu v $ <br />SiiV12i R11C1., <br />OTHER ADDITIONAL INSUREDS-T <br />PR <br />CANCELLAIM 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 20, 2017 By Stella Fajardo <br />