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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2018-33 <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 />Apex Insurance Services <br />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Theresa Robertson - <br />TYPE: Dance <br />16889 Nichols Street #D <br />N-2018-142 <br />DATE(S): _.02/05/18-12/31/18 <br />Huntington Beach, CA 92647 <br />LOCATION: Southwest Senior Center <br />*Liquor Liability Yes ❑ No <br />"Liquor Liabilit after 12 am ends before 2 am El <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: SEP41026 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2018 EXPIRATION: JANUARY 1, 2019 <br />COMMERCIAL GENEIL\L LIABILITY <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 Limit 1,000,000 <br />Damage To Premises Retired 'to You (Any One Premises) 100,000 <br />the Master Policy do not apply to this <br />Certificate Of Insurance <br />Medical Payments Any One Person) 5,000 <br />MEGL643 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />1:1 $1,000,0001$3,000,000 <br />❑ $2,000,000152,000,000 <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 fo f *6111. <br />OTHER ADDITIONAL INSUREDS .Sj <br />Kimberly Pugh <br />Gue�a 01 <br />G <br />NS <br />CANCELLATIOShould the above described policy be cancelled Were the expiration date thereof, notice be deli a r!^i o dance with the policy <br />provisions. r <br />l <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 5. 2017 by Stella Faiardo- REVISED 6/(3/18 <br />