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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 201145 <br />CERTIFICATE OF INSCIti <br />COVERAGE EXCLhT1EG FOR NOMINEE EVENTS SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS, <br />SPECIAL EVENT LLIBR,IT Y PROGRAM <br />"F'A"'"'°"°"'°O <br />P, 0. Box Wo <br />20 Civic Center Pan <br />NawportReach, CA9208 <br />Santa Ami CA 92701 <br />LiccoseNo:OC36861 <br />I,W9,W1 <br />NAMED INSURED(EVENTROLDERp, <br />EVENTNFORMATION: <br />J4410 Debra <br />TYPE Zomba <br />110TaugeloStreat <br />DATE(S)' MIOLII-11101 <br />hioa,YC1A 92618 <br />LOCATION, Center <br />I <br />N�a�j``�1�3`�G� <br />rLiquorLiabOiry Yes 1'oZl <br />This B tocertify $9 the hisemoe policy listed below has been usued lo above insured named (event joiner) fork polity <br />puiodindicatd. This cemflcaro islssttd as amathrof ir<ottnaoen0olyEd eonfeano nits upon! e:ca dflate holder. This <br />catifiate does not affirmatively or negatively amend, extend "t the coverege afforded by dre policy listed end it does not <br />constitute acanad"Mark institute oerria, and raprzsemative, producer and certlfioate holder The insurance <br />described herrin is Subject to all $a armst excl'siores and conditions of such porityi i4), <br />U I SEPI000001 <br />EFFECTIVd:JANUARY 1,2011 EXPIRATIWJANUARY 1,2o12 <br />fromJ,lpgeQllLimu <br />TZWp� <br />u.eunnrmaeU <br />DEDUCTIBLE: Non <br />Pmdaa&CompinaiCm¢h'mf <br />I,W9,W1 <br />kw-d&m4r.1mBDIW <br />I,OW,W1 <br />ExhO.=0mLmil <br />i,W1ide0 <br />FimDv4(Any0mFne) <br />500 <br />Wdkmrmlaey02Pmw.) <br />m <br />Liquor (Rpurebarod) <br />IOW,OW <br />"Woois'mroad"i�¢mcAMmaslu¢S ssm;s�y'4peens;no�gan®ioo9wua aUti:s<u!J¢, hiorWw,OfatW li¢Eilirycvmgoulofthe <br />ercsrsai7,m¢ukwc¢awoaftropa:iwNinswrdauv�(ermtholkrb lti iaraxotloanap}irw: Arsy'naummlirxCkapl¢n <br />AUTHORIZED REPRESENTATIVE, �� ^tw <br />' <br />DATE ISSUED._pecembar222010 by'BnaMorair <br />