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EVANSTON INSUR-ANCECOMPANY <br />CERTIFICATE, NO.: 2016-16 <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 />11. 0. Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT 1--IOLDER): <br />EVENT INFORMATION: <br />Debra Henninger <br />TYPE: Piloxinjl (Boxine/Youtli) <br />3490 Spectrum <br />DATE(S): 01/07/16 — 12/31/16 <br />Irvine, CA 92618 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes 0 No <br />*,*Lis,uo,r, 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 hISLIred narned (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:: SEP41020 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2016 EXPIRATION: JANUARY 1, 2017 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit S 2,000,000 <br />Products & Completed Operations 1.000,000 <br />SPECIAL CONDff]ONS:. <br />Personal & Advertising Injury 1,000,000 <br />The rollowing endorsements attached to <br />Each Occurrence Limit 1'000000 <br />the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 100,000 <br />Certificate 01'111SUrance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (if purchased) 1'000,000 <br />Optional Limits Purchased <br />❑$1,000,00053,000,000 <br />El $2,000,00052,000,000 <br />DamageTo Property (if purchased) <br />e <br />The limits of insurance apply separately to each event insured by this policy as ifa separa i '111 has been issued for that event. <br />OTHER ADDITIONKIL INS t5qW9 <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice win be delivered in accordance with the pohey <br />provisions <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 7, 2016 by Briza Morales <br />