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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2017-28 <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 />Mariesa N. Secnndo <br />TYPE: Danza Folklorico <br />71.43 Fullerton Way <br />DATE(S): 02/01/17 — 12/31/17 <br />Stanton, CA 90680 <br />LOCATION: Jerome Center & El Salvador <br />�„ <br />*Liquor Liability Yes ❑ No F <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(ics) 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 />COMMLRC1At, GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & C-otnpleted Operations 1,000,000 <br />SPECIAL CONDITIONS: <br />Personal &. Advertising htjury 1,000,000 <br />The following endorsements attached to <br />Fach Occurrence Limit A,C)00,C100 <br />the Masten' Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 100,000 <br />Certificatie Of Insurance: <br />Medical Payments (Any One Person) 5,00O <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />F] $1,000,00053,000,000 <br />F] $2,000 0 00/$2,000,000 <br />" <br />Damage To Property (If purchased) <br />P <br />% <br />o, <br />The limits of insurance apply separately to each event insured by this policy as ifa separate policy of insurance <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 />Covlsions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 30, 2017 by Stella Fajardo <br />