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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO,: 635907136500162265 <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 />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Salamon Rivera <br />TYPE: Dance (Various) <br />709 S Parton St. <br />DATE(S): 02124/2016-1212612016 <br />Santa Ana, CA 92701 <br />LOCATION: Southwest Senior Canter <br />*Liquor Liability Yes No(j) <br />**Liquor Liabiliafter 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: $EP41020 <br />MASTER POLICY DATES: EFFECTIVE: January01, 2016 EXPIRATION: January 01, 2017 <br />COY&MRCIAL GENERAL LIABILITY &rural <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />A$grogute 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 or <br />Each Occurrence Limit L0001000 <br />the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 100,000 <br />Certificate O£Inamorace: <br />Medical Payments (Any One Person) 3,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased( <br />I <br />❑ S1,000,0003,000,000 <br />❑ $2,000,000/$2,000,000 <br />Property Damage (If purchased) <br />No Property Damage Coverage <br />Ua5 <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of in -aP19 osued:for' th d event, <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATIONShould the above described policy be cancelled before the expiration dale thereof, notice will be delivered inaccordance with the policy <br />rovisions. <br />AUTHORIZED REPRESENTATIV.C: <br />DATE ISSUED: 02/1012016 <br />