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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2017-06 <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 />Mark James <br />TYPE: Piano <br />5213 W Flight Ave. <br />DATE(S): 1/01/17-12/31/17 <br />Santa Ana, CA 92704 <br />LOCATION: El Salvador Center <br />*Liquor Liability Yes [:1 No N <br />"Liquor Liability after 12 and ends before 2 am El <br />.............. <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: SEP41023 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit S2 <br />�000:()00 <br />Products & Completed Operations 1 000000 <br />SPECIAL CONDITIONS: <br />Personal & Advertising Injury 1,000,000 <br />The following endorsements attached to <br />Each Occurrence Limit 1.000,000 <br />the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 100,000 <br />Certificate OfInsurance: <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (if purchased) 1,000,000 <br />Optional Limits Purchased <br />® $1,000,000/$3,000,000 <br />A <br />F-1 $2,000,00052,000,000 <br />Damage To Property (If purchased) <br />�ell \e',N <br />The limits ofinsuranceapply separately to each event insured by this polucy as if separate policy ofinSLIrancc hj,•04.�,V% !Rbll <br />�119PK <br />nt, <br />OTHER ADDITIONAL INSURED* -`--5\\'4 <br />LC <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will he delivered in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: —December 20, 2016 by Stella Fajardo . ............. . ...... <br />