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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br /> City of Santa Ana <br />Driver Alliant Insurance Services in conjunction with 20 Civic Center Plaza, M-28 <br />Apex Insurance Services Santa Ana, CA 92701 <br />P. O. Box 28323 <br />Santa Ana, CA 92799-8323 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Angela Pineda TYPE: Aerobics <br />4122 West Kemp Avenue JJ- d-D05 - rA5 DATE(S): Anrill - December 31. 2006 <br />Santa Ana, CA 92703 LOCATION: Sal Gado Center <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, tenns or conditions of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEPIOOOOOl <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2006 EXPIRATION: JANUARY 1,2007 <br />COMMERCIAL GENERAL LJABILlTY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury I ,000,000 <br />Each Occurrence limit [ ,000,000 <br />Fire Damage (Any One fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />The limits of insurance apply separately (0 each event insured by this policy as if a separate policy of insurance has been issued for that event. <br />"Who is insured" is amended (0 include. as an insured, the person or organization shown in this schedule, but only with respect to liability arising oul of the <br />ownership, maintenance or use of the premises used by the: named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insu'reds listed. <br /> <br />~;Z~ <br /> <br />AUTHORlZED REPRESENTATIVE: <br /> <br />DATE ISSUED: March 31.2006 <br /> <br />3t; <br />X.'<~-<-17 <br /> <br />