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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF I"ISURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEP ARA TE APPLICATIONS FOR ""OMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br /> City of Santa ADa <br />Driver Alliant Insurance St::rvices in conJunction with 20 Civic Center Plaza~ M-28 <br />Apex [nsurance Services Santa Ana, CA 92701 <br />P. O. Box 28321 <br />Santa Ana, CA 92799-8323 <br />(949) 661J.-8163 <br />License No; DC 36861 <br />NAMED INSURED (EVENT HOLDER): EVE:>!T JHOR MA TION: <br />Angela Pineda TYPE: Aerobics - <br />4122 West Kemp Avenue tJ- ~OD5- 005 DATE(S): Anrill - December 31. 2(106 <br />Santa Ana, CA 92703 IV- oaOOS-09'6"-O/ LOCATION: Sal Gado Center <br />This is 10 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. terms or ~onditions of any contrac~ or other document Vlith respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the polic~es described herein is subject to aU 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 04SEP100000I <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2006 EXPIRATION: JANUARY 1,2007 <br />COMMERCIAL GENERAl. UABILlTY OCCURRENCE FORM DEDUCTIBLE; ND~E <br />Genml Aggre~(e Llmit $ 2,000,000 <br />?roducls &. Compleled Operations 1,000,000 <br />Personal &. Ad....enising Injury 1,000,000 <br />Each Occ\luence limil r ,{IOO,OOO <br />FiR Damage (Any One fire) 50,000 <br />Medica~ Paymems (Any Om: Person} 5,000 <br />The limits ofinsuraJ'.ce apply separately 10 eacn event insured by this policy as if a separate policy ofinsurarlC"e has been iSSued for that event. <br />"Who is insured" is amended [0 include, as an insured, the PersOll or organi1:lluon shown in this sc!ledule, but on!}' with respe~t to li,bility arising: OUI of(ne <br />OW[lcrshilJ. maintcnar.ce or llse oflhe pr~mi&es used by the named in~urc;d (~cnt ho:der). This il'l$U1"ll.ftcc docs 1'101 "Pp1y to' Any "1le:cuTTcnee" which takes place <br />aOer the event hoJder ceases tc be a tenant ill that premises <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLA nON: Should the: above describL'..d po:~cy to cancelled before the expiration date thereof. tbe i5suing company will mail 30 diys wrillen notice to the <br />certificaLeholder and adJitional insurcds listed, <br /> <br />~~~ <br /> <br />AUTHORlZED REPRESENTA TIVE: <br /> <br />DATE ISSUED- March 31 2006 <br /> <br />Y~/,i <br />/-./'-~-c.;7 <br />' - : " - - ~ ' <br />