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I:b ANSTON INSURANCE COMPANY 1: it, ANSTON INSURANCE COMPANY CERTIFICATE NO.: - CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LLABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) City of Santa Ana Alliant Insurance Services, Inc. in conjunction with 20 Civic Center Plaza, M-28 Apex Insurance Services Santa Ana, CA 92701 P O. Box 6450 . Newport Beach, CA 92658 (949)660-8163 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Salomon Rivera TYPE: Dance Class 709 S. Parton St. DATE(S): San. 1, 07 - Dec. 31, 07 Santa Ana, CA 92701 LOCATION: Southwest Senior Center 'I "Liquor Liability after tam ❑ -Dills is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this vertificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEPI000OOI MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2007 EXPIRATION: JANUARY 1, 2008 I ONN111i( Al til°.NLRAL LIABILI 1 Y OCCURRENCE FORM DEDUCTIBLE NONE t t91e1'al 1Egl Crate Illlat $ 2,000,4W I'mducts & ('nrnplttcd Operations 1,000,000 I'cnonal & Advertising Injury 1,000,000 I adi Owtumic, Limit 1,000,000 I u, Damage IAny Onc hire) 50,000 Medical Pawnenu(Ally One Person) 5,000 I he hinds of mwramc apply separately to each event insured by this policy as ifa separate policy of insurance has been issued for that went. iViv, is insured' is amended to include, as an insured, the person or organization shown in this schedule, but only with expect to liability arising out of the nwmhip. inanocnauce or use of tlu, premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place :air, the o cal holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS tNCE LI.AI�N: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the rcruticate holderand additional insureds listed. /�� 7:z- \U"rHORIZIiD REPRESENTATIVE: t ,r_ )ATE ISSUED December 28 2006 lonerated liv Risk Management Division by: