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,#_ 000b- v z1 <br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 200740 <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. EVENT LIABILITY SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />Alliant Insurance Services, Inc. in conjunction with <br />Apex Insurance Services <br />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />(949) 660 -8163 <br />License No: OC 36861 <br />Rodolfo R. Sehuame <br />2424 w. First Street #133 <br />Santa Ana, CA 92703 <br />City of Santa Ana <br />20 Civic Center Plaza, M -28 <br />Santa Ana, CA 92701 <br />TYPE: Karate Class <br />DATE(S): 01/19/07 - 12131/07 <br />LOCATION: Santa Anita Park <br />tam <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, terms 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 04SEP 1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2007 EXPIRATION: JANUARY 1, 2008 <br />COMMERCIAL OENERAL LIABILITY <br />OCCURRENCEFORM <br />DEDUCTIBLE: NONE <br />Cmm-A Aggregate licit <br />$ 2,000,000 <br />Products & Conte Operations <br />1,0001000 <br />Personal & Advaticatg lniurY <br />1'000'000 <br />Each Occurrence Limit <br />1,0001000 <br />Fne Damage (Any One Fire) <br />50,000 <br />Medial Payments (Any One Person) <br />5,l= <br />each event <br />of insurance has been issued <br />"who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the <br />ownership, meiutenana or use of the premises used by the named insured (event holder} Ibis insurance does not apply to: Any "oc turence" which rakes place <br />be a tenant in <br />CeNCFt 1 ATION: Should ate 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 insureds listed <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: Januar 29 2007 <br />Generated by Risk Management Division by: 0 /'' <br />7- <br />