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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO_: 2010 -014 <br />� - �O o 7 -O3 i -C�3 <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. in conjunction with <br />Clty of Santa Ana <br />Apez Insurance Services <br />20 Civic Center Plaza <br />P. O. Box G450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 368G1 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Denise Robles <br />TYPE: Aerobics <br />10672 Claussen Street <br />DATE(S): February 2010 — December 2010 <br />Garden Grove, CA 92840 <br />LOCATION: Salado Center <br />•Liquor Liability Yes Q No <br />•�Li uor Liabilit after 12 am ends before 2 am Q <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: 1 OSEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2010 EXPIRATION: JANUARY 1, 201 I <br />C'OMMERCIA I_ GENERAL LIAL3ILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />Generel Aggregntc Limit E 2,000,000 <br />Products 8e Completed Operations 1.000,000 <br />Personal � Advertising Injury 1,000,000 <br />L-ach Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) SO,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (lf purchased) 1.000.000 <br />The limits of irnuraneo apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. <br />"Who i5 insured" is amrnded to include, as an insured, the person or organi]alion shown in this schedule, but only ,vith respect to liability arising oui of the <br />ownership, maintenance or use ofthe premises used by the named insured (event holder). This insurance does rtot apply to: Any "occurrence" which lakes place <br />after the event holder erases 10 be a tenant in that premises - <br />OTHER ADDITIONAL INSUREDS <br />Hortencia Nunez <br />LANCE ATION- Should the above described policy be cancelled Ix fore the expiration date thereof, the issuing company will mail 30 days a.rinen notice to the <br />certificate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: �� � �'C <br />DATE ISSUED: February 8. 2010 BriTa Morales <br />