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EVANSTON INSLTR ANCE COMPANY CERTIFICATE NO.: 2008-15 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) City of Santa Ana Alliant Insurance Services, Inc. in conjtmction with 20 Civic Center Plaza, M-28 Apex Instuance Services Santa Ana, CA 92701 P. O. Bax 6450 9 f~ ry ~~ c/~ Newport Beach, CA 92658 N _ ~ u l,' I ~ ~V (949)660-8135 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Marlene L. Shaw TYPE: Dance 14446 Pimlico Road DATE(S): Mav 1 2008 -December 31. 2008 Westminster, CA 92683 LOCATION: Salirado Center *Liquoz Liability Yes ^ No **Li uor Liabili after 12 amends before 2 am ^ This is to certify that the policies of inslrrance 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 certificate tray be issued or may pertain, the instuance afforded by the policies described herein is subj ect to all the terms, exclusions and conditions of such policies. Limizs shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEP1000001-4 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2008 EXPIRATION: JANUARY 1, 2009 COMMERCIAL GENERAL LIABQ.ITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $ 2,000,000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence limit 1,000,000 Fire Damagc (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000,000 The limits of insurance apply separately w each event insured by [his policy as if a sepetatcpolicy ofinsurance has been issued for that event. "Who is insured" is amended to include, as an insured, O:e person or organira[lon shown in this schedule, but on}y with respect to liability arising out of the ownership. maintenance or use of tlx premises used by the named insured (even[ holder). This insurmroe deer not apply to: Any "occurtrnce" which mkes place after the event hairier ceases to be a tenant in Ourt premises. OTAER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy to cancelled befarc the expinfion date thereof, [he iswing company will rnail 30 days written notice to the cerdFeate holder and additional insureds listed. ~~~ AUTHORIZED REPRESENTATIVE: DATE ISSUED: