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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 200740 <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 (ADDMONAL INSURED) <br />City of Santa Ana <br />Alliant Insurance Services, Inc. in conjunction with <br />20 Civic Center Plaza, M-28 <br />Apex insurance Services <br />Santa Ana, CA 92701 <br />P_ O. Box 6450 <br />Newport Beach, CA 92658 <br />(949) 660-8163 <br />Linens No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Rodolfo R. Sehuatae <br />TYPE: Karate Class <br />DATE(S): 01119/07-1251107 <br />2424 w. First street #133 <br />LOCATION: Santa Anita Park <br />Santa Ana, CA 92703 <br />**Liquor Liabi]i after 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 />eesti5cah may be issued or may pertain, the insurance afforded by the policies d=ribed herein is subject to all the terms, <br />'exchlsions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEPI000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2007 EXPIRATION: JANUARY 1, 2008 <br />COMMFRCiALGENERAL LIABILITY <br />OCCJRRENCEFORM <br />DEDUCTIBLE: NONE <br />General d81;c6W boat $ 2,000.000 <br />Premrets & Completed Operations I.t�� <br />Personal & Advabstag Injury <br />1.000,000 <br />Each Occurrence Limit <br />Foe Damage (Any One Fire) 50,000 <br />Medical Paymmte(Any One Person) 5,000 <br />7bs limits olmauamce apply separately to each event insured by this policy u if a =Wwc POlicy of irwrmtea has been issued for Out event. <br />"who is irutued" is avtended to include, as an insured, the person or otganimtion shown in this schedule, but only with respect to liability arising out of the <br />ownetbip, ttt®hnan,, m use of the premises used by the named insured (event holder} 'Kris haurunee does not apply to: Any `occurrence- which takes place <br />after ft went holder eesses to be a taunt in that premises. <br />. <br />OTSER ADDITFONAL INSUREDS <br />C6UCEt t & 1TONL Should the above described policy to cancelled before the expiration date tlweof, the issuing company will nail 30 days writmn notice to the <br />certificate holds an4 additional insureds listed <br />AUTHORIZED REPRESENTATIVE: — <br />DATE ISSUED: JamiaT 29.2007 ` ' <br />Generated by Rick Management Division by: Z2�4� } yd`s <br />(110 <br />