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EVANSTON INSMANCE COMPANY <br />CERTIFICATE NO.: 2009-07 <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOl01IFTE , EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL. EVENT LIABILITY PROGRAM <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED:—_January 12.2009 f •. <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />City of Santa Ana <br />Alliant Insurance Services, Iac. in conjunction with <br />1(949)660-8135 <br />20 Civic Center Plaza <br />Apex Insurance Services <br />Santa Ana, CA 92701 <br />P. 0. Box 6450 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT WPORMATION: <br />Sonia 14 i*Win <br />TYPE: Ballet <br />AcadetrofInternational Dance <br />DATE(S): Jan. 12 -Dec. 31 <br />220 E. 4' Street, Ste 202 <br />LOCATION: Salgado Ggnter <br />Santa Ana,'CA 92701 <br />"Ligttar Liability Yes ❑ No ❑ <br />"Liquor Liability after 12 sue ends before 2 em <br />This is to certify that the policies of insurance listed below pave been issued to the insured owned 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 Perot* the insurance afforded by the policies described herein is subject to all the tetn s, <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: 04SEP1000001-5 <br />MASTER POLICY DATES, EFFECTIVE: JANUARY 1, 2009 EXPIRATION: JANUARY 1, 2010 <br />COMMERCIAL GENERAL LIABILOY <br />General Aggregate Limit $2,000,000 <br />OCCURRENCEFORM <br />DEDUCTMLE: NONE <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury IAW,000 <br />Each Occurrence Limit 1,000,000 <br />OV <br />D AS TO FO <br />Fir Damage (Any One Fire) 50,000 <br />Medial Paymauts(Any One Person) 5.000 <br />Liquor Liability (If purchased) 11000.000 <br />OSEPH <br />W. F ETCHER <br />The Omits ofinsiannce apply seWratelY beach mat insured by this policy ere ifaa atepot that -int <br />licyofirumraoce <br />"Whoa inured"ie amended to include, wan insured, the person ororganiutien O&Z in 9tis sebedule, bu 'th respect to EWN1y.wi8ing out ofthe <br />ownership, mairaonance or use of the premises uxd by the romed insured (event holder). 'lois insurance does not apply to: Any "0e0urrence" which talxs place <br />ceder the event holder oases to be a tenant in that promises. ' <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should Me shove described policym cancelled betbre tM eepireaon date thereof, the issutalccwapanywill mail 30 days written notice to the <br />certificate holder and additional insureds limed <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED:—_January 12.2009 f •. <br />