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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2010-024 <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 />City of Santa Ana <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. O. Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Nydia Duran <br />TYPE: Fitness Dance <br />2033 Harvard Street <br />DATE(S): June 1 — December 31 <br />Santa Ana, CA 92704 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes 0 No <br />**Liquor Liability 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: I0SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2010 EXPIRATION: JANUARY 1, 2011 <br />COMMERCIAL Ci F_NERAE_ LIABILITY <br />General Aggregate Limit S 2,000,000 <br />OC'C'URRENCE FORM <br />DRDtJCTll31.F.' NONJ <br />Products 8c Completed Operations 1,000,000 <br />Personal 6c Advertising Injury 1,000,000 <br />Each Occurrence Limit 1.000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy or insurance has been issued for that event. <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 ofthe <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />C'ANC'FL.LATION. Should the above described policy be cancelled before the expiration date thereof, the issuing company will mail 30 clays written notice to the <br />certi Beate holder and additional insureds listed. <br />AS TO FORM <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: June 1, 2010 Briza Morales City Attorney <br />