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EVAN' TON fNSURANCE COMPANY <br />CERTIFICATE NO.: 2012-10 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />. ........... —.-. <br />PUBLIC ENT'IT'Y (ADDITIONAL INSURED) <br />. .................. <br />Alliant Insurance Services, Inc. in conjunction with <br />City of Santa Ana <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. C. Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: CC 36861 <br />NAMED INSURED (EVKKTTi5LDER)-, <br />IN NT INFORMATION: <br />Academy of International Dance <br />TYPE: Dance <br />Attn: Sonia l.'" is <br />DATE(S)- 01/03/12 —12/31/12 <br />214 N. Broadway <br />LOCATION: Jerome Center and Salgado Center <br />Santa Ana, CA 92701 <br />*Liquor Liability Yes El No E <br />"Liquor <br />Liability after 12 am ends before 2 am <br />This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy <br />period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This <br />certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not <br />constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance <br />described herein is subject to all the terms, exclusions and conditions of such policy(ies). <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 12SEPIOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 <br />COMML-'RCIAL GENERAL LIABILI . l"Y <br />OCCURRENCE FORM <br />DED4X'TR3LE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Pcrsona0 & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 100,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />0 $1,000,000/$3,000,0,00 <br />El 52,000,000�/52,000,000 <br />The limits of insurance apply separately to each vent insured by this policy as if a separate policy of insurance has been issued for that event, <br />"Who is insured" is arnended to inctudc, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the <br />ovmership, maintenance or use of the premises used by the named insured (event holder), 11is 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 />CA-NC Fl.LADQN�, Should the above dekscHbcd policy be cancelled before the expiration date thereof notice will be Wivered in aocoTdance with the policy <br />2rovisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 01/03/12 bvBriza Morales <br />