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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2011 -33 <br />CERTIFICATE OF INSURANCE <br />COVERAGE EXCLUDED 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 />Fighting For Fitness, Inc. <br />TYPE: Martial Arts (non contact /instructional only) <br />15 Georgetown <br />DATE(S): June 2, 2011 — December 31. 2011 <br />Irvine, CA 92612 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes � No <br />* *Li uor Liabili 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 aiT-trmatively 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: 11SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products � Completed Operations 1,000,000 <br />Personal 8c Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) SO,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 [his polity as if a separate policy of insurance has been issued for [hat 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 of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply [o: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />AN r ATION- Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />rovisions. Ev et%rt will be made to deliver 30 da s written notice to the certi£cate holder and additional insureds listed- <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: Jun 02 2011 b Briza Morale <br />6' 1 <br />— — � '� <br />VG= <br />._aura Stitt Sh edy <br />iA �_ „�i zA nt City A torncy <br />