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EVANSTON INSURANCE COMPANY CERTIFICATE NO.. 634511708293713203 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER � PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services P. O. Box 6450 Newport Beach, cA 926ss N -2011 -116 : License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Suzanne Ryan TYPE: Health 8 Fitness (Non Sport) 16292 Eagle Lane DATE(S): 10/04/2011 - 12/29/2011 HunYingtOn Beach, CA 92649 LOCATION: Southwest Senior Center *Liquor Liability Yes � No * *Li uor Liabili after 12 am ends before 2 am Q This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 11SEP1000001 MASTER POLICY DATES: EFFECTIVE: January 01, 2011 EXPIRATION- January 01, 2012 COMMERCIAL GENERAL LIABILIfY OCCURRENCE FORM DEDUCTIBLE: NONE - General Aggregate Limit $ 2,000,000 Products 8c Completed Operations 1,000,000 Personal � Advertising Injury 1,000,000 Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000,000 The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. "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 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 after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS f�i'�� .�_� Stitt Sheccly - CANCELLATION Should the above described policy be cancelled before the expiration date thereof, the issuing company will mail 30 days written notice [o the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 09/09/2011 ��,.�