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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012-03 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRARf PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City Of Santa Ana Apex Insurance Services 20 Civic Center Plaza P. O. Box 6450 Newport Beach, CA 92658 Santa Ana CA 92701 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Flor Hernandez TYPE: Aerobics 13100 Chapman Ave., Apt. 3-108 DATE(S): 01/03/12 — 12/31/12 Garden Grove, CA 92940 LOCATION: Jerome Center, Loean Center *Liquor Liability Yes Q No **Li uor Liability after 12 am ends before 2 am 0 This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUtNIBER: 12SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 COMMERCIAL GENERAL LL4BILUUY OCCURRF_NCE FORM DEDUCTIBLE: NONL. General Aggregate Limit $ 2.000,000 Products 8 Completed Operations 1,000,0oo Personal Advertising Injury 1,000.000 Each Occurrence Limit 1,000,000 Fire l>—ge (Any One Fir.) 100,000 Medical Payments (Any One Person) 5.000 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased 0 51,000,000/S3,000,000 0 $2,000,000/$2,000,000 The limits of insurance apply se stately w each event insured by this olicv xts if a sc aratc. policy of insurance has been tssuod for that event. "Who is insured" is amended to include, as an insured, the person or organization shown in [his schedule, but only with respect to liability arising out ofthe ownership, maintenance or use ofthe premises used by the named insured (event holder). This insurance does not apply to. Any "occurrence" which takes place alter the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELi_A T] )NV Should the above d -scribed policy be cancelled before the expiration date thereof. notice will be delivered in accordance with the policy rovisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 12/20/11 by Briza Morales