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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2011-10 CERTIFICATE OF INSURANCE COVERAGE EXCLUDED FOR NOMINEE EVENTS SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with Citv of Santa Ana Apex Insurance Services 20 Civic Center Plaza P. O. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Flor Hernandez TYPE: Aerobics 13100 Chapman Ave., Apt. 3-108 DATE(S): 01/19/11 — 12/31/11 Carden Grove, CA 92840 LOCATION: Jerome, Loean, Santa Ana Centers _ *Liquor Liability Yes 0 No **Liquor Liability after 12 am ends before 2 am E 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(ics). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 11SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 ('OMNIFRC'IAL Cil?NFRAL LIABILITY OC'C'URRENC'E FORM DF.DI1("I'II31 F: NONF General Aggregate Limit S 2,000,000 Products & Completed Operations 1,000,000 Personal & Advenismg Injury 1,000,000 I ach Occurrence Limit 1,000,00) 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,fa separate policy of insurance has been issued for that event. "who is insured" is amended to include, as an insured, the person or orgam—ion shown in this schedule, but only with respect to liability arising out ofthe 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 alter the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. Every effort will be made to deliver 30 clays written notice to the certificate holder and additional msured(s) listed. �f AUTHORIZED REPRESENTATIVE: DATE ISSUED: