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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 634599044606591 554 <br />CERTIFICATE OF INSURANCE <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 />P. O. Box 6450 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Nancy Lopez <br />TYPE: Dance (Various) <br />911 S. GoldenweSt Ave. <br />DATE(S): 01/07/2012 - 12/22/2012 <br />Santa Ana, CA 92704 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes 0 No <br />—Liquor Liability after 12 am ends before 2 am Q <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 12SER1000001 <br />MASTER POLICY DATES: EFFECTIVE: January 01, 2012 EXPIRATION: January 01, 2013 <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 & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <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 this policy as if a separate policy of insurance has been issued for that 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 ofthe premises used by the named insured (event holder). This 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 />Lwra <br />.h.ssistant (,tty t orncy <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 12/19/2011 <br />