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N- 2007 - 031 -OS <br />EVANSTON INSURAZVCE COMPANY <br />CERTIFICATE NO_. 2012 -19 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />A1liant 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 />� <br />Newport Beach, CA 92658 <br />Santa Ana, CA 92'701 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVE1�1T INFORMATION: <br />Denise Robles <br />TYPE: Aerobics <br />1664 W. Cindy Lane, Apt. D <br />DATE(S): 01/26/12 — 12!31/12 <br />Anaheim, CA 92803 <br />LOCATION: Salsado Community Center <br />�� <br />Liquor Liability Yes Q No <br />'" —[J 1 — d <br />• *Li uor Liabili after I2 am ends before 2 am Q <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 afFirmatively 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: l2SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2012 EXPIRATION: JANUARY 1, 2013 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCf�LE- NONE <br />General Aggregate Limit $ 2,000,000 <br />Products � Completed Operations 7,000,000 <br />Personal 8c Advertising Injury 1,000,000 <br />Each Occurrence Limi[ 7,000,000 <br />Fire Damage (Any Onc Fin) 100,000 <br />� j� f� jt4) �,� t_�!? f`t ty <br />l�<) 1' (`j e� ��? <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability �If pnrchased) t.000,000 <br />Optioaal Limits Purchased <br />- --- -- - -- ---,__`_ <br />- - -- -- <br />o S1,00o,000/$3,000,000 <br />3 �: � ;, � <br />-� ,; <br />© s2,000,000�2,000 000 <br />, , �:", � c � Y <br />� � � � > � -, � , <br />The limits of isur�ce apply s l to each even[ insured by this polic a9 if a s to li of insurance has been issued for that event. <br />"Who is insured" is amended to inc9ude, tLS ut insured, the person or organization shown in this schedule, but only with respect so liability arising out of the <br />ownership, main[enanoe or use of she premises used by the named insured (evrnt holder). This insurance dots not apply to: Any "occurrence^ which takes place <br />after the event holder ceases to be a trnant in that remises. <br />OTHER ADDITIONAL INSUREDS <br />Hortencis Nunez <br />CANCELLATIONS Should the above described policy be canxlled before the expiration date thereof notice wiFl be delivered in accordance with the policy <br />revisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 01!26/12 by Briza Morales <br />