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EVANSTC)N INSURANCE COMPANY <br />CERTIFICATE NO.; 2013.36 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />�xl w A v 1 I -! # (n - o f3 p, <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Inn uran" Services, Inc. in conjunction with s <br />City of Santa Ana <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P. 0, Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION; <br />Somalia Ryan <br />"TYPE: Uetilth & Fitness (Non Sport) <br />16292 Engle Lane <br />DATE(S); 5/13/13 ®12/31/13 <br />Huntington Reach, CA 92649 <br />LOCATION, Sopjltweat ior Sen Center <br />*Licitlor Liability Yea ❑ NO <br />**Liquor Liability after 12 am ends before 2 not ❑ <br />This is to certify that the insuranoa policy listed below has been issued 'to the above Insured named (event holder) for the policy <br />period indicated, This eertifioatc 13 Issued as a matter of information only and confers no rights upon the certificate holder. This <br />oert9fteots does not affirmatively or negatively amend, extend or triter 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(les). <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: SEP41011 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2013 EXPIRATION: JANUARY I, 2014 <br />COMMERCIAL ABNDRAL IJABUT'Y <br />OWURRENC1: FORM <br />DEDUCTIBLE: NONE <br />Qenand Apgragate Limit $ 2,000,000 <br />Vrodoetz &. Completed Operations 1,04)0,090 <br />Flliepul 6% Advxltising Injury 1,900,090 <br />Each Oaeurranea Lhnh 1,000,000 <br />Fire Mimosa (Ally Ona Fire) 140,000 <br />Mledicol Ilaymants(Any One Vernon) 5,000 <br />Liquor Liability (If Purchased) 40,004 <br />pt into Limits Purehased <br />$1,000,000/53,000,000 <br />$2 000 000/$2,000 000 <br />Thal nntlts of limun m apply aepai ataly to cacti evem Inured by this pulley as rra separate policy or Insunonca has been imp, n] for that event, <br />"Who {a 'nitai'ad" Ifl amended to 11roadc, a0 till insured, the punion or organhartlon shown In this Schedule, but only with te.5pect to liability arising out orthe <br />ownership, InAlid l a1144 or Use o'F111e premi*0a abed by the ranned insia'M (event holder). This Insurance dw3 not apply to: Any `occurrence " Which lakes place <br />atlas the event holder ceases to he tenunt in that premises, <br />OTHER ADDITIONAL INSUREDS <br />CANCFI I ATIf7N Should the above deaaribad policy be cancelled beroie the expiration date d?ercor, notice will be delivered in accordance with the policy <br />aroviaions. <br />AUTHOWED RE?RBSENTA'I"IVC: <br />BATE ISSUED: Nlav 13, 2013 by Briza MoriijQ <br />