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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.- 2012-03 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />I PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant 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 />Newport Beach, CA 92658 N-2008-139-004 <br />Santa Ana, CA 92701 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Flor Hernandez <br />TYPE: Aerobics <br />13100 Chapman Ave., Apt. 3-108 <br />DATE(S): 01/03/12 — 12/31/12 <br />Garden Grove, CA 92940 <br />LOCATION: Jerome Center,Center <br />*Liquor Liability Yes 0 No <br />`*Li uor I iabili after 12 am ends before 2 am 0 <br />This <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 />herein is subject to all the terms, exclusions and conditions of such policy(ies). <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 12SEPI000OOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1. 2013 <br />COMMLRCIAL GENF_RAL L(ABILri"Y <br />General Aggregate Limit S 2.000.000 <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE, <br />Products 8 Completed Operations I.ODO,000 <br />Personal 8c Advertising InJ ury 1.000.000 <br />CFach Occurrence Limit 1,000.000 <br />Fire Damage (Any One Fire) 100,000 <br />Medical Paymmta (Any One Person) 5.000 <br />Liquor Liability (If purchased) 1.000.000 <br />Optional Limits Purchased <br />0 S1,000,000/S3,000,000 <br />52,000,000/S2,000 000 <br />The limiu of insuntnce Iy s arnaely [o each event insured b this lieu d ife se tc olic Of iraurnnce has born issued for the[ cwmt. <br />"Who is insured" is rmetuleal to include, at an insured, the person car organtfation shown in th,s schedule, but only with respect to liability arising out of the <br />ownatship, maintenance or cave of the premtsas used by [he named —wed (event holder). This i­cu does not apply to: Any "occurrence' which takes place <br />after the event holder -cakes to be a tenant in that remises. <br />OTHER ADDITIONAL INSUREDS <br />CANCFI. lATIONShmrld the above described polity be oanaelIe d hefere the expiration date [hereof. nonce will be delivered in accordance with the policy <br />revisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 12/20/11 by Briza Morales <br />