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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2013-12 <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 />20 Civic Center Plaza <br />P. O. 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 />Academy of International Dance <br />TYPE: Dance <br />Attn: Sonia Miskulin <br />DATE(S): 01/08/13 –12/31/13 <br />214 N. Broadway <br />LOCATION: Jerome and Salgado Centers <br />Santa Ana, CA 92701 <br />*Liquor Liability Yes 0 No N <br />**Liquor Liability after 12 am ends before 2 am ED <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: SEP41011 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2013 EXPIRATION: JANUARY 1, 2014 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTBLE: 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) 100,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />E] $1,000,000/$3,000,000 <br />0 $2,000,000/$2,000,000 <br />The limits of insurance apply separately to each event insured by this policy as ifa 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 of the 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 />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy <br />rovisions. <br />AUTHORIZED REPRESENTATIVE: <br />AP/yP—�R,O <br />DATE ISSUED: January 8 2013 by Briza Morales <br />LIS sTcn" <br />Assistant City Attorney <br />�r <br />