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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2014-19 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Aliiant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services 20 Civic Center Plaza P. O. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Denise Robles TYPE: Aerobics 1664 W. Cindy Lane, Apt. D DATE(S): 01114/14 —1213 1/14 Anaheim, CA 92802 LOCATION: Salado Community Center *Liquor Liability Yes ❑ No "',201 **Liquor Liabilitafter 12 am ends before 2 am ❑ This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not constitute a contract between the insurance carrier; authorized representative, producer andcertificate holder. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(cs). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: SEP41014 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2014 EXPIRATION: JANUARY 1, 20t5 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE, NONE General Aggregate Limit $ 2,000,000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence Liant 1,000,000 Fire Damage (Any One Fire) 100,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1.000,000 Optional Limits Purchased [] $1,000,000/$3,000,000 ❑ $210001000/$210001000 Property Damage (If purchased) ❑ Limit $50,000 Deductible $500 ❑ Limit $100,000 Deductible $1,000 Tire limits or insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. "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 ownership, maintenance OF use of the promises used by the named insured (event holder). This insurance does not apply to: Any "occurrence"which tales place after the event Bolder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS Hottencia Nunez CANCELLATION: Should Che above described policy be cancelled before the expiration date thereof, notice wilt be delivered in accordance with the policy rovisicns. AUTHORIZED REPRESENTATIVE: DATE ISSUED: January 14 2014 by Briza Morales