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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2016-17 <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 />1". 0. Box 6450 <br />Santa Ana, CA 92701 <br />Newport Beach, CA 92658, <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER):: EVENT INFORMATION: <br />Guadalupe De Santos TYPE: Zumba <br />2070 S. Olive Street DATE(S): 01/07/16 — 12/31/16 <br />Santa Ana, CA 92707 LOCATION: Memorial Center <br />*Liquor Liability Yes[] NoZ <br />*,*Li2uorLiability after 12 am ends before 2 ant ❑ <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. The insurance described herein is subject to all the tertns, exclusions and conditions of such policy(ies) unless <br />amended as described in Special Conditions. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: SEP41020 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2016 EXPIRATION: JANUARY 1, 2017 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Lirrut $2,000,000 <br />Products & Completed Operations 1,000,000 <br />SPECIAL CONDITIONS <br />Personal & Advertising Injury 1,000,000 <br />The hallowing endorsements attached to <br />Each Occurrence Limit 1,000,000 <br />the Master Policy do not apply to this <br />Darn age To Premises Rented To You (Any One Prern ices) 100,000 <br />Ccrt i ficate Of InSUrauCC: <br />Medical Payments (Any One Pei -son) 5,000 <br />Liquor Liability (If purchased) I poo'000 <br />Optional Limits Purchased <br />F-1 $1,000,0001$3,000,000 <br />El $2,000,00052,000,000 <br />Damage To Property (If purchased) <br />The limits Of insurance apply separately to each event insured by this policy as i f a separate policy insurance has been issued for that event <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION Should the above described policy be cancelled before the expiration date thereof, notice will be defiVeFed in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: — January 7. 2016 by Briza Morales <br />