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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2017-17 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />l�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 />Maria Madrigal <br />'TYPE: Fitness <br />2613 W Hall Ave <br />DATE(S): 01/03/17 — 12/31/17 <br />Santa Ana, CA 92704 <br />LOCATION: El Salvador <br />K) -- '5?_c%) <br />*Liquor Liability YesEl No N <br />"Liquor Liability after 12 am ends before 2 am <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 terms, 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: SEP41023 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit S2,000,000 <br />Products & Completed Operations I,000,000 <br />SPECIAL CONDITIONS: <br />Personal & Advertising injory 1,000,000 <br />The following endorsements attached to <br />Each Occurrence Limit 1,0()0,000 <br />the Master Policy do not apply to this <br />Damage To Premises RC111edT0 YOU (Any One Premises) 100,000 <br />Certificate Of Insurance: <br />Medical Payments (Any One Pei -son) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />$1,000,00013,000,000 <br />$2,000,000/$2,000,000 <br />Damage To Property (If purchased) <br />The limits OfITISLirancc apply separately to cacti event inSUred by this policy as if a separate <br />event. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will he delivered in accordance with the policy <br />provisions. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 3. 2017 By Ste] <br />