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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2016-11 <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 />Flor Hernandez <br />TYPE: Aerobics <br />940 W. Chapman, Suite 100 <br />DATE(S): 01/01/16—12/31/16 <br />Orange, CA 92868 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes ❑ No <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: SEP41020 <br />MASTER POLICY DATES: EFFECTIVE: JAIVUARY 1, 2016 EXPIRATION: JANUARY 1, 2017 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE, NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />SPI.?CIAL CONDITIONS: <br />Personal & Advertising Injury 1,000,000 <br />The following endorsements attached to <br />Each Occurrence Limit 1,000,000 <br />the Master Policy do not apply to this <br />Damage To Premises Rented To You (Any One Premises) 100,000 <br />Certificate Of Insurance: <br />Medical Payments (Arty One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />❑ $1,000,00053,000,000 <br />❑ $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 if a separate policy of insurance has been issued for that <br />OTHER ADDITIONAL INSUREDSQ <br />Geraldine Valencia <br />w 0 <br />CANCELLATION; Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in acc?ir ance with the policy <br />provisions, <br />,/ �•�''—�... �-iL`e�..-G.-Est._—, <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: December 22, 2015 by Briza Morales m <br />