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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2016-09 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />II PRODUCER I PUBLIC ENTITY (ADDI"riONAL INSURED) II <br />Alliant Insurance Services, Inc. in conjunction with City of Santa Ana <br />Apex Insurance Services 20 Civic Center Plaza <br />P, O. Box 6450 Santa Ana, CA 92701 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Denise Robles <br />TYPE: Aerobics <br />1664 W. Cindy Lane, Apt. D <br />DATE(S): 01/01/16—12/31/16 <br />Anaheim, CA 92802 <br />LOCATION: Saleado Community tenter <br />*Liquor LiabilityYes ❑ No ❑ <br />**Liquor Liability after 12 ana ends before 2 ani ❑ <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 ternls, 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: JANUAR`t' 'l, 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 />SPECIAL CONDITIONS' <br />Persontal & Advertising Iniury I,000,000 <br />'fhe following endorsements attached to <br />Each Occurrence Limit 1..000.000 <br />the Master Policy do not apply to this <br />DamageTo Premises Reuted "F0 You (Any 0. is Premises) 100,000 <br />Certificate Of hrsura rce. <br />Medical Payments (Arry One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />Optional Limits Purchased <br />❑ $1,000,0001$3,000,000 <br />❑ S2,000,000/$2,000,000 <br />Damage To Property (If purchased) <br />The limits of insurance apply separately to each event insured by this policyas if'a separate policy of insurance has been issued for that event'. <br />OTHER ADDITIONAL INSUREDS <br />"ortencia NuQ ez <br />CANCELLATION" Should the above described policy be cancelled before the expiration date thereon, notice will be delivered in accordance with the policy <br />C47vlS1o175. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: December 17, 2015 by Briza. Morales <br />