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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: 2016-08 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, hic. 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 FIOLDER): <br />EVENT INFORMATION: <br />Khai (Kevin) Hoang <br />TYPE: Dance/Fitness <br />14401 Poplar <br />DATE(S): 01/01/16 —12/31/16 <br />Tustin, CA 92780 <br />LOCATION: - Southwest Senior Center/Garfield Center <br />*Liquor Liability Yes [-1 No F1 <br />**Liquor I-iabilitX 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(ics) 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 />COMM[RCIAL GENERAL LIABI LITY <br />OCCURUN(T FORM <br />DMUCTIBLENONE <br />General Aggregate Limit $2,000,000 <br />Products & Completed Operations I'mo,000 <br />SPECIAL 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 01111SURHICe <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />\JA - <br />Optional Limits Purchased <br />7 $1,000,0001$3,000,000 <br />El $2,000,000/$2,000,000 <br />Daniage'l"o Property (If purchased) <br />'rhe limits of insurance apply separately to each even illAffed by this policy as if separate <br />Ne for that event. <br />OTHER ADDITIONAL, INSUREDS <br />CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice wfll be delivered in accordance with the policy <br />7roviS4)11s, <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: —December 16, 2015 by Briza Morales <br />