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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br /> CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTRY (ADDITIONAL INSURED) <br />DfiverAlliant Insurance Services City of Santa Aha <br />P.O. Eox28323 20 Civic Center Plaza, M-28 <br />Santo Aha, CA 92799-8323 P.0. Box 1988 <br />(949)660-8163 Santa Aha, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFOP. MATION: <br />/~/ _,~f 3t- ~.~r~ TYPE: Self Improvement <br />Atejandro BUlne~' /0 -.AFC ~- C~$' DATE(S): 1/14/04 - 12/31/04 <br /> LOCATION: S.A. Jail <br /> <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indic&reeL Nol~ithstanding any requircmcms, terms or conditions of any coutract ur other documem with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described hereIn is subject to all thc ternts, <br />exclusionS and conditionS of such policies. L/mits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEP1000001 <br />MASTER POLICY DATES: EI~'~'~3CTIVE: JANUARY 1, 2004 EXPIRATION: JANUARY 1, 2005 <br /> <br />COMMERCIAL GENERAL LIABILITY ' OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Each Occurrence Limit !,000,000 <br />Fir~ Damage (Any One Fire) 50,000 <br />M~thcal Payments (Any One Pemon) 5,000 <br /> <br />OTHER ADDITIONAL INSLri~D$ <br />CANCELLATION: Should the above deserihed policy to cancelled before the expiration date thereof, the issuing ~y wilt mail 30 days written not/ce ~o the <br /> <br />DATEISSUED: January 14, 2004 <br /> <br /> <br />