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EVANSTON INSLrRANCE COMPANY <br />CERTIFICATE NO.: <br /> <br /> CERTIFICATE OF I~SURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />"i~RODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Alliant Insurance Services City of Santa Aha <br />P.O. Box28323 20 Civic Center Plaza, M-28 <br />SantaAna, 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 INFORMATION: <br />P~ ~ ,.-qd"( ~- - / ' '~' TYPE: Self Improvement <br />Daniel Adharz /(,-~?(-L~'~-'L;TI DATE(S): 1/14/04 - 12/~I/04 <br />jp, ~;L,~,¢. _ ~)~ 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 I~riod <br /> indicated. Notwithstanding any requirements, wa'ms or conditions of any con~ract or other document with respect to which this <br /> certificate may be issued or may pertain, the insuranc~ afforded by tl~ policies described herein is subject to all thc terms, <br /> exclusions and conditions of such policies. Limits shown may have be{m reduced by paid claims. <br /> INSURANCE CARRIER: Evanston Insurance Company <br /> MASTER POLICY NUMBER: 04SEP 1000001 <br /> MASTER POLICY DATES: EIqo'I~CTIVE: JANUARY I, 2004 EXPIRATION: JANUARY 1, 2005 <br /> <br /> COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br /> Genera Aggregate Limit $ 2,000,000 <br /> Products & Completed Operations !,000,000 <br /> Peraonal & Advertising Injury <br /> Each Occurrence Limit 1,000,000 <br /> Fi~ Damage {Any One Fire) 50,000 <br />I Med cai Payments (Any One Person) 5,000 <br /> <br /> Tt~ limits of insurance apply separately to each event/nsured by this policy as if a ,separate poli~y of insurance has been issued for that event. <br /> OTHER ADDITIONAL INSUREDS <br /> <br />DATEISSUED: January 14, 2004 <br /> <br /> <br />