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<br /> <br />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: <br /> <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br /> <br />Driver Alliant Insurance Services <br />P. O. Box 28323 <br />Santa Ana, CA 92799-8323 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />¡J .. dt(j ~ I,X~ <br />Daniel Achatz N ':;{Céi3. ¿; 7/ <br />, . ,. 'uiß <br />Iv .~CUJ -L' TÓ <br /> <br />City of Santa Ana <br />20 Civic Center Plaza, <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br /> <br />M-28 <br /> <br />EVENT INFORMATION: <br />TYPE: Self Improvement <br />DATE(S): 1/14/04 - 12/31/04 <br />LOCATION: S.A. Jail <br /> <br />TIris is to certifY that the policies of insurance listed below have been issued to 1he insured named above for the policy period <br />indièated. NotWithstanding any requirements, tenns or conditions of any contract or other document with respect to wIDch tIDs <br />certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the tenus, <br />exclnsions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance C<>mpany <br /> <br />MASTER POLICY NUMBER: 04SEPIOOOOOI <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 <br /> <br />EXPIRATION: JANUARY 1, 2005 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />Genera1 Aggregate L1rml <br />Products & Completed Operations <br />Personal & Advertising Injury <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTIBLE: NONE <br /> <br /> , ' <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <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 event. <br />"Who is Însured" Îs amended to include, as 3D insured. the person or organization shown in-this schedule, but only with respect to liability arising out of the <br />ownership, maintenance or use of the prennses used by the named insured (event holder). This insurance does not apply to: Any "occunencc" which takes place <br />after the event holder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLA nON: Shou1d me above described policy to cancel1ed before the expiration date thereof, the issujng company win tnIIiJ 30 days wriUen notice to the <br />certiñcate holder and additional insureds lìsted. <br />AU1HORIZEDREPRESENTATIVE:~ ß' <br />,'-C..:vvd7 <br />DATE ISSUED: January 14, 2004 <br /> <br />$ 2,000,000 <br />1.000,000 <br />1 000 000 <br />