ACHATZ, DANIEL 1B -2003 - Laserfiche WebLink

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r EVANSTON INSURANCE COMPANY CERTIFICATE NO.: CERT1F1CATE OF INSURANCE , EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LlABllJTY PROGRAM PRODUCER: fV ./)-00"1.-\ 2- ~ PUBLIC ENTITY (ADDITIONAL INSURED) \'.-I' L, o~2- - [)Y.~ Driver AUia¡lt InsuranCe Services P v '2-co 1.\ -oq V Calf on Sa.n.ta. Ana. P.O.Box28323 f'.J :? "3 0+1 20 C.¿vic. Cen.teJL Plaza., M-28 Santa Ana, CA 92799-8323 - H:;>;:) - Sa.n;l:a. Ana., CA 92701 (949) 660-8163 License No: OC 36861 NAMED INSURED (EVENT HOLDER): I EVENT INFO~TIm: . na1. eln I TYPE: nó c.t.io - S ImpfWvemen.t Va.n.i.el Ac.ha;tz DATE(S): I/Uó/U~ 1Zt:>IIU~ LOCATION: S.A. J 1U.L This is to certifY that the policies of insurance listed below have been issued to the insured named above for the policy period indicàÌed. Notwitbstandmg any reqw.ç....Jrts, terms or conditions of any contract or other dn,.n.......t with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies descnòcd herein is subjcct to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Inswance Company MASTER POLICY NUMBER: 05SEPIOOOooI MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2005 EXPIRATION: JANUARY 1,2006 COMMERCIAL GENERAL UABIUfY OCCURRENCE FO¡¡M DEDUCTIBLE: NONE General Agpga1c Umit S 2,000,000 Products &< Completed Operations 1,000,000 " p- &< Advortisins InjUl)' 1,000,000 Each Occum:ncc [jmit 1,000,000 File Damosc (Any One Fire) SO,OOO Medical Payments (Any One Penon) 5,000 . The limits of insurance apply separately to each event inaurecI by dlis policy as if a separate poJicy of insurance has been issued for that event '"Who is insured" js amended to include, as an insured, the perscIJ or orpnizatiœ shown in this schodule, but only with respect to Jiability Irisin. out of the ownership. mainteoancc or use of the pn:mi'CI used by the named insured (event holder-). This insurance docs not apply 10: Any "occurrcncc" which lakes plocc aftcrthe event holder ceases to'bc a tenant in that premises. OTHER ADDITIONAL INSUREDS , . CANCEUA TION: Should the above described policy to cancelled before the expiration date thereof. the issuing COJJ1'3DY win mai1 30 days written notice to the urtificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: ~;Z~ o..../. .~ /;:"')1,-;;, /4: í ,.,. -- ./ DATE ISSUED, Ja.nuaJtlf 6, 2005