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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 />SP]gCIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDr~IONAL INSUREDi <br />Driver Alliant Imurance Services City of Santa Aha <br />P.O. Box28323 20 Civic Center Plaza, M-28 <br />Santa Aha, CA 92799-8323 P.0. Box 1988 <br />(949)660-8163 Santa Ana, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED' (~VENT HOLDER): c EVENT INFORMATION: <br />A) - ''~ ~- ~ /l~ TYPE: Sel~ .,Improvement <br />Chri~ C0Wpe~ ~' - ~fc~'p- /?]~ DATE(S): 1/14./04 - 12/3'1/04 <br />fi - ~,¢Oix- I I ~ LOCATION: S .Ao Jail <br /> <br />This is to certify that the policies of insorance listed below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, terms or conditiol~s of any conWact or other document with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described her~in is subject to all the i~n~, <br />exclusions and conditions of such policies. Limits shown roay have bozn reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insuran~ Company <br />MASTER POLICY NUMBER: 04SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2004 EXPIRATION: JANUARY 1, 2005 <br /> <br /> COMMERCIAL GENEKAL LIABILITY OCCURRENCE FORM DEDUCTIBLE; NONE <br /> Oe~-sd Ag~gam Limil $ 2,000,000 <br />Products 8: Corapleted Operati~ms 1,000,000 <br />Pei~onal & Advertising Injm'y 1,000,000 <br />Each Occurrence Limit ] ,000,000 <br />F/re Damage (Any One Fire) $0,000 <br />Medical Payments (Any One p~rson) 5,000 <br />The limits of insurance apply separately to each event insured by this po]ic~ as ifa separate policy of insurance has been issued fort. hat event. <br />"Who is insured' is amended to in¢[udc, as an insured, the p~-$on or organization daown in this sched~d¢, but only with respect to liability arising out of the <br />ownership, matht~nance or use of the premises u~d by the named insured (event holder). This insurane~ does not apply to; Any "occurrence" which takes plac~ <br />after the event holder ceaxe.~ to b~ a tenant/n thet premises. <br />OTHER ADDITIONAL INSUREDS <br />C~NC E LLATION~.' Should the above described policy to cancelled befo¢¢ the expirafiuu date thereof, the issuing company will n~ai130 days wr/tten notice to the <br />ce~ificate holder and additional insmeds listed. , <br /> <br />Au'rHoRIZleDREPRESENTATIVE:~~~-c~ <br />DATEISSUED: January 14, 2004 <br /> <br /> <br />