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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br /> CERTIFICATE OF IblSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br /> PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br /> Driver Alliant Insurance Services City of Santa Aha <br /> P.O. Box28323 20 Civic Center Plaza, M-28 <br /> Santa Ama, CA 92?99-8323 P.0. Box 1988 <br /> (949)660-8163 Santa Ana, GA 92702 <br /> License No: OC 36861 <br /> NAMED INSURED (EVENT HOLDER): c EVENT rNFORMATION: <br /> pd ~ ,~ ~C- ?' I(~ TYPE: Self Improvement <br /> Chris CoWPer~ ~ - 51tO.~- C~t-~ DATE(S): 1/14/04 - 12/91/04 <br /> ]~ - ~2tO~ - I I I LOCATION: S .A. Jail <br /> <br />This is to certify that the policies of inaorance listed below have been issued to lhe immvA named above for the policy period <br />indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this <br />~ certificate may be issued or may pextain, the insurance afforded by the policies described herein is subject to all the terms, <br />exclusions and conditions of such policies. Limits shown may hav~ b~n reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2004 EXPIRATION: JANUARY 1, 2005 <br /> <br /> COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br /> General Agg~gate Limit $ 2,000,000 <br /> Products & Complel~l Operations 1,000,000 <br /> personal & Adv~iiaing InjuDt 1,000,000 <br /> Each Occurrence Limit 1,000,000 <br /> Fire Damage (Any One Fire) 50,000 <br /> Medical Payments (Any One P~n) <br /> <br /> ownership, maintenance or use of the premises ua~d by thg named insure~l (~mt holder), This insurance does not apply to: Any ~oecu~mce" which takes <br /> OTHER ADDITIONAL INSURgDS <br /> c.e~tiO ~ate holder, and additional insu~eds listed, <br /> <br />AUTHORIZED REPRESENTATIVE: %~ <br />DATEISSUED: January 14, 2004 <br /> <br /> <br />