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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]~CIAL EVENT LIABILITY PROGIOdVI <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />D~v~r Alliant Insurance Services City of Santa Ana <br />P.O. Box28323 20 Civic Center Plaza, M-28 <br />SantaAna, CA 92799-8323 P.O. Box 1988 <br />(949) 660-8163 Santa Aha, CA 92702 <br />Li~,eme No: OC 36861 <br />NAMED INSURED (EVENT. ~ HOLDER): c EVENT INFORMATION: <br />N - '~ CCC- c~ [~ TYPE: Self Improvement <br />Chris Cowper, .gr _ ~fC,~- ~'~1 ~ DATE(S): 1/~/04 - 12/31/04 <br />~ - Z~'~ - I I I LOCATION: ~ .A. Jail <br /> <br />This is to certify that the policies of insurance listed below have been mSUed to the insured nzmed above for thc policy period <br />indicated. Notwithstanding any requirements, ferns or conditions of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims, <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2004 EXPIRATION: JANUARY I, 2005 <br /> <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />Gea~d Agg~gatv Limit $ 2,000,000 <br />Produ~ & Completed Operations 1,0~0,000 <br />personal & Advertising Injuvj 1 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />M~d/cal Payments (Any One person) <br /> <br /> The limits_of insurance apply separately to each event insured by this policy as ifa aeparat~ policy of insurance has been issued for that event. <br /> "Who i~ insured" is amended m include, as an insured, thc p~son or organization shown in this scheduk, but only with respect to liability arising out ofth~ <br /> owr~rship, maintenance or use oftbe premises u~d by the named insured (event hold,r). This insurance doe~ not apply to: Any "occunvnce" which take~ place <br /> after the o,~'n t holder ceases ~ b~ a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br /> CANCELLATIQN: Should the abow d~erlb~l poliny to cancelled before th~ cxpira6o~ dat~ thereof, the issuing company will mail 30 days w~ttcn notic~ to the <br /> certificate holder and additional insln~d$ listed. <br /> <br />DATE ISSUED: <br /> <br />AU2~iORiZEDREPRESENTATiVE:C"v~'~//~f~.<r <br /> January 1~, 2004 <br /> <br /> <br />