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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: - <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Alliantinsurance Services <br />City of Santa Ana <br />P. O. Box 28323 <br />20 Civic Center Plaza, M-28 <br />Santa Ana, CA 92799-8323 <br />P.O. Box 1988 <br />(949) 660-8163 <br />Santa Ana, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />TYPE: Self Improvement <br />Sylvia Francon "'�c'i" " c' �'� <br />DATE(S): 1/14/04 — 12/31/04 <br />LOCATION: S.A. Jail <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, terns 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 tears, <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 1, 2004 EXPIRATION: JANUARY 1, 2005 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />products & Completed Operations 11000,000 <br />Personal & Advertising Injury 1,000,000 <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 insured" is amended to include, as an insured, the person or organization drown in this schedule, but only with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event hoMa). This insurance does not apply to: Any "occurrence" which takes place <br />at= the event holder ceases in be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION' Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: <br />DATEISSUED: January 14, 2004 <br />