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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: PUBLIC ENTITY (ADDITIONAL INSURED) <br />DdverAlliantInstuanceServices City of Santa Ana <br />P. O. Box 28323 20 Civic Center Plaza, M-28 <br />Santa Ana, CA 92799-8323 P.O. Box 1988 <br />(949)660-8163 Santa Ana, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED (EVENT TiOLDER): EVENT INFORMATION: <br />~~ `~~(~'~ ~ ~ / TYPE: Self Improvement <br />Estala Anaya _ <br />tip. ac-c3 ~~"('~ DATE(S): 1/14/04 - 12/31/04 <br /> LOCATION: S.A. Jail <br />This is to certify that the policies of insuratce listed below have been issued to the insured 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 maybe issued or may pertain, the insurance afforded by Ute policies described berein 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 1, 2004 EXPIRATION: JANUARY 1, 2005 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />Geitcral Aggregak Limit S 2,000,000 <br />Products & Corrgdeted Operations 1,000,000 <br />Personal B 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 separakly [a each event insured by this policy as if a separate policy of insurance has been issued for that even[. <br />"Who is insured" is amended ro include, as an insured, the person or organization shown in.this 5cheduk, but only with respect ro liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply ro: Any "occurrence" which takes place <br />after the evrnt holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br /> <br />CANC LATION• Should the above described policy ro pncelled before the expiration dak tlrereof, the issuing company will mail 30 days wrinen notice to the <br />certificak holder eM additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: <br />January 14, 2004 <br />