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EVANSTON INSU1LANCE COMPANY <br />CERTIFICATE NO.: <br /> <br /> CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC EN'III'f (ADDITIONAL INSURED) <br />Driver Alliant Insurance Services City of Santa Aha <br />P.O. Box28323 20 Civic Center Plaza, M-28 <br />Santa Ana, CA 92799-8323 P.0. BOX 1988 <br />(949) 060-8163 Santa Ana, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Javier Saldiyar }X,t~ ?~,C(_'~.3 .~d~- TYPE: Self Improvement <br /> DATE(S): 1/14/04 - 1.2/31/04 <br /> LOCATION: S.A. Jail <br /> <br />Tl~ is to certify that the policies ofinsmance listed below have been/ssued to the insured named above for thc policy period <br />mdiiated. Notw/thstandhag any requ/rement% term~ or cond/fions of any conWact or other document with respect to wh/ch this <br />certificate may be issued or may pertain, thc msnsance afforded by the policies dcscr/bed here/n is subject to all thc terms, <br />exclusions and condit/ons of such policies. Limit~ .shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEP1000001 <br />MASTER POLICY DATES: I~FI~'i~CTIVE: SANUARY l, 2004 EXPIRATION: JANUARY l, 2005 <br /> <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />C~nc~al Ag~cegete Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />pe~onal & Advertising Injuvd 1,000,000 <br />Each Occurrence Limit 1.000,000 <br />FiR Damage (Any One Fire) 50.000 <br />Medical Payments (Any One Person) 5,000 <br /> <br />The limits of insurance apply separately to each event insured by this policy as ifa separate policy of instwance bas been issued for that event. <br />OTHER ADDITIONAL INSIIREDS <br /> <br />AUTHORIZEDREPRESENTATIVE:~'t~/~ffY~'<.~e <br />DATEISSUED: January 14, 2004 <br /> <br /> <br />