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<br />EVANSTON INSURANCE 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: <br /> <br />PUBLIC EN1TIY (ADDmONAL INSURED) <br /> <br />Driver Alliant Insurance Services <br />P. O. Box 28323 <br />Santa Ana, CA 92799-8323 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />N -aa'c;-{S'¡ <br />Tony Delgado/J - ;;{D0~- i 14- <br />j>J ~'[lO:\ -- ('15 <br /> <br />City of Santa Ana <br />20 Civic Center Plaza, <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br /> <br />M-28 <br /> <br />EVENT INFORMATION: <br />TYPE: Self Improvement <br />DATE(S): 1/14/04 - 12/31/04 <br />LOCATION: S.A. .Tail <br /> <br />This is to certify that the policies of insurance listed below have been issned to the insured named above for the policy period <br />indièated. Notwithstanding any requirements, terms 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 descnDed herein is subject to all the terms, <br />exclns¡om and conditiom of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Imurance Company <br /> <br />MASTER POLICY NUMBER: 04SEPlOOOOOI <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 <br /> <br />EXPIRATION: JANUARY I, 2005 <br /> <br />COMMERCIAL GENERAL LlABIUTY <br />General Aggregate Limit <br />Products &. Completed Operations <br />Personal & Advertising Injury <br />Each Occurrence Limit <br />Fire Damage (Any One Fire) <br />Medical Payments (Any One pen¡on) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTffiLE: NONE <br /> <br />$ 2,000,000 <br />1,000,000 <br />1,000,000 <br />],000,000 <br />50,000 <br />5,000 <br /> <br />The limits of insurance apply separately to each event insured by Ibis: policy as if a separate policy of insurance Iuis been issued for that event. <br />"Who is insured" is amended to include. as an insured. the person or organization shown 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 holder). ThÎs insurance does not app1y to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br /> <br />OTHER ADDITIONAL INSUREDS <br /> <br />CANCELI A TION: Should the above described policy to cancelled before the expiration date thereof. the issuing company win mail 30 days written notìce to the <br />certificate holder and additiona1 insureds listed. <br /> <br />AmH=RH'RESENTATIV~ ~ <br /> <br /> <br />DATE ISSUED: January 14, 2004 <br /> <br />'P~ vb¡ <br />