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<br />,--- <br /> <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: f'-,). ~t..oc>O-~T . <br /> <br />. V- ]A:P3 - tS'1- 5 <br />Driver Allia¡lt Insurance Services t-> - 2DD1- - ,) L{ <br />P.O.Box28323 .1\1-~-ct1 <br />Santa Ana, CA 92799.8323 . r - <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />I <br />TOYlIj Veiga.do <br /> <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br /> <br />Cdlj 06 Sa.n.ta. AM <br />20 C'¿v'¿c. Ce.ntVL Plaza., M-28 <br />Sa.nta. AM, CA 92701 <br /> <br />, <br /> <br />EVENT INFORMA.TION: . ,._.0 - 06 <br />TYPE: Inl,;(;Jw.c.-ti.o,ILU--S",,- <br />DATE(S): I/UbIU~ - IZt:>IIU~ <br />LOCATION: S.A. Jeu.{. <br /> <br />Imp.IWv eme.nt <br /> <br />This is to certify that the policies ofinsuraucelisted below have been issned to the insured named above for the policy period <br />indicaÌecl. Notwitbstaoding 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 descn"bed herein is subjcct to all the terms, <br />exclusions and conditions of such policics. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br /> <br />MASTER POLICY NUMBER: 05SEPlOOOOOI <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2005 <br /> <br />EXPIRATION: JANUARY 1,2006 <br /> <br />COMMERCIAL GENERAL UABIUfY <br />General Agrop" Umi. <br />Products '" Completed Opcntions <br />Personal '" Advutisins Injury <br />Each Occum:nce Limil <br />FiJO Damage (Any One Fire) <br />Medical Payments (Any One Person) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTmLE: NONE <br /> <br />$ 2,000,000 <br />t,ooo,OOO <br />1,000,000 <br />1,000,000 <br />50,000 <br />5,000 <br /> <br />The limits of insurance apply separately 10 each event insured by tiJi. policy as if a separate policy of insurance hu been issued for that event <br />"Who is insured" is amended to include, IS an insured. the person or orpnizatim shown in this schedule. but only with respect to 1iability arilrinS out of the <br />ownership, maintenance OT UK urthe premises oued by the named insured (even. bolder). This insuranœ does not apply 10: Any "-""""",," which talces ploce <br />after the event holder ceases to'be a tenant in lhatpremises. <br />OTHER ADDmONAL INSUREDS <br /> <br />CANCP.T I Á TION: Should Ibe above described po1icy to cancelled before the expiration date thereof, the 1ssuing cOJJ1W1Y win mail 30 days written notice to the <br />certificate holder and additiooal insureds listed. <br /> <br />AUTIIORIZED REPRESENTATIVE: <br /> <br />~;Z~ <br /> <br />"J(:L ,<:_- <br /> <br />,J>! <br /> <br />DATE ISSUED: <br /> <br />Ja.YlUiVLIj 6, 2005 <br /> <br />þ~y <br />.. ./"..... ,-.' ,.. <br />