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"lam' EVANSTON INSURANCE COMPANY <br />CERTIFICATE No— <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />DfivwAlfianthtaorameSexvims <br />City of Santa Ana <br />P. O, Box 28373 <br />20 Civic Center Plaza, M -28 <br />Santa Ana, CA 92799 -8323 <br />Santa Ana, CA 92701 <br />(949) 660 -8163 ' <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER) <br />EVENT Ir�tructional —Self Improvemen <br />TYPE. <br />Robert J. Ash <br />DATE(S): c — exam er , 3 <br />13361 Prospect Avenue <br />lACADO City Hall, Santa Ana <br />Santa Ana, CA 92705 <br />This is to certify drat the policies of iowmnm listed below have been Wined to the irk nam A above for the Po1iCY PWW <br />indicated. Notws&sbmdw6 stay r gmmmts, me tx tia ft= of any contract cr tither domunad with ropect to which this <br />cextificabe maybe ieeixad a may pasaaca �e ieartnsaee atioaded by dnpoAeiw dascrtbra bcmie a sabject to all the terms, <br />exclusions and con&acma of such policies. I units shown may have been red med by Paid clams. <br />INSURANCE CARRIER: Ev=Aod bum= Comsidny <br />MASTER POLICY NUbEW 02SEPIODMI <br />MASTER POLICY DATES: TFFEC IM JANUARY 1, 2003 ERPIItAT10N: JANUARY 1, 2004 <br />CObAlERCUL($NERALL ABB.RY <br />OCCURRENNCEPORM <br />DEDUCTIBLE NONE <br />G"md AaGCPW Limit S IAO0,0oo <br />Pashr:xsleComplsad Opaooaw IAWAe0 <br />Pawad & Adrmbmc kimy I xkm <br />Pwrh Oooutttace UWt ] Room <br />FimVa=W(Amy0wFM) SOW <br />M Payasaas (Amy Ow Pmam) SAM <br />The limits ofimmmm apply b cwh watismad by Wa podgy as ifa eepwo policy dhow==bwbas imaedfat dud evaot. <br />"Wbo simvd"s soended io m ®a ®ad.6al>ameasmpxto•am iawais B,ia adi146maad9 wMY �spevtbd6�'tymw8ma offAe <br />owoesbip. asimeoaomormeofd :pamsmuwdbydseasadsaad(aaaaaal c* TaiasamwwdomrmXappfyta Ary"msmrmoa^whirhmlasphca <br />aNm the event iolderomsm a 6e saran ialhat poaism. <br />OTIM ADDITIONAL RiSUREDS <br />CANCEUAT10N: ShoWd dwabovadseobdpawy to cwcdWbdmdwmgbd= aw6mmL 4cjwdharampwy will roW 30days vrtitmnotice to dw <br />cmrifiras bolder adsd4Wwd mw=h timed. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: <br />/03 <br />APPROVLll AS TO FORM <br />unit �hccdy <br />DePULY OLA rnev <br />