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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTs. SEE SEPARATE APPUCATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT UABJLITY PROGRAM <br /> <br />PRODUCER: PUBUC ENTITY (ADDmONAL INSURED) <br />Driver AI1iant Insurance Services City of Santa Ana <br />P,O.Box28323 20 Civic Center Plaza, M-28 <br />Santa ADa, CA 92799-8323 P.O. Box 1988 <br />(949) 660-8163 Santa Ana, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFO~ON: t,¿ <br />AtñJt.edo M.vaJLa.do ¡J - :;2.003- /13 TYPE' ymna.6 c.6 <br />1419 S. Syc.amOll.e, *6 DATE(S): 'IS - '~'JI,O4 <br />Slll1ta Ana, CA 92701 LOCATION: JeJLDme t;eMVl <br /> This is to certify that the poliei.. of insurance 1isœd below have been issued to the insured named above for the policy period <br />indiCated N otwithatanding any reqUÍl'elDlmts, terms or conditions of any contract or other document with respect to which this <br />ccrtifieate may be issued or may pertain, the insmancc afforded by the policies dcscnòed h=in is subject to aU the terms, <br />cxc1nsions and conditions of such policies. Limi1B shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Bvanswn Insurance Company <br />MASTER POUCY NUMBER: 04SBPlOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2004 EXPIRATION: JANUARY I, 2005 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aar<ptc Limit S 2,000,IlOO <br />Producll & ~I- Openttion, 1,IlOO,IlOO <br />PcroonaJ & Advertiains Injwy 1,IlOO,IlOO <br />Each o.:cun.nc. Limit 1,IlOO,IlOO <br />Pin: I>arnop (Any One Fire) so,ooo <br />Medical Pa,....." (Any One Person) S,IIOO <br />Tho limi" of insuroncc apply aopll1ltdy to ...h event ÍIIIurod by llria poliçy II ifa .....mto ~Iicy 0(- ... boon iuued fo<lbat event <br />"Who ;. inaured" i..mended 10 include, .. .. inaured. ... penon or .....f2aIion - In .1Iri1 _ulo, but only wilb - to liability ariai.s out or Ibe <br />ownonhip. ..in- or .... 0( the........ .- by the named inaured ("'" holder} This - doa not apply 10: Any""""".'" which taIcos place <br />aðor the OYOIIt holder...... to be a ~, In lbat........, <br /> OTHER ADDITIONAL INSUREDS <br /> <br />CANCElU. TION' Should the...... dessribod policy to ......lIocI- the expin¡tion cIa1a -. the iuuins oompony will ..;1 30 days writ"'" notice to tho <br />scrtifi..,. - and additiooaI inaurcda lined. <br /> <br />AumoRIZED REPRESENTATIVE; ~~ <br />DATE ISSUED: 1/5104 <br /> <br />',J'I'1«;VLJ:. i.;' ,.. ""kjv;. <br /> <br />-~,." <br /> <br />""""'Ui. City ¡'lIli"'.e, <br />