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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; PUBUC ENTITY (ADDITIONAL INSURED) <br />Driver Alliant Insurance Services City of Santa Ana <br />P. O. Box 28323 20 Civic Center Plaza, M-28 <br />Santa Ana, 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 INFORMATION: <br />¡J - '.),1 (; j - 1)14 TYPE: Self Improvement <br />Kathleen. Nelson N~ ;;Wuj- ci¿l- \ DATE(S): 1/14/04 12/31/04 <br /> LOCATION: S.A. Jail <br /> <br />This is to certifY that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, terms or conditions of any con1ract or other document with respect to which this <br />certificate may be issued Or may pertain, the insurance afforded by the policies described herein is subject to all the teIIl1S, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEPIOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY 1, 2005 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate bmil $ 2,000,000 <br />Products & Co~lele<! Operalions 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each Ü<currence bmil 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5.000 <br />The limits of insu"",ce apply sepa"'tely to each event insured by Ibis policy as if a separate policy or insu",nce has been issued for that event. <br />-Who is insured'" is amended to include, as an in,ured, the """on,,, organi,,'ion shown inthi. schedule, but only with respect to liability arising out of the <br />owne"hip. maintenance or u,e ofthe premises used by the named insured (event holda-). This insurance d"", nol apply to: Any "occu..."ee"' which takes place <br />after the evenl holder ceas.. 10 be a tenant in that premis... <br /> OTHER ADDITIONAL INSUREDS <br /> <br />CANCELI.A nON: Should the above describe<! policy to eanceUed before the expj",ûoo date thereof, the issuing company will mail 30 daY' written notice to the <br />certifiCate hold« and additional in,....d, listed. <br /> <br />AUmm<WID RE'>=ENTATIVE. ~~ <br />DATE ISSUED: January 14,2004 <br /> <br />ff)~ <br />/r--.J/w<'d¡ <br />