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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: - <br /> CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPUCATIONS FOR NOMINEE EVENTS. <br /> SPECIAL EVENT UABIUTY PROGRAM <br />PRODUCER: PUBUC EN1TIY (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 .,.~l{iô'iA TYPE: Self Improvement <br />Kathleen' Nelson J\,- ,:¡cc~~.¡1i4-ì DATE(S): 1/14/04 12/31/04 <br /> LOCATION: S.A. Jai1 <br /> <br />This is to certify that the policies of insurance listed helow have been issued 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 wmch tms <br />certificate may be issued Or may pertain, the insurance afforded by the policies described berein is subject to all the tenDS, <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 /> <br />COMMERCIAL GENERAL LIABILITY <br />General Aggr.gate Limit <br />Products & Co~leted Operations <br />P"""nal & Advertising Injury <br />Eoch Qcçum:n.. Umit <br />Fire Damage (Any One Fire) <br />Medical Paymeots (Any One Person) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTIIILE: NONE <br /> <br />$ 2,000,000 <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />50,000 <br />5,000 <br /> <br />The limits of insu...... apply sepandely to eaeh event insured by this policy as if a separate policy of i",,",.ee has been issued fOl" that eveot <br /> <br /> "Who is insured" is amended to include, as an insured, the pe<sun 01" organization shown in this schedule, but only with respect to liability arising out of the <br /> owne.-ship, mainteoance or use of the premises used by the named insured (event holder), This ins"",""" does not apply to: Any "occ........" which takes place <br /> afu:r the event hulder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br /> <br /> CANCELIA nON: Should the above described policy to cancelled before the expiralinn date thereof, the issuing company will mail 30 days written notice to the <br /> certificate bolder and additional insureds listed. <br /> AUffiŒUZID> RW""""'A TI "', ~~ <br /> <br /> DATE ISSUED: January 14, 2004 <br /> Wi- <br /> /3;/ (' <br /> ¡/' -'lk'('(! <br /> <br />