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<br />EVANSTON INSURANCE COMPANY <br />CERTIF1CATE NO.: <br /> <br />¡1t,I'. A}1.?,;(lio/\'" Ôtr/"/ <br /> <br />CERTIF1CATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPUCATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT UABILITY PROGRAM <br /> <br />PRODUCER: <br /> <br />PUBLiC ENTITY (ADDmONAL INSURED) <br /> <br />Driver Alliant Insurance Services <br />P. O. Box 28323 <br />Santa Ana, CA 92799-8323 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOWER): <br />Richard Greger <br />17561 Brent Lane <br />Tustin, CA 92780 <br /> <br />City of Santa Ana <br />20 Civic Center Plaza, M-28 <br />Santa Ana, CA 92701 <br /> <br /> <br />- OD9 <br /> <br />EVENT INFORMATION: <br />TYPE: Self Improvement <br /> <br />DATE(S): 115/04 - 6/30/04 <br /> <br />LOCATION: ¡,hrk ('.~nter <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 conlI'act 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 terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br /> <br />MASTER POUCY NUMBER: 04SEPIOOOOOI <br /> <br />MASTER POUCY DATES: EFFECTIVE: JANUARY I, 2004 EXPIRATION: JANUARY 1,2005 <br /> <br />COMMERCIAL GENERAL LIABIUTY <br />General Aggregate Limit <br />Prod..., & Completed Operations <br />Personal & Advertising Injury <br />Each Occumnee Limit <br />Fim Dama¡c (Any One Fim) <br />MediCAl Payments (Any One Person) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTIBLE: 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 />1òcr °!S of 0 <br /> <br />..1 to <br /> <br />.. <Cdb Ib- <br /> <br />'f <br /> <br />f- <br /> <br />ha been' ed ~ thaI <br /> <br />urn "'"""nee a"",y separa y cae even InlU y "",,'cy.., a...,....."",cyo """",nee I ,.... or even- <br />"Who is inlu",d" is amended '0 inelud.,.. on i......-cd, the,.....n Of organi...... shown in Ibis sehedul., hut only wilh _t to liability arising out of the <br />own...hip, ",.;ntcnanee or Ule of the premises used by the named insUTed (event holder}. This insu,"""" docs not apply to: Any "oceunonce" which takes place <br />after the event holder c<aSCS to be a tenant in that <=nises. <br /> OTHER ADDITIONAL INSUREDS <br /> <br />CANCELLA nON: Should the aha"" described ""licy to cancel1ed bc{on: the expiration da.. thereof, the issuing c""1""Y wil1 mail 30 days wriltcn notice to the <br />certificate holder and additional in_s lisled. <br />AUTHORIZEDREPRESENTATNE: ~~ <br />/\.PPRC'\¡E~ ;,'GLI, <br />DATE ISSUED: January 5, 2004 ,..' <br /> .._~ O-<-'~-j:;-o.- <br /> aura S:i" kc-.èj <br /> "-"istant C'tv ':c- <br /> (fIV( <br /> <br />