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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 LIABILITY PROGRAM <br /> <br />PRODUCER: <br /> <br />PUBUC ENTITY (ADDITIONAL INSURED) <br /> <br />Driver Alliant Insurance Seryjces <br />P, 0, Box 28323 <br />Santa Ana, CA 92799-8323 <br />(949)660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br /> <br />Kafhleen Nelson ¡J -dN j- <br />¡\,- ,C;¡úo3- <br /> <br />City of Santa Ana <br />20 Civic Center Plaza, M-28 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br /> <br />1'/4 <br />014-1 <br /> <br />EVENT INFORMATION: <br />TYPE: Self Improvement <br />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 havc been issued to the insured named above for the policy period <br />indièated. Notwithstanding any requirements, tenns Or conditions of any contract or other docnment with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described hereio is subject to all the tenus, <br />excInsíons and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br /> <br />MASTER POLICY NUMBER: 04SEPlOOOOOI <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 <br /> <br />EXPIRATION: JANUARY I, 2005 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />General Aggn:gate Limit <br />IToducts & Co~leted Üpenltions <br />Personal & Advertising Injury <br />Each Occurrence Limit <br />Fire Damage (Any One Fice) <br />Medical Payments (Any One Person) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTIBLE, NONE <br /> <br />$ 2,000,000 <br />I ,000,000 <br />1,000,000 <br />I,OOO,ooo <br />50,000 <br />5,000 <br /> <br />The limits of insuranee apply separately to each evenl insured by this policy as if a separate policy of insurance has been issued for that event. <br />"Who is insured" is amended to include. as an imueed, the _on or organization shown in ibis sebedule, but only with respect 10 liability arising out of the <br />ownership, mainlenanee or use ofthe pcemises used by the named insured (event holder). This insurance does not apply to' Any "oceu.,."ee" which takes place <br />after the event holder ceases to he a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br /> <br /> <br />CANCEl LA nON, Should Ibe above described policy to cancelled hefore the expiratioo date thereof, Ihe issuing company will",.;¡ 30 days written notice to the <br />certificate holder and addilional insureds listed, <br />AUtHORIZeD ""REmOn" A TIV. ~~ <br /> <br />DATE ISSUED: January 14, 2004 ' <br /> W'" <br /> / r31~ "'1 <br /> <br />