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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: - CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) Driver Alliam Insurance Services City o b Santa Ana 20 Civic Centim Ptaza, M -28 P. O. Box 28323 Santa Ana, CA 92799 -8323 Santa Ana, CA 92701 (949) 660 -8163 License No: OC 36861 NAMED INSURED (EVENT HOLDER): /J- o { o � . EVENT INFORMAT12N. a Sa2aa Dancing �JCtt Sae.omon RiveAa - au`,f - " °( TYPE: DATE(S): 2/23 0 - 1 709 S. Pa�ttan StAeet LOCATION: Southwebt Senzoh Cen-teA Santa Ana, CA 92701 This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this certificate maybe issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, and conditions of such policies. Limits shown may have been reduced by paid claims. exclusions INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 05SEP100000I MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2005 EXPIRATION: JANUARY 1, 2006 COMMERCIAL GENERAL LIABILITY OCCURRENCEFORM DEDUCTIBLE: NONE General Aggregate Limit 5 2,000,000 Products & Completed Operations 11000,000 Personal & Advertising Injury 1,0001000 Each Occurrence Limit 11000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 51000 The limits of insurance apply separately so each event insured by this policy as if a separate policy of insurance has been issued for that event "Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the ownership, maintenance or use of the premises used by the named insured (event [older). This insurance does not apply to: Any "oceurrenee" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS APPROVED AS TO FOR:,, i - uea, — Stitt Shee Assistant City Attornov CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: Febxuany 23, 2005