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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: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver AlIiant Insurance Services Cily on San:ta Ana <br />P. O. Box 28323 20 Civic Ce.~eJl. Plaza, M-U <br />Santa Ana, CA 92799-8323 San;ta Ana, CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Tom BJtown ¡J- ~ooLj- 044 TYPE: I nJ.¡bwc:tiona.t - Pain.:tinq <br />4 L e. e. S:tJt e. e.:t DA TE(S): 8/06/04 - IV31104 <br />IJtvine., CA 92620 LOCATION: MpmoJuéaf/El Sa.i.vadoJt Ce.~eJl. <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 contract 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 />MASTER POLICY NUMBER: 04SEPl 000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY 1,2005 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />The limits of insurance apply separateJy to each event insured by this policy as if a separate policy of insurance has been issued for that event. <br />"Who is insured" is amended to incJude, as an insured, the person or organization shown in this scheduJe, but onJy with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLA TION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed, <br /> <br />AUTHORIZED REPRESENTATIVE, ~~ <br /> <br />DATE ISSUED: 5/18/04 <br /> <br /> <br />~~~ <br />