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<br />. <br />EVANSTON INSURANCE COMPANY <br />CERTIF1CATE NO.: <br /> <br />CERTIF1CA TE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: <br /> <br />PUBLIC ENTITY (ADDffiONAL INSURED) <br /> <br />Driver AIliant 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 HOLDER): <br /> <br />CWUna MOJ!.gel11andeJt <br />1230 S. Van Ne6~ Avenue <br />Santa Ana, CA 92707 <br /> <br />Calf a 6 Santa Ana <br />20 C-i.v-i.c. Cen-teJt P.taza, <br />Santa Ana, CA 92701 <br /> <br />M-28 <br /> <br />0 <br /> <br />EVENT INFORMATION: <br />TYPE: AeJtob-i.c. & Sa..t6a C.taMe6 <br />DATE(S): 5/3/04 - 12/31/04 <br />LOCATION: Vt1JÚOl1.6 Cen-teM <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 />indièated. 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. Umits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br /> <br />MASTER POLICY NUMBER: 04SEPlO0000I <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 <br /> <br />EXPIRATION: JANUARY I, 2005 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />General AggregAte Limit <br />Products & Completed Operations <br />Personal & Advertising Injury <br />Each OccuITence Limit <br />Fire Damage (Any One Fire) <br />Medical Payments (Any One Person) <br /> <br />OCCURRENŒFORM <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 />The limits of insurance apply separately 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 include. as an insured, the person or organjzation shown in this schedule, but only 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 pJace <br />after the event ho]der ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br /> <br />CANCELLA nON: Should the above descnèed poJicy to cancelled before the expiration date thereof. the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds hsted. <br /> <br />AurnO"',," ""',,"mITATIV>;, ~%- <br />DATE ISSUED: 4/29/04 <br /> <br />r;Yt£~M3~]{'. 'y <br /> <br />JW}- <br />