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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 Alliant Insurance Services Cay 06 Sa.n-ta. Ana. P. O. Box 28323 20 C~v~c Cente~ Pla.za., M-28 Santa Ana, CA 92799-8323 Sa.n-ta. Ana., CA 92701 (949) 660-8163 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: SUv~ Rom~o TYPE: A~o b~c CW.6e..6 DATE(S): 5/03/04 - 12/31/04 17045 MedalUon, #49 LOCATION: Salaa.do Cent~ TU..6.ti.n, CA 92780 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, tenns or conditions of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the tenns, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEPIOOOOOI MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY I, 2005 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCrffiLE: NONE General Aggregate Limit $ 2,000.000 Products & Completed Operations 1.000,000 Personal & Advertising Injury 1.000,000 Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 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. "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 Tlamed insured (event holder). This insurance does not apply to: Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS 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. A"",OR""""''''''''AT'", 10~ DATE ISSUED: 4/29/04 /,, (/ff~u c:.Ji;y {/lIy