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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 (ADDmONAL INSURED) <br /> - <br />Driver Alliap.t Insurance Services CUy 06 Santa. Ana <br />P.O.Box28323 20 C~v.ic C entu P .la.za., /.1-28 <br />80013 Ana, CA 92799-8323 Santa. Ana., CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOlDER): . . EVENT INFORMATION: <br />S~v~ Rom~o N - .),{)(Y!-C3') TYPE: Aphnbic}, <br />17045 Meda..e..Uon, #49 ",--cJ.DCt/- oY';- 01 DATE(S): "Inqln~ - 1?1"lln~ <br />T ULltin, CA 92780 LOCATION: ~nignrln ('OIllTOh <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 rc.,";'""",nts, tenDs or cODditions of any contract or other document with RSpeCt to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the tams, <br />exclusions and conditions of sw:h policies, Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: BVIID8ton Insurance Company <br />MASTER POLICY NUMBER: 05SEPlOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL UABIUTY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Agreple limit $ 2,000,000 <br />Produ... & ClJD1>leted Operati... 1.000,000 <br />- & Advcrtismlllljury 1.000,000 <br />EacI1 Occutrence limit 1,000,000 <br />Fn. Domage (Any One Fn.) 50,000 <br />Medical Payments (Any One Penon) S,OOO <br />The limits ofiu8unncc opply oepon1dy 10 eacb """". i:wmI by lhiJ poIic:y.. if. _Ie policy of illIUIlIIll:C bas boon isauod few tbat event <br />"Who is insw-ed" is amended to include" as.. insured. the pason or arpnizatim shown in this ICbedulc. but ooIy with rcrpc:ct 10 lillrility arisina out oCtile <br />own_ip. main_ or uae of tile promiaca used by tile named inau.... (....t bolder). Thi. msul1lllCC does not opply 10: Any "cx:c:um:nce" whicb takes plocc <br />afterthe event holder ceases to'be a tmant in that premises. <br /> OTHER ADDmONAL INSUREDS <br /> . <br />CANrF..t I.A TJON: Should the above described policy 10 cancelled before the expiration dare thereof. the issuing company win mail 30 days written notice to the <br />certificate holder and additimal insureds listed. <br /> <br />,- <br /> <br />AUTIfORIZED REPRESENTATIVE: <br /> <br />~~~ <br /> <br />. S TO F01UYl <br />APPROVED A <br />~t2- ----- <br />C"tV /,',. , <br />Asslstant JI <br /> <br />DATE ISSUED: MMc.h 9. 2005 <br />