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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: - <br /> <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEP ARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: <br /> <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br /> <br />Driver Alliant 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 />Re.ne.e. Sanc.he.z <br />25062 Camino vet Man, #8 <br />Laguna Niguet, CA 92677 <br /> <br />Cily 0 ð San.:ta. Ana <br />20 Civic. Ce.n:tVt Plaza, <br />San.:ta. Ana, CA 92701 <br /> <br />M-28 <br /> <br />¡./ -~oo4 -031 <br /> <br />EVENT INFORMATION: <br />TYPE: IVlld"JlllC';tioVlai - Yoga <br />DATE(S): f¡/07/04 17/'il/04 <br />LOCATION: SnP:Jndn reVlteh <br /> <br />TIlls 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, tenns 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 tenns, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br /> <br />MASTER POLICY NUMBER: 04SEPIOOOOOI <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2004 <br /> <br />EXPIRATION: JANUARY 1,2005 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />Genera] Aggregate Limit <br />Products & Completed Operations <br />Personal & Advertising Injury <br />Each Occurrence Limit <br />Fire Damage (Any One Fire) <br />Medical Payments (Any One Person) <br /> <br />OCCURRENCE FORM <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 appJy 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 organization 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 hoJder). 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 /> <br />OTHER ADDITIONAL INSUREDS <br /> <br />CANCELLA TION: Should the above descnòed policy to cancelled before the expiration date thereof, the issuing company win mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AlffHORIZED REPRESENTATIVE: ~~ <br /> <br /> <br />DATE ISSUED: 5/18/04 <br /> <br />P::£H~cLy <br />