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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 AlIiant Insurance Services P. O. Box 28323 Santa Ana, CA 92799-8323 (949) 660-8163 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EtUc. M. Sern.e JII-J,j)t>i-o~ 516 W. 17th S~eet, #C San:ta Ana., CA 92706 Cdy 06 San:ta Ana 20 Ci.vic. CenteJt P.fA.za, San:ta Ana, CA 92701 M-28 EVENT INFORMATION: TYPE: lionPth f. ¡=itMO^^ - 1MktJrIlCtÅ..on DATE(S): t;/It;/n4 - 1?/~1/n4 LOCATION: L~fl''4' BQ!lleÜ~3' ('q~tqh llis is to certifY that the policies of insurance listed below have been issued to the insured named above fOT 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 OT may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEPlOOOOOI MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY I, 2005 COMMERCIAL GENERAL LIABILITY General Aggregate Limit Products & Completed Operations Personal & Advrnising Injury Each Occurrence Limit Fire Damage (Any One Fire) Medical Payments (Any One Person) $ 2,000,000 1,000,000 1,000,000 1,000,000 50,000 5,000 OCCURRENCE FORM DEDUCTIBLE: NONE The 1imits 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 named 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 descnòcd poJicy 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<ITHORmIDRill'RE"'NTATN& 1,;,~ DATE ISSUED: 5/18/04 ~?