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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: - <br /> CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br /> SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Allíant Insurance Services Cay 06 San:t:a. Ana <br />P. O. Box 28323 20 C,¿v'¿c. Ce.nteA P.(aza, M-28 <br />Santa Ana, CA 92799-8323 San:t:a. Ana, CA 92701 <br />(949) 660-8 I 63 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />E¿,;the.!l. ConVt.e.!l.M TYPE: I M.tJULc.Uona.t - AJ¡;tJ., & ClUll.tfJ <br />4840 Rando4 Avenue. DATE(S): 6/02/04 - 12/3//04 <br />Lal2ewood, CA 90713 LOCATION: MrmnniaP/Mcfaddpn rrn.trn~ <br />Ths 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, 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. Linùts shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEPIOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY 1,2005 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />General 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 />$1,000,000 <br /> ,000,000 <br /> ,000,000 <br />1,000,000 <br />50,000 <br />5.000 <br /> <br />The limits of insurance apply separately to each event insured by this policy as jf a separate policy ofínsurance has been issued for that event. <br />"Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the <br />ownership maintenance or use of the premises used by the named insured (event holder) This insurance does not apply to' Any "occurrence" which takes place <br /> <br />after the event hoJder ce8$es to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancel1ed before the expiration dale thereof. the issuing company wil1 mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />AmHOR",,,,,,,""'N"''''E, 10~ <br />DATE ISSUED: 5/18/04 ,ytU/l~jf~C(~ <br />