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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 Alliant Insurance Services Cay 06 Sa.rda. Ana. <br />P. O. Box 28323 20 C~v~e Cent~ Pla.za., M-28 <br />Santa Ana, CA 92799-8323 Sa.rda. Ana., CA 92701 <br />(949) 660,8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Va.rùe.l JohnMn TYPE: I Yl.6;/:.1tuiliona£ - Mu..6~e <br />2140 E. S~~Yl.6 Avenue DATE(S): 6/05/04 - 12/31/04 <br />La. Ha.bJta., CA 90631 LOCATION: J~ome ReCJ1.ea..Uon Cent~ <br />. . <br /> <br />This IS to certIfy that the poltcles of Insurance hsted below have been Issued to the msured named above for the poltcy penod <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. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br /> <br />MASTER POLICY NUMBER: 04SEPIOooOO¡ <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 <br /> <br />EXPIRATION: JANUARY I, 2005 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />General Aggregate Limit <br />Products & Completed Operations <br />Personal & Advertising Injury <br />Each Occurrence Limit <br />F D (A 0 F ) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTIBLE, NONE <br /> <br />>TO amage ny no ". <br />Medical Payments (Any One Person) 5.000 <br />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. <br />"Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liabiJity 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 />after the event holder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancened before the expiration date thereof, the issuing company win mail 30 days wriUen notice to the <br />certificate holder and additional insureds listed. <br />AUŒO"''''' R8'RE"NTATIVE, é:&.~ ;#;~~1 <br />DATE ISSUED: 5/18/04 <br /> <br />$ 2.000,000 <br />1.000.000 <br />1.000.000 <br />1,000,000 <br />50 000 <br />