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<br />EVANSTON INSURANCE COMPANY <br />CERTIF1CATE 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 (ADDffiONAL INSURED) <br />Driver AlIiant Insurance Services C.í..tlf 0 ß San.ta. Ana <br />P. O. Box 28323 20 C'¿v'¿c. Ce.n.teJ/. Plaza, M-28 <br />Santa Ana, CA 92799-8323 Sa.n.ta. Ana, CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMAp:ION: <br />Jane.;(; Sc.he.Jur1eJ/. TYPE: .(.I1.no ClaM e.I> <br />34 BtUòba.ne. (¡Jalf DATE(S): ~/UI!U4 - IZ/51/U4 <br />IJtv'¿ne., CA 92612 LOCATION: VaJuOM LOC.a.tWM <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 />indièated. 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 />It""SURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEPlO0000l <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2004 EXPIRATION: JANUARY 1,2005 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE, NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1.000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each OccuITence Lîmit 1,000,000 <br />Fjre Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />The limits of insurance apply separately to each event insured by this policy as jf a separate pohcy 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 premîses used by the named insured (event holder). This insurance does 110t apply to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premses. <br /> OTHER ADDITIONAL INSUREDS <br />CANCF.LLA TlON: Should the above described policy to cancelled before the expiration date thereof, the issuing company win maH 30 days written notice to the <br />cenificate hoJder and additional insureds listed. <br /> <br />AmHORŒEORill''''''''''TIVE, '&.~ <br />DATE ISSUED: 4/29/04 <br /> <br />/\ C' <br />(1ci1/,J/\L ,fly <br /> <br />I <br />/IAß [}-- ! <br />