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<br />,- . <br /> <br />. <br /> <br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE 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 (ADDITIONAL INSURED) <br />Driver Alliapt Insurance Services Calf 06 Sa.nta. Ana <br />P. O. Box 28323 20 C~v~c Cent~ 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 INFORMATION: <br />Janet Shermer tJ - ,}.ocJf-- ole [1 TYPE: Pi:aRS <br />34 Brisbane Way /J.- ~Oc:4.{)r.:O'-0f DATE(S): &1 gal T.T3.Gor CeRtsr <br />Irvine, CA 92612 0 LOCATION: 4/1R/O'i - 1?/'l1/O5 <br />1bis 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 descn1led 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 />MASTER POLICY NUMBER: 05SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL LlABIUTY OCCURRENCE FORM DEDUCTIBLE: NONE <br />Gmenl Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />The limits of insurance apply sepanately to c=ach event insured by this policy as if a scpan.te policy of in.urance has been issued fOT 1hat event. <br />"Who is insured" is amended to include. as an insured. the person or organization shown in this schedule, but only with rc:spec:t to liability arising out of the <br />ownership, maintenance or use of the premiSC5 used by the named insured (event holder-). This insurance docs not apply to: Any"occurrence" which takes place <br />after the event holder ceases to'bc a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br /> A.PPROVED AS TO FORM , <br /> ~g;/{?~J(l / -- <br /> I Lau," , . <br /> Assistant City Attorrll.''/ <br />CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />~-/~ <br /> <br />DATE ISSUED: <br /> <br />April 1 R, ?OO'l <br />