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<br />r <br /> <br />EVANSTON INsURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />Cf:RTD1CAT£ OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPUCATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODVÇER: <br /> <br />PUBLIC ENTITY (ADDmONAL INSURED) <br /> <br />Driver Alliant Insurance Services <br />P. O. Box 28323 <br />Santa Ana, CA 92799~8323 <br />(949) 660.8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT H?LJ?£R, !.~ ," C' <br />fJ - ,IN:)' -1.),/) <br />Da.niel Aêharz' tV - ,.";{Ct../.3,' ¿: 1 J <br />^/ ' -) "[' '1 _/).A.o <br />IV.. 0:-"'\./ '.o;~. .... TO <br /> <br />City of Santa Ana <br />20 Civic Center Plaza, <br />P.O. :Box 1988 <br />Santa Ana, CA 92702 <br /> <br />M-28 <br /> <br />EVENT INFORMATION: <br />TYPE: Self Improvement <br />DA~S): 1/14/04 - 12f31/04 <br />LOCATION: S.A. Jail <br /> <br />This is 10 certity that the policies of insurance listed below have been issued 10 the insured named above for the policy period <br />i.ndíèåted. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to w1Uch this <br />certiñcate may be issued or may pertain, the ÌDSurance afforded by the policies described herein is subject to all the terms, <br />exc1usiotls and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston insurance Cömpany <br /> <br />MASTER POLICY NUMBER: 04SEPIOOOOOl <br /> <br />MASTER "OLlCY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION; 1ANUARY 1, 2005 <br /> <br />CQMMER.CIAL GENERAL LLUtLITY <br />Œ::ner:a1 Aggregate Jj mit <br />ProdLldS & Complc:tcd OpenItions <br />Pel$M# & Adyertj$ing Injury <br />EAch OccUlTe~t'e Limit <br />Fin: Damage (Any Ont' Fire) <br />Medical PJlytne'1ts (Any One Pc::rsan) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTIBLE: NONE <br /> <br />S 2,000,000 <br />1,000.000 <br />1,000,000 <br />1.000.000 <br />SO.OOO <br />5.000 <br /> <br />The limit& of insurance a) ply separately to ~h event insured by tbis policy AS ifascparatepolicy ofilalll1llnce baa been issued for thatcvmt. <br /> <br />~Who is insured" is amr¡ndcd to include. as.u ill8U~. tJte pcr.ioo or organization Mown in.dli, ,çhedule, but only witn respect to liability arising out oflhc <br />owncrsbi¡>. maintenance or Use of the promises tIsed by !tie IWI1ed i:asured (evenl bolder). This in'u1'8fIcc does not apply to: Any "OCCI.DTc:nc:e" whichlak¡:¡ plac% <br />afttr the evalt holder ceases to be a tenant in tiJat premiscs. <br />OTHER ADDITIONAL INSUREDS <br />CANCELL\ TJQN~ Should £he above described policy to caoccl1ed before the expìl'llÓOll date Ihereof. tile i5Slring company wjJ lJ1IIiJ 30 days Wlittcn notice to ÙIC <br />certificate holder and BdditiDllaJ insuroda listed, <br />AUTHORIZED REPRESENTATIVE, ~~ ~} <br />'~ .~ (X'7 <br />DATE ISSUED: January l4, 2004 <br />