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<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: <br /> <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br /> <br />rv ./ ?-DDl.. -\ 2- ~ <br />\'-I ,~ ì- o.?z- - D 'Y.~ <br />Driver AlliO 1t Insurance Se1Vices ~ v '2-co a; -oq c> <br />P. O. Box 28323 .. J ..., --:0. <br />Santa Ana, CA 92799-8323 - - ¿...o.::> J - Ot[ <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOlDER): <br /> <br />Cay 06 Santa. AM <br />20 CiviC'. Ce.n.teJL pfuza, M-28 <br />Santa. AM, CA 92701 <br /> <br />, <br />, <br /> <br />EVENT INFORMA,TION: . -" - "6 <br />TYPE: InMJULc.:Uon"""-S",,, <br />DATE(S): I/Ub/U~ - 12/jl/U' <br />LOCATION: S.A. JlUL <br /> <br />ImpJtov eme.n.t <br /> <br />Varúe.i Aeha;tz <br /> <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 />indicaied. Notwitbstanding any requirements, terms or conditions of any conllaCt or other docwnent with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies descnDed herein is snbject to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. ' <br />INSURANCE CARRIER: Evanston Insuxance Co¡q>any <br /> <br />MASTER POLICY NUMBER: OSSEPlOOOOOI <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2005 <br /> <br />EXPIRATION: JANUARY 1,2006 <br /> <br />COMMERCIAL GENERAL UABIUTY <br />General A¡sreplc Linùl <br />Prod.... '" Comp1etod Operations <br />Personal '" A<Mrtising InjUl}' <br />Each 0c<una1ce linùl <br />Fire Domoge (Any One Fire) <br />Medical Payments (Any One Person) <br /> <br />OCCURRENCE FO!!M <br /> <br />DEDUCTIBLE: NONE <br /> <br />$ 2.000.000 <br />1.000.000 <br />1.000,000 <br />1.000.000 <br />50.000 <br />s.ooo <br /> <br />, <br /> <br />The limits of insurance apply separately to each event jnswœ by 1his poIjçy as jf. separate policy of insunmce has been ilSUcd for that event <br />"Who is insured" is amended to include, as on insured, 1he person ar arpnizatiœ shown in this schedule, bul only with respect to liability arising out of 1he <br />ownership. maintenance ar use of the prcnù... used by \be named insured (ev"l hoId..~ This insunutœ docs nOI apply to: Any "occurrence" which lakes p1occ: <br />after the event holder ceases to'be a tenant in that premises. <br />OTHER ADDmONAL INSUREDS <br /> <br />, <br /> <br />CANCEl 1 A TION' Should the above descnòc:d poJicy to cancelled before the expiration date thereof. the issuìng company win mail 30 days written notice to the <br />ccrtificalc holder and additional insureds listod. <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />~;Z~ <br /> <br />c.-/. . <br />,/¿:~/Lt: .(; /Lt" í <br />v ' / <br /> <br />DATE ISSUED: <br /> <br />Ja.nu.iVlY 6, 2005 <br />