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<br />EV AÑSTON INSURANCE COMPANY <br />CERTmCATE NO.: <br /> <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPUCA110NS FOR NOMINEE EVENTS. <br />SPECIAL EVENT UABILITY PROGRAM <br /> <br />PRODUCER: PUBUC ENTITY (ADDmONAL INSURED) <br />Driver Alliant IDsuIance Services City of Santa Ana <br />P. O. Box 28323 20 Civic Center Plaza, M-28 <br />Santa ADa, CA 92799-8323 P.O. Box 19BB <br />(949) 660-8163 Santa Ana, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOlDER): EVENT lNFO~ON: v.. <br />A£'6Jr.edo A£.vaJt.a.do TYPE' 1Jmna.ð e6 . <br />1419 S. Syc.wnoJr.e, #6 DA~S): lIS - 1~/jl104 <br />Santa AM, CA 92701 LOCATION: JeMme Le.n.:ceJr. <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 allY requirements, terms or COnditiODS of allY contract or other document with respect to which this <br />certifi<:ate may be isaued or may pertaiD, the insurance afforded by the policies described herein is subject to .n the terms, <br />exclusions and COnditiODS of such policies. Limi1s shown may have been rednced by paid claims. <br />INSURANCE CARlUER: Evanston Inauratll:e Company <br />MASTER POLICY NUMBER: 04SEPlOOOOOI <br />MASTER POUCY DATES: EFFECTIVE: JANUARY 1,2004 EXP1RA110N: JANUARY 1, 2005 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />am..,,¡ Awep'" umit S 2.000.00o <br />- & Completed Openttions 1,000,000 <br />Persona) & Advertising Injury 1,000,000 <br />Each Occurrcncc Limit 1.000,000 <br />Fire ~ (Any One Fire) 50,000 <br />Medico! Paym,r"s (Any One Forson) S,OOO <br />The limits of insurance apply Icparatcly to each cwnt mlunJd by Ibis policy as if a seøarate øolicy of inaurance hu been Wued for that event. <br />"Who is inIumI" hi amended to include, 81 an insured, the person or orpniødon shown in ,this 8CbcduIc. bu1 only with relpectlO liabiUty arising out of1he <br />ownership, n-.intenance or use ofthc pwernises UICd by the named insured (evcut holder). This insurInce doe¡ not apply to: Any "occum:ncrJ' which takes place <br />after the evt:nt holder ceasellO be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above dcacribod policy to cancelled before me expiration date thereof. the iAuins çompeny win mail 30 days writton notice to the <br />certificate hoktcr and 8dditìonaI inIurcds listed. <br /> <br />AUTHORIZED REPRESENTATIVE: ~~ <br />DATE ISSUED: 115/04 <br /> <br />',J'jIUUV}';J"' <br /> <br />!':' ..'" ':JV:. <br /> <br />-~.. <br /> <br />~¡~':'¡:Ha¡li. (,.,'11.)' }-\IU'I-'.è'. <br />