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<br />BV ANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE , <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE E"W'''''''' <br />SPECIAL EVENT LlABllJTY PROGRAM . <br /> <br /> - <br />PRODUCER; PUBUC ENTITY (ADDITIONAL INSURED) <br />Driver Alliapt Insurance Services Cäy on Santa. AIIIl . <br />p, O. Box 28323 20 C~v~e Cent~Plaza, M-28 <br />Santa Ana, CA 92799-8323 Santa. AIIIl, CA 92701 <br />(949) 660-8163 <br />License No; OC 36861 <br />NAMED INSURED (EVENT HOLDE13i . EVENT INFORMATION; <br />AinJtedo AtvMado tJ, ~~ (I') TYPE; I 11.6:t1tuc.t,¿o IIIli - Gtll/lnMUCh <br />1419 S. SyeamoJte, #6 IV --'2.,.;>0'3 -U 3-q DATE(S): 1/01/05 - 12/31/05 <br />Santa. Ana, CA 92701 LOCATION: lohnm() Crn:tPJt <br />This is to certify that the policies of insurance listed below have been issued to the msured named above for the policy period <br />indicàted. Notwithstanding any requirements, terms or conditinns of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the msurance 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 />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 05SEPlOOOOOI <br />MASTER POLICY DATES: EFFECTIVE; JANUARY 1,2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL L1ABIUTY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operaricms l~OOO.OOO <br />Personal & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any On. Fire) 50,000 <br />Medical Payments (Any On. Pmon) 5,000 <br />The limits of insurance appJy separately to each event insured by this policy as if a scp8I'Ite policy of insurance has been issued for that evenL <br />"Who is insured" is amended to inc1ude, II an insured, lite person or organization shown in this schedu1e. but only with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance docs not apply to: Any"occurrence" which tabs place <br />after the event holder ceases to'be a tenant ìn that premises. <br /> OTHER ADDmONAL INSUREDS <br /> , <br />CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail30 d~ written notice to lite <br />certificate holder and additional insureds listed. <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />~/~ <br /> <br />~~ <br /> <br />DATEISSUED:--12/28/04 <br />