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<br />- <br /> <br />EV ANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLlCATJONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT UABWTY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDmONAL INSURED) <br />Driver Alliant Insurance Services City of Santa Ana <br />P. O. Box 28323 20 Civic Center Plaza, M-28 <br />Santa ADa, CA 92799-8323 r.O. B~~ 1986 <br />(949) 660-8163 Santa Ana, CA 92702 <br />License No: OC 36861 <br />NAMEP INSlJRED (tNEN!' HOLDER): EVENT INFORMATION: <br /> ¡..) . d.(i'C~ ( g'l TYPE: Self Improvement <br />Tony Delgado ,. '-jJ - JD0:J-'- ì 14- DATE(~): 1/14/04 - 12/31/04 <br /> /1,' :),(]Cb . - ("15 LOCATION: S.A. Jail <br />This is to certify that the policies of iœurance listed below have been issued to the insured named above: for the policy period <br />indièåtcd. NotWÏth~taDd.ing any rcquiJerne1ÚS, tenDS Dr conditions of my contract or other document with respect to wmch this <br />certificate may be issued (Jr may pertain. the insurance afforded by the policies descn'bed herein is subjec;t to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INStTRANCE CARRIER: Evanston Insmaø;e Company <br />MASTER POLICY NUMBER: 04SEPlOOOOOl <br />MASTER POLICY DATES; EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY 1, 2005 <br /> I <br />COMMERCIAL GENERAL LIABIunr OCCURRENCE FORM ùEDUCTmLE: NONE <br />G1mcral Aggregate Limit S 2,000,000 I <br />Producta 8t. Completed OperàtiOl'ls 1,000.000 <br />Personal & AdvCl1ising Injury 1,000,000 <br />Each OccUITC!1CC: Limit ],000,000 <br />FiTe Damage (Any One Fire) 50,000 <br />MalicaI Pa.ymeng; (Any One Person) ~,OOO <br />The limits ofìnsurance app]y separately tocach event insured by !hÏ5policyas ifueplnttepolìcyofiJliW'llnce hubecn issued for that evcnl. <br />KWJIo is inlfLlred" is alJ1C1Jdec to incl"óe. iii ~ í~, the J'C"SOn Of orpniPticn show¡¡ in,tbi, ¡çbcduk. but only wilh rupcçllO ]iabilitylU'iIPing outofthc <br />ownership, naintenance or life of the premiSCli UKd by !be named insUTCd (CYÇnt holder). This msurancc doc$ not apply to: Any ~ocçurrcnce" which likes pIaçc <br />after the ~ll1oldcr CCilSQ 10 ~ a tcnant in dial JIRI1'Ûse5. <br /> OTHER ADDITIONAL lNSUIUIDS <br />CANCELLA nON: Should the above òC$I;I'Îbcd poHcy to cancelled before the expiration dau: thereof, the issuing ~y wiU mail 30 days written notice to me <br />cel1ifig¡tc IIOld~ and additional ÌII5\m:IIb listed. <br /> <br />AVTHORIZED REPRESENTATIVE, ~A'~ <br />DATE ISSUED: January 14, 2004 <br /> <br />'(31 ~ <br />./\.iLßV, <br /> <br />