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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: - <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Alliant Insurance Services <br />City of Santa Ana <br />P. O. Box 28323 <br />20 Civic Center Plaza, M -28 <br />Santa Arta, CA 92799 -8323 <br />P.O. Box 1988 <br />(949) 660 -8163 <br />Santa Ana, CA 92702 <br />License No: OC 36861 <br />NAMED INSURED (EVENT BOLDER): <br />EVENT INFORMATION: <br />etf - - 1/ j <br />TYPE: Self Improvement <br />Ron Israel 3 <br />DATES: 1/14/04 - 12/31ZQ4 <br />' 3 C (4( <br />LOCATION: _ -..As_" t <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 />indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the insurance 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 04SEPI000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2004 EXPIRATION: JANUARY 1, 2005 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTBIE: NONE <br />G6cral Aggregate Urnit $ 2,000,000 <br />Products & Completed Operations 11000x000 <br />Personal & Advertising Injury ] ✓000,000 <br />Each Occurrence limit 1,000.000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payn eats (Any One Person) 5,000 <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of ingn"ce has been issued for that event. <br />"Who is iostured" is sounded to include, as an irttiured, the person or or$anbatioo shown in this schedule, but only with rrxpect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insure = does not apply to: Any "occurrence" which takes place <br />after the event holder Ct13CS to be a tenant in tlWt premises. <br />OTHER ADDITIONAL INSUREDS <br />CANCF,LAA119N Should the above described policy to cancelled before the expiration date ahueof, the issuing company wil t mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: January 14, 2004 _ _ <br />