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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: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Alli8 1t Insurance Services C.alj 06 San-ta. Ana. <br />P. O. Box 28323 tJ /' òV oV\ ..-~CX~. 20 Civic. Ce.n;tvr. Plaza, M-28 <br />Santa Ana, CA 92799-8323 San-ta. Ana., CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENf HOWER): ' EVENT INFORMATION: <br />Sovúa M-i..6kulin I TYPE: VnVl(t() <br />Ac.ade.mlj 06 I n;t'l. Vanc.e. DATE(S): lln~/nç - 1?/~llnç <br />2409 S. Rda. Walj LOCATION: UnhjQfI~ <br />San-ta. Ana. CA 92704 <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, tenns or conditions of any contract or other document with respect to wlúch 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: 05SEPlOOOooI <br />MASTER POLICY DAmS: EFFECTIVE: JANUARY 1,2005 EXPIRATION: JANUARY 1.2006 <br />COMMERCIAL GENERAL L\ABIUTY OCCURRENŒ FORM DEDUCTffiLE: NONE <br />General A¡øreptc Limit S 2,000,000 <br />Products & Completed Open¡riOll. 1.000,000 <br />Personal & Advertising Injury 1,000.000 <br />Each Occurrence ümit 1,000.000 <br />Fin: Damage (Any One Fire) 50.000 <br />Medical Payments (Any One i'eßon) S.ooo <br />The limits of insunmce apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event <br />"Who is insured" is amended tD include, as an insured, the pason or organization shown in this schedule. but only with respect to liability arising out of tile <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrencc" which takes place <br />after the event holder ceases to' be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br /> /J- <br /> ~ '/ <br /> ;/~ <br /> v <br />CANCELLATION' . Should the above described po1icy to cancened before the expiration date thereof, the issuing company will mai1 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTHORlZED REPRESENTATIVE: <br /> <br />~~~ <br /> <br />DATE ISSUED: <br /> <br />1/03/05 <br /> <br />