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<br />EV ANSTON 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: <br /> <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br /> <br />Driver Alliant Insurance Services <br />P. O. Box 28323 <br />Santa Ana, CA 92799-8323 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />. Mic.hael. MtjeJU> <br />16327 Mil1..6tJteam Lane <br />C~o~, CA 90703 <br /> <br />Ciltj 06 San:ta. Ana <br />20 Civic. Cen:teJt Plaza, <br />Santa Ana, CA 92701 <br /> <br />M-28 <br /> <br />EVENT INFORMATION: <br />TYPE: I n-6Vw.ilio nal - T enrU/.> <br />DATE(S): 7/12/04 - lZ!31!04 <br />LOCATION: Cabtúlio TenrU/.> Cen:teJt <br /> <br />TIùs 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 /> <br />MASTER POLICY NUMBER: 04SEPIOOOOOl <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 <br /> <br />EXPIRATION: JANUARY 1,2005 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />General Aggregate Limit <br />Products & Completed Operations <br />Personal & Advertising Injury <br />Each Occurrence Limit <br />Fire Damage (Any One Fire) <br />Medical Payments (Any One Person) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTIBLE: NONE <br /> <br />$ 2,000,000 <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />50,000 <br />5,000 <br /> <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. <br /> <br /> <br />"Who is insured" is amended to in dude, as an insured, the person or organization shown in this schedu]e, but only with respect to liability arising out of the <br /> <br />ownership, maintenance or use of the premises used by the named insUTed (event holder). This insurance does not apply to: Any "occurrence" which takes place <br /> <br />after the event holder ceases to be a tenant in that premises. <br />OTHER ADDITIONAL INSUREDS <br /> <br />CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds ]isted. <br /> <br />AUTHORIZED REPRESENTATIVE, ~~ <br /> <br />DATE ISSUED: 5/18/04 <br /> <br />~AA~7 <br />