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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 (ADDmONAL INSURED) <br />Driver Alliapt Insurance Services C~y On Santa A~a <br />P. O. Box 28323 20 Civic. Centelt- Plaza, M-28 <br />Santa Ana, CA 92799-8323 Santa Ana, CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />C h:ti6 til1e A~g e.eLi. TYPE: 1 V1},Iflll ('finVll1f - rJraa:t;, <br /> DATE(S): 2/07/05 - 6/,0/0; <br />N -;;{ 005-- 0 I L LOCATION: SaRgado rvn:tV!1 <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 contIact or other document with respect to which this <br />certificate may be illsued or may pertain, the insurance afforded by the policies described herein ill 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 UABIUTY OCCURRENCE FORM DEDUCTIBlE: NONE <br />General Aggregate Limit S 2,000.000 <br />Products & Completed Oper.llions 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fi.. Darnase (Any One Fire) SO,OOO <br />Medical Payments (Any One Penon) S ,000 <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of inSllJ'8DCe has been issued for that event. <br />"Who is insured" is amended to include, iii an insured, the person or organization shown in this schedule, but only with respect to liability arising out of tile <br />ownenhip, maintenance'" use of the premises used by the named insured (event holder). This inSUl1lllCC does not.JRI'Il'~~ v.<I'(retap(J~ <br />after the event holder <<ases rObe a tenant in that premises. . P <br /> OTHER ADDITIONAL INSUREDS / WLQ...--Cd'A-, <br /> "'Laura Stitt Sheedy , <br /> ASSIstant City Attorney <br />CANCELLATION. Should the above described policy to cancelled heron: the expiration date thereof, the issuing company will mai130 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTIIORIZED REPRESENTATIVE: <br /> <br />~~~ <br /> <br />DATE ISSUED: <br /> <br />2/07/05 <br />