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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: PUBUC ENTITY (ADDmONAL INSURED) <br />Driver Alli8¡1t Insurance Services C.äy 011 Santa. AM. <br />P. O. Box 28323 20 C~v~e Cent~ 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 />Su.6an Blaek. TYPE: I f'udtLuc.:tio nlLt - CJtoehe:Unq <br />Ai" ;}..où5 ,- Od-I DATE(S): 2/07/05 - 6/30/05 <br /> LOCATION: SlLtBado C p ntp.!t <br />TIùs i~ to certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indicàted. 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 a111he 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 I, 2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL UABIUTY OCCURRENCE FORM DEDUCTIBlE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Opera~ons 1.000.000 <br />Personal & Advertising Injury 1.000,000 <br />Eacb Occurrence Limit 1.000,000 <br />Fire Damage (AnyOne Fire) 50.000 <br />Medical Payments (Any One Person) s,ooo <br />The IimiU of insurance apply separately to caeh event insured by this poticy as if a separate po1içy of insurance has been issued fOT that event. <br />"Who is insured" is amended to include. as an insured. the person or organization shown in this scbc:dulc. but only with respect to 1iability arising out of the <br />ownership. maintenance or use of the premises used by the named insured (event holder). This insurance does not app1y to: Any "occurrence" which takes p1ace <br />after the event holder ceases f1J'be a tenant in tbIt premises. <br /> OTHER ADDITIONAL INSUREDS <br /> " .'ROVED AS TO FORM ' <br /> ~ )/" <br /> .' /7">-7/1 Q .<-" :-" ~ <br /> j/ ",»." c"..-", ,f. <br /> Assistant City Attor;¡,,;\ <br />CANCELLHION' Should the above described po1jcy to cance11ed before the expiration date thereof. the issuing company will mail 30 days written notice to the <br />certificate holder and additjonal insureds listed. <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />~~~ <br /> <br />DATE ISSUED: <br /> <br />2/07/05 <br />