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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE , EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPUCATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) Driver A1liapt Insurance Services Cay 06 Sllnta. Mtll P. O. Box 28323 20 Civic. Ce.n;tQJt, P.iaZll, M-28 Santa Ana, CA 92799-8323 Sllnta. Ana, CA 92701 (949) 660-8163 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: AbJr.ll Ne.gJr.e.te. TYPE: I vu,;tJl1lr;tj ol11l1-mlu,A c.. hA YlgiYlg 223 S, Vove. S.tJte.e.t DATE(S): llQll0~ - 17/~110~ OJta.Ylg e., CA 92869 LOCATION: , nu'~ RnlAlP j V1grOWJ-Oh 1bis is to certify that the policies of insurance listed below bave been issued to the insured named above for the policy period indicated. Notwiths1anding any requirements, terms or conditions of any contnlCt or other documenl with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclu3ions and conditions of such policies. Limits shown may bave been reduced by paid claims, INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 05SEPIOOOOOI MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2005 EXPIRATION: JANUARY 1,2006 COMMERCIAL OENERAL LIABIUTY OCCURRENCE FORM DEDUCTIBLE: NONE Oencnl Aggnple Limit $ 2,000,000 Products '" Completed Operations 1,000,000 Personal'" A_.. Injury 1,000,000 cach Occurrence Limit 1,000,000 Fi.. Damage (Any One Fire) 50,000 Medical Paym:nts (Any One Penon) 5,000 The limits of insurance apply separately to each event insured by this policy as if a separate policy of inlW'l.l'lCC has been issued for that evenL "Who is insured" is amended to include, as an insured. the person or organization shO\W in this schedule, but only with respect to liability arising out ofthc ownership, maintenance or use ofthc premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place after the event holder ceases to'be a tenant in that premises. OTHER ADDmONAL INSUREDS , CANCELLATION: Should the above: described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. " AUTHORIZED REPRESENTATIVE: ~/~ DATE ISSUED: IZ/28/04 ~'Aoy~.