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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: <br />Driver Alliant Insurance Services City o6 Santa Ana <br />P. O. Box 28323 20 Civic CenteA Peaza, M -28 <br />Santa Ana, CA 92799 -8323 Santa Ana, CA 92701 <br />(949) 660 -8163 <br />License No: OC 36861 <br />Makgahet Patorick TYPE: 7"tnuctionat - Dance <br />102 S. Glendon StAeet DATE(S): 6103104 - 12131104 <br />Anaheim, CA 92806 /1/— eZDO� —D'�7 LOCATION: Sout at Seniors CenteA <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 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 terns, <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: 04SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2004 EXPIRATION: JANUARY 1, 2005 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit <br />$2,000,000 <br />Products& Completed Operations <br />1,000000 <br />Personal & Advertising Injury <br />1,000 000 <br />Each Occurrence Limit <br />1,000000 <br />Fire Damage (Any One Fire) <br />50,000 <br />Medical Payments (Any One person) <br />5,000 <br />1 The limits of insurance apply separately to each event insured by this Policy M if 2 separate policy of insurance has been issued for that event. <br />who is insured' is amended to mclude, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any -occurrence, which takes place <br />after the event holder ceases to be a tenant in that oremises. <br />ADDITIONAL <br />CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will nail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: 5118104 <br />