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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CER'lIDCATE 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 A!lillj1t Insurance Services Cay 0 II Santa. Ana <br />P. O. Box 28323 20 Civic. Ce.nta Piaza, M-28 <br />Santa Ana, CA 92799-8323 Santa. Ana, CA 92701 <br />(949) 660-8163 <br />License No: DC 36861 <br />NAMED INSURED (EVENT HOIDER): , ' EVENT INFORMATION: <br />S~v.i.a RomVto N-o),{Jo1-{;3') TYPE: AVJrnhiN. <br />11045 Me.daLUoYl, #49 N- :~oLA~ 0"'1- 01 DA TE(S): ~/nqln~ - 1?/~1 In~ <br />T lLAtiYl, CA 92180 LOCATION: ~nfgnrln rv~tVh <br />This is to certify that the policies of insurance Jisted below have been issued to the inswm named above for the policy period <br />indicated. Notwitbsho...!n,g any ~.........ts. terms or conditions of any contract or other dOCUlDllJll with respect to which this <br />certificate may be issued or may pertain, the iDsurance afforded by the policies described herein is subject to all the temlS, <br />exc1nsions and conditions of such policies. LimilB shown may have been reduced by paid claims. <br />INSURANCE CARlUER: EVllII8Ion Ins\l1"llDCC Company <br />MASTER POLICY NUMBER: OSSEP1000001 <br />MASTER POLlCY DATES: EFFECTIVE: JANUARY 1,2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL UABIUTY OCCUllRENCE FORM DEDUCTIBLE: NONE <br />Galenl AanPIe Limit $ 2,000.000 <br />Products It C~1eted 0peratl0llS 1,000,000 <br />Personal It Adverlisinllnjury 1.000,000 <br />Each Occmm1ce Limit 1.000,000 <br />Fin> Do..... (Any One Fire) 50,000 <br />ModicaI Pa,ments (Any One Pmon) 5,000 <br />The limits of insunnce apply.......1y 10 each ....t_ by thi. policy u if. __Ie policy ofin........ hill boon illllOd f... thot event <br />"Who is insured" is amended to include, U 10 insured, the person or orprization shown in this schedule, but culy with 1'CIpCCt 10 liability arising: out of the <br />own.....ip, moin_... use of the prernis5 used by the namod in...... (....t holder). TIti. in........ doeo not apply 10: Any "occam..:." which takes place <br />a&rthe event holder ceases tIJ'be a tenant in thatpremi.ses. <br /> OTHER ADDmONAL INSUREDS <br /> , <br /> . <br />CANr:RI J A nON: Should the above described policy 10 amc:clled before the expiration date thereof. the issuing company win mail 30 days writtel1 notice to the <br />certificate holder and additional insureds listed. <br /> <br />,. <br /> <br />AurnORIZED REPRESENTATIVE: <br /> <br />~~~ <br /> <br />S TO FOIUvl <br />APPROVED A. <br />~~:,,;~Z --_.- <br />~~, <br />elf\! "~I <br />Assistant <br /> <br />DATE1SSUED: Ma4eh 9. 2005 <br />