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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 (ADDITIONAL INSURED) <br /> City of Santa Ana <br />Driver Alliant Insurance Services 20 Civic Center Plaza, M-28 <br />P. O. Box 28323 Santa Ana, Ca 92701 <br />Santa Ana, CA 92799-8323 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Burt Call TYPE: Summer Baseball Camp <br /> DATE(S): 6/1/05 - 12/31/05 <br /> LOCATION: Memorial Rec Center <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 terms, <br />exclusions and conditions of such policies. Limits shovm may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEPIOOOOOl <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2005 EXPIRATION: JANUARY I, 2006 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDlJCTIBLK NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1 .000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Pcrson) 5,000 <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issucd for that event. <br />"Who is insured" is amendcd to includc, 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 thc 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 premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, thc issuing company will mai130 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />~/~ <br />AUTHORIZED REPRESENTATIVE: ___ _____ . <br /> <br />/\r~--';~;:J','~.:) <br /> <br />.-....J <br /> <br />;'-) <br /> <br />DATE ISSUED: Julv 19, 2005 <br /> <br />/~/ I <br />.---/-,_..L..' <br /> <br />. (/ <br />/ <br />