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<br />~ <br /> <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: <br /> <br />PUBUC ENTITY (ADDmONAL INSURED) <br /> <br />Driver Alliapt Insurance Services <br />p, O. Box 28323 <br />Santa Ana, CA 92799-8323 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />Ce~ GUahtan~o <br /> <br />C-U1j on San-ta Ana <br />20 Civic Cent~ Plaza, M-28 <br />San-ta Ana, CA 92701 <br /> <br />EVENT INFORMATION: <br />TYPE: Ivu..:tJtuc;UonlLt-CMkU <br />DATE(S): 2/07/05- 6/30/05 <br />LOCATION: lawn RawlinQ Cvn;tV!l <br /> <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 aU the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br /> <br />MASTER POLICY NUMBER: 05SEPlOOOOOl <br /> <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2005 EXPIRATION: JANUARY 1,2006 <br /> <br />COMMERCIAL GENERAL LIABIUTY <br />General Aggregate Limit <br />Products & Completed Operations <br />Pcnonal & Advatising Injury <br />Each Occ:urrenec Umit <br />Fire Damage (Any One Fin:) <br />Medical Payments (Any o.e Person) <br /> <br />OCCURRENCE FORM <br /> <br />DEDUCTIBLE: NONE <br /> <br />$ 2,000.000 <br />1.000.000 <br />1,000,000 <br />1.000,000 <br />50.000 <br />5.000 <br /> <br />The lim1lS of insurance: apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. <br />"Who is insured" is amended to include, 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 ofthc premiac:s used by the named insured (event holder). This insunmcc: does not apply to: Any"occurrence" which takes place <br />after the event holder ceases to'be a tenant in that premises. <br />OTHER ADDmONAL INSUREDS A )" ,." ....r, <br /> <br />'" <br /> <br />~ <br />~n{j <br />ur S ill Sheedy <br />Assistant Citv Attor.-iv <br /> <br />CANCELLATION. Should the above described policy to canceJ)ed befcre the expiration date thereof, the issuing company Will mai130 days wriUen notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTHORIZED REPRESENT A TlVE: <br /> <br />u;Z~ <br /> <br />DATE ISSUED: <br /> <br />2/07/05 <br />