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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: PUBUC ENTITY (ADDmONAL INSURED) <br />Driver Alliapt Insurance Services Cdy 06 Santa. AM. <br />P. O. Box 28323 20 C~v~e Cent~ Plaza, M-28 <br />Santa Ana, CA 92799-8323 Santa. Ana, CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Judy Sek{ndtebeek TYPE: I nMJulcXJ onai.-O/uUJ n(l <br /> DATE(S): 2/07 /05~ 6/30/0r, <br /> LOCATION: Ul1hirlllA <br />This is to certify that the policies of ioaurance liated below have been issued to the insured named above for the policy period <br />indicated. Notwithstanding any requiremcnta, 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 shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 05SEPIOOOOOI <br />MASI'ER POLICY DATES: EFFECTIVE: JANUARY 1,2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL UABIUTY OCCURRENCE FORM DEDUCTIBLE: NONE <br />G.......I Aggregate [jmit $ 2.000.000 <br />Products & Completed Operations 1.000,000 <br />Personal & Advertising Injury 1,000.000 <br />Each OccUITCIlCe Limit 1,000,000 APPRO ED AS TO FORM <br />Fi... Damase (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 h 7-/? <br /> . . <br /> . <br />The limits of insurance apply separately to each event insured by this policy as if a separate pohcy 0 <br />"Who is insured" is amended to include. as an insured.1he person or organization sho-wn in this scbedU1e_i~t!:~1'tbl}ffl!~ arising out of the <br />ownership. maintenance or use oCtile premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place <br />aftcrthe event holder ceases tn'be a tenant in that premises, <br /> OTHER ADDmONAL INSUREDS <br /> , <br />CANCELLATION- Should the above described policy tn cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />U;f~ <br /> <br />DATE ISSUED: <br /> <br />2/07/05 <br />