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<br />EVANSTON INSURANCE COMPANY <br />CEIHIFICATE :'iO.: 2007-08 <br /> <br />CJi:RTlFICATE OF INSURANCE <br />EXCLlJD~:S COVERAGE FOR NOMINEE F:VENTS. SEE SEPARATE APPLICATIONS F'OR NOMINEE Ji:VENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />!f I'RODlJCcR PUULIC ENTITY (ADDITIONAL INSURED) <br />I, City of Santa Alia <br />II <br />if ,\illant Insurance SerVH.:e:.:, 1m.:, in conjunction with 20 Civic Center Plaza, M-28 <br />,I }\po Insuram:e Service:; Santa Ana, CA 92701 <br />'I II O. Box 6450 <br />r ~.:wport Beach, CA 92658 <br />I (<J49) 660-8163 <br />i LlCt"llSt,;' No: OC 36861 <br />I !\AMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />I) Leticia Quiroz N-2.0cY-133 TYPE: Self-Improvement <br />ii 71 I W. First Street. E-103 N-2DCY-J 3.3-0\ DATE(S): 01101107 - 12131107 <br />II SOlllta Ana. CA 92701 LOCATION: Santa Alia Jail <br /> ~._- **L1quor LLabllity after 2am 0 <br />:: 'llll~ i~ to certify that the policies of lllsurance listed below have been issued tu lhe insured named above for the policy period <br />1: llldic<.lted. Notwithstanding any reqUIrements, tenus or conditions of any contract or other document with respect to which this <br />Ii ..:~rtilicatl' may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, <br />~ "::\:Clll.~lons and conditIons of s.uch policIes. LLUlits shown may have been reduced by paid claims. <br />I ''''~'m '~m. ","~ '"'..- ,"-, <br />: 'lASTER POLICY NUMBER: 04SEPIOOOOOl <br />I EXPIRATION: JANUARY 1,2008 <br /> ' 'lASTER POLICY DATES: EHECTIVE: JANUARY 1,2007 <br />,I :: (l\Hvll-I-/:('I\1 \irNLRAI UAI3IIITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />:1 ',cllcl-~1 _'\ggreg:.Jl~ Llmil $ 2,000,000 <br />j hldm;t-; & Completed Operatlom j ,OOO,OUO <br />~ I'cl~i<lllUI & :\ullnllslI1g Injury 1,000,000 <br /> I J.:h ()':cllrr~ll(l: l.llll11 I ,000,000 <br />i I in: Dalllage (AllY One Firc) 50,000 <br />.I ro..lcoi..:al Pavmems lAnyOnel'erSl1nj :',000 <br />~ . <br />I ~ Ill' IllTlits ofinslIran<.:c apply separately \() each event insuretl by this policy as if a separate policy of insurance has been IssUed tor that C'o'cnt. <br />I <br />, <br />! \'dll' i, insured" i.;; amended w include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out ofthc <br />l' '\Hr,llIp, lIlaiTlk'n;Jlil;e or u~e of the premises used by the named insllred (event holder). 'l11is insurance does not apply to: Any .'occuITcncen which takes place <br />!L ..ih;:' th..: ~\'~nl h"ldn Lca~l~-, tll Iw a ttml!ll i" lhal prt:mises <br /> W._' ..___ _._ OTHER ADDITIONAL INSUREDS <br />I~ <br />-...-.. <br />! P// (? <br /> I 1}7~ <br /> " <br /> I~- <br /> ;! _.,~ <br /> II ..A~lliJ..A TI( IN SlillUld till: <Jbuve de,eribnl policy lU cancelled before the' expiration date thereof, the issuing company will mail 30 days written notice to the <br /> ! .l:r:iliLJte hnldtl,mdaddilillnal insureds listed <br /> <br />A'~;f ~ <br /> <br />\lJTHORIZED REPRESENTATIVE: <br /> <br />DATE ISSUED: _---kHlli!IY__Ol'--2_QO~ <br /> <br />r~'I'JII!rored In' Risk MUJHIKement Division by: <br /> <br />11!>~ 'I/?~'kU1~ <br />