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<br />EVANSTON INSURANCE C~PANY <br />CERTIFICATE NO.: - <br /> <br />....,; <br /> <br />o'l..f) ~I <br />N - '2fJ __ <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br /> City of Santa Ana <br />Driver AIliant 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 />Said Abdelsayed TYPE: Arts <br /> DATE(S): January 1 - December 31, 2003 <br /> LOCATION: Lowell Elementary <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 shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 02SEPl000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2003 EXPIRATION: JANUARY 1,2004 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit S 1,000,000 <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 Person) 5,000 <br />The limits of insurance apply separately to each event insured by this poJicy as if a separate poJicy 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 witb respect to liability arising out of the <br />ownership, maintenance or use of the premises wed by the 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 />CANCELLA lION: Should the above described policy to cancelled before the expiration date thereof. the issuing company will mai130 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AurnDID"'" """"'''''ATIV~ ~~ <br /> <br />DATE ISSUED: <br /> <br />1/22/03 <br /> <br />APPROVED AS TO FORM <br /> <br />~;.t <br />, e 1 <br />La\uu lcody <br />Deputy City Al10rncy <br />