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<br />DiAMOND STATE INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Robert F. Driver Company, Inc. \1:J7J City of Santa Ana <br />P. O. Box 28323 20 Civic Center Plaza <br />Santa Ana, CA 92799-8323 M-28 <br />(949) 660-8163 ,/ Santa Ana, CA 92702-1988 <br />License No: OC 36861 ...llO1." <br />NAMED INSURED (EVENT HOLDER): ~; l/ EVENT INFORMATION: <br />Vi Duong / TYPE: Instructional - Softball <br />11924 Verbena Ct. DATE(S): 7/12/02 - 6/30/03 <br />Fountain Valley, CA 92708 LOCATION: <br />This is to certii'y that the policies of insurance listed below have been issned 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: Diamond State Insurance Company <br />MASTER POLICY NUMBER: CCL0040170 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2002 EXPIRATION: JANUARY 1,2003 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ J ,000,000 <br />Products & Completed Operations I,DDD,ODD <br />Personal & Advertising Injury ] ,000,000 <br />Eacn Occutrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,DOD <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of inswance has been issued for that event. <br />"Who is insured" is amenderl to include, as an insnred, the pelSOn Or organization shown in this schedule, but only with reapect to Hability an,m. out of the <br />o,,",ernbip, maintenance or use of the PrenUses used by the namerl insured (event holder). This inswance does not apply to: Any "occUlTenee" which takes place <br />after the event holder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br /> APPROVED AS TO FORM <br />CANCELLATION: Should the above deScribed policy to cancelled before Ihe expiration date thereof, the issuin .co, 0. will mall 30 days written notice to the <br />certificate holder and additional insureds listed. ~ E ...... <br /> .... .......,,,... r <br /> -"'. <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />f{:hriU/~ <br /> <br />Deputy City Attorney <br /> <br />DATE ISSUED: <br /> <br />10/31/02 <br />