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., , i . DIAMOND STATE INSURANCE COMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) Robert F. Driver Company, Inc. City of Santa Ana P. O. Box 28323 20 Civic Center Plaza Santa Ana, CA 92799-8323 M-28 (949) 660-8163 Santa Ana, CA 92702-1988 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION; Christopher Avery TYPE: Self Improvement Partnerwerks, Inc. DATE(S): September 12, 2002 P.O. Box 1046 LOCATION; City Yard 220 S. Daisy Comfort, TX 78013 Santa Ana, CA This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Diamond State Insurance Company MASTER POLICY NUMBER: CCL0040170 MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2002 EXPIRATION: JANUARY 1,2003 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCfIBLE: NONE General Aggregate Limit $ 1,000,000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 The limits of insumnce apply separately to each event insured by this policy as if a separate (K)licy of insurance has been issued for that event. "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 afthe ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does DOt apply to: Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLA nON: Should the above described policy to cancel1ed before the expiration date thereof. the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. AUTHORlZED REPRESENTATIVE: ~n~~ DATE ISSUED: 9/05/02 APPROVED AS TO FORM a;{;', 411....- Q[A; 7- Itaura Sheedy Deputy City Attorney .