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<br />DiAMOND STATE INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />t'J /" UXJ~ - OLfS <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT UABILITY PROGRAM <br /> <br />PRODUCER: PUBUC ENTITY (ADDITIONAL INSURED) <br />Robert F. Driver Company, Inc. Cily of Santa Ana <br />P. O. Box 28323 20. . CivIe Center Plaza <br />Santa Ana, CA 92799-8323 M-28 <br />(949) 660-8163 Santa Ana, CA 92702-1988 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br /> TYPE: Self Improvement - Class II <br />Nora Carillo DATE(S): July 1, 2002 - June 30, 2003 <br /> LOCATION: 60 Civic Center Plaza <br /> S.A. Jail <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: Diamond State Insurance Company <br />MASTER POLICY NUMBER: CCL0040170 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2002 EXPIRATION: JANUARY 1,2003 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCfIBLE: NONE <br />G-.l Aggregate Umit $ 1,000,000 <br />Products & Completed Operations 1,000,000 <br />Persoml & Advertising [njmy 1,000,000 <br />Eacb OccUlTCOCe Limit I.OOO~OOO <br />Fire Damage (Any One Fire) 50,000 <br />Medico! Payments (Any One Pen;on) 5,000 <br />The limits of insur.mce apply separaldy to each event insund by this policy IS if a sepaI3Ie policy of i__. has been issued fur that event <br />"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 of the <br />OWDCIShip. maintenance or use oftbe premises used by the named insured (event bolder). This inswmcc does DOt apply to: Any "occllllellCe" which takes place <br />aftuthe event holder ceases to be a tenant in that pmmises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancelled before tbe expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate bolder and additional insull'ds listed. <br /> <br />AUTIIORlZED REPRESENTATIVE: <br /> <br />r:n~~ <br /> <br />DATE ISSUED: <br /> <br />7/25/02 <br />