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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />;J - ZmL- /If'/ <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br /> City of Santa Ana <br />Driver A1liant 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 /> TYPE: Instructional - Ballet <br />Sonia Miskulin DATE(S): January I, 2003 - June 30, 2003 <br />220 E. Fourth Street, Ste. 202 LOCATION: Salgado Center <br />Santa Ana, CA 92701 <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 descnbed herein is subject to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid c!aims. <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 02SEPIOOOOOI <br />MASTER POLICY DATES: EFFECTNE: JANUARY I, 2003 EXPIRATION: JANUARY 1,2004 <br />COMMERCIAL GENERAL liABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />Genem! Aggregate Limit $ 1.000,000 <br />Products & Completed OpOllltions 1,000,000 <br />Persooal & 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 linUts of insurance apply SCpamtely to each event insured by this policy as if a separate policy of i.nsurauce has been issued for that event. <br />"Who is insured" is amended to include. as an insured, the person or organization showD in this schedule, but only with respect to liability arising out of the <br />ownership, maintenance or use oftbe premises used 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 ADDmONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancelJed before the expiration date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed, , <br /> <br />Aurnmuzrum"'-""'ATIve ~~ <br />DATE ISSUED: February 6, 2003 <br /> <br />AP;~ ::l:ORM <br /> <br />Deputy City Attorney <br />