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CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM \0.~ tSV"\ ~~ DIAMOND STATE INSURANCE COMPANY CERTIFICATE NO.: PRODUCER: PUBLIC ENTI1Y (ADDITIONAL INSURED) Robert F. Driver Company, Inc. City of Santa Ana P. O. Box 28323 20 . Ch1c 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: Sonia Miskulin TYPE: Instructional - Ballet 220 E. Fourth Street, Ste. 202 DATE(S): December 11, 2002 - June 30, Santa Ana, CA 92701 LOCATION: Salgado Center 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, tenDS or conditions of any contract or other document with respect to which this certificate may he issued or may pertain, the insurance afforded by the policies described herein is subject to all the tenns, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Diamond Stale Insurance Company MASTER POLICY NUMBER: CCL0040170 MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2002 EXPIRATION: JANUARY 1,2003 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCI1BLE: NONE GeDeIal Aggregate Limit $ 1,000,000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence Limit J ,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Pe""n) 5,000 The limits of insurance apply sqmrately to each event insured by this policy as if a separate policy of insurance has beeo issued for that event. "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 ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS ~ ED ~! TO FORM ^ { ~I TINE L.' E SHAW Cltv Alt"tnlllV CANCELLATION: Should the above described policy to cancelled before the expiration date thereof. the issuing company will mail 30 days wriUen notice to the certificate holder and additional insureds listed. 03 AUTHORIZED REPRESENTATIVE: ~nn-eflcJ. DATE ISSUED: nprpmhpr 11, ?OO?