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V4W 1.I EVANSTONINSURANCECOMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM AUTHORIZED REPRESENTATIVE: 2/12/03 DATE ISSUED: PUBLIC ENTITY (ADDITIONAL INSURED) PRODUCER: Driver Alliant Insurance Services ( City of Santa Ana P. O. Box 28323 20 Civic Center Plaza, M -28 ^,�� Santa Ana, CA 92799 -8323 Y Santa Ana, CA 92701 (949) 660 -8163 4 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Instructianal— Music Abra Negrete TYPE: — DATE(S): 223 S. Dove Street LOCATION: Lawn Bow ng Center Orange, CA 92689 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: Evanston Insurance Company MASTER POLICY NUMBER: 02SEP100000I MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2003 EXPIRATION: JANUARY 1, 2004 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $1,000,000 Products& Completed Operations 11000.000 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 insurance apply separately to each event insured by this policy as if a separate policy of insruarree 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 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 CANCELLATION: Should the above described policy to cancelled bef ore the expiration date thereof, the issuing company will mail 30 days written notice to the APPROV LD AS 1'0 FORM certificate holder and additional insureds fisted. AUTHORIZED REPRESENTATIVE: 2/12/03 DATE ISSUED: