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<br />DIAMOND STATE INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Robert F. Driver Company, Inc. City of Santa Ana <br />P. O. Box 28323 20 Civic 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 lNFORMA~I~l <br />Sandra Padilla TYPE: e Improvement <br /> DATE(S): Il/IQ/O? - "I,O/O? <br /> LOCATION: flO r.iv;r> C,:llnt'Por P'~'7.::lI <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 I, 2003 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE, NONE <br />General Aggregate Limit S 1,000,000 <br />Products & Ccmpleted Operations 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Aoy One Fire) 50,000 <br />Medical Payments (Aoy One P=) 5,000 <br />The limits of insunmce apply separately to each event insured by this policy as if a separate policy of insurance has been issued for 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 />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 ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancelled before the expimtion date thereof, the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />f?f)ri-efJl~ <br /> <br />DATE ISSUED: <br /> <br />11/20/02 <br /> <br />APdWVED AS TO FORM <br /> <br /> <br />'f!3d. 0 .e.6L7 <br />Liura Sheedy ( <br />Deputy City Altorney <br />