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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />. t-r J~~ <br />JJ /J- DO <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Alliant Insurance Services City of Santa Ana <br /> 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 INFO~TI~Nt - Instructiona <br /> TYPE: e mprovement <br />Sandra Padilla DATE(S): l/nl/n~ - h/~n/n~ <br /> LOCATION: ~~n""~ ATl::l T::dl - ;;n ri'17ir> Cente <br />This is to certify that the policies of insurance listed below have been iasued to the insured named above for the policy period <br />indicated. Notwithstanding any requirements, tenus or conditions of any conlrnct or other document with respect to which this <br />certificate may be issued or may pertsin, 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 claims. <br />INSURANCE CARRIER; Evanston Insurance Company <br />MASTER POLICY NUMBER: 02SEPI 00000 1 <br />MASTER POLICY DATES; EFFECTIVE: JANUARY 1,2003 EXPIRATION; JANUARY 1,2004 <br />COMMERCIAL GENERAL UABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 1,000,000 <br />Products & Completed Operations 1.000,000 <br />Personal & Adverti,iog Injury 1.000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any 000 Fire) 50,000 <br />Medical Payments (Any One Penon) 5,000 <br />The limits of insunmce apply separately to each event insnn:d by this policy as if. separate policy of insnnmce has been iisned 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 />ownemup, maintenaoce or use of the premises used by the named insured (event holder). This insurance does Dot apply to: Any "occunence" which takes place <br />after the event holdereeases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancelled 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 />AmHORm<D",""",EmAnw, ',&,.~ <br /> <br />DATE ISSUED: <br /> <br />2/6/03 <br /> <br />Plz <br /> <br />O"ED A" '\ n FORM <br />t\...~ r l'- " <br />l3lf\U~!if ..--'- <br /> <br />L'Llra Sheed <br />')c:puty City .\ [I 'fH'Y <br />