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DIAMOND STATE INSURANCE COMPANY <br />CERTIFICATE NO.: <br />Robert F. Driver Company, Inc <br />P. O. Box 28323 <br />Santa Ana, CA 92799 -8323 <br />(949) 660 -8163 <br />License No: OC 36861 <br />Juan Reyes <br />2521 W. Sunflower, #N5 <br />Santa Ana, CA 92704 <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br />City of Santa Ana <br />20 Civic Center Plaza <br />M -28 <br />Santa Ana, CA 92702 -1988 <br />N, zoo 2 -12M <br />TYPE: Instructional — Softball <br />DATE(S): — 3 <br />LOCATION: Various Parks in Santa Ana <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 1, 2002 EXPIRATION: JANUARY 1, 2003 <br />COMMERCIAL GENERAL LIABILITY <br />General Aggregate Limit <br />Products & Completed Operations <br />Personal & Advertising Injury <br />Each Occurrence Limit <br />Fire Damage (Any one Fire) <br />Medical Payments (Any One Person) <br />The limits of insurance <br />$ 1,000,000 OCCURRENCEFORM DEDUCTIBLE: NONE <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />50,000 <br />5,000 <br />this policy as <br />"Who is insured" is amended to include, as an insured, the ' --- -" has been issued ror mat event. <br />person or oroani�mi. - shown in this schedule, but only with respect to liability arising out of the <br />ownerahip, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any ° <br />after the event holder ceases to be a tenant in that n ,nip occurrence' which takes place <br />CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will ail 30 days written notice to the <br />certificate holder and additional insureds listed. [n <br />AUTHORIZED REPRESENTATIVE: <br />DATE ISSUED: <br />10/31/02 <br />City Attorney <br />