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<br />SANTR ANA RISK MGMT. <br /> <br />Fax:714-547-5311 <br /> <br />Mar S 2005 11:22 <br /> <br />P.04 <br /> <br />EVANSTON INSURANCE COMPANY <br />CERTI:FICATE NO.: <br /> <br />CEll.TIFlCATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINJi:E EVENTS. SEE SEJ.' MlATE AJ>J.'LICATIONS FOR NOMTh'EE EVENTS. <br />SJ.'ECIAL E\'ENT LIAJllLlIY FROGRAM <br /> <br />FROPUC~ PUBLIC ENTITY (ADDffiONAL INSURED) <br /> City of Santa An> <br />Driver Alliant Insurance Services in conjunction with 20 Civic Center Plaza., M-28 <br />Apex Inmrance Services Santa An., CA 92701 <br />P. O. Box 28323 <br />Santa Ana, CA 92799-8323 <br />(949) 660.8163 <br />WeeD" No, OC 36861 <br />}lAMED INSURED (EVENT HOLDER): IV-d.CO.J.-dlK EVENT INFORMATION: <br />Daniel Achatz Iv - ;;.00;),. UK TYl'Eo Instru.ttiona1/Self~ImDrovement <br /> N. 0\al3- e71 DATE(S), Januarv 1 - December 31. 2006 <br /> N_~-,')<jO LOCATION: Santa Ana Jail <br /> N -~c.;, - 0'1,;- 01 <br />N -~OO;'-(yf,-O~ <br />This is to certify that the policiEs of insurance 1i61ed belo"W have been 'issued to the ms\Ued ~ above for the policy period <br />indicated_ Notwithstanding ~ requirements, te:r:ms or conditions of any contract Qr other document with r~ct to which this <br />certific'il:te may be issued 01" may pertain, ~ insurance afforded by the policies described herein is subject to all the terms, <br />exclusions and conditions of such policie!l_ Lttnits shown may bave been reduced by paid claims. <br />INStJRANCE CARlUER: Evan'ton IIlSutance Company <br />MASTER POLICY NL'MJIER: 04SEl'LOOOOOl <br />MASTER POLICY DATES: E)!'FJi:CTIVE, JANUARY 1, 2006 EXPIRATION: JANUARY 1,2007 <br />COMMeRCL'-L GEN.UL LlABlUTY OCCURRENCE fom DEDOCTlllLl', NONE <br />Genet"'! Ag.gregate Limit $1,000,000 <br />Produ.c;bi & Completed Operations 1,000,000 <br />Perlooat & Adverti.sinz .Injury 11'00,000 <br />Each Ocelm~ce Emit 1,000,000 <br />Fire Diunate (Any Onc Fire) 50,000 <br />Medical Payment!; (Any One hrson) 5,000 <br />The lirrtit6 of losursncc apply scp<l!"lltE:1y to c:H.(:h cvent im~ by this "olley as if.. .&~111 policy ofinsUt'aJ:ll;e b.:<s bei:'n issued for ~t eant. <br />'"Wl'.o is insured"js amended to in~l\l~,l..$.lIII insured, mepBr50rt or orgllniz:ation ShOWfl:in this :schedule, but only with respect tQ liability Brisingout of the <br />ownership, ma\nten~nce or lJie of the premi~ usrnl. by the named insured (event bolder). Tb.ii "insurance doi;'S oot apply to: .Any "'occurrence" which takeS ?Iaee <br />afU'r thc ~t holder Cll.iSC5 to ~ ill tenant in tbi.t premisC'i. <br /> OTIlER ADDITIONAL INSUREDS <br />CA NrFT 1 A no};": Sbould the above describe.1 policy to Cilncelled b~ore thll: expiration Q.2te IbcJcof, 1hl: issuing cornpm,y witt mail 30 days wntten r.otic;e to Ihe <br />, C~1il hollkr and additionaJ io~urcd.! liste<l. <br /> <br />~;f~ <br /> <br />~.l?';'~~~:=:: ~.: .s.:... .!.~-' <br /> <br />A,,'THORlZED REFRESENTATIVE: <br /> <br />L'~ <br /> <br />? .,,,,~:a: .:. ";";:" .~~:.-:,~.~,,~ <br /> <br />DATE lSSUED' Januat'i 20, 2006 <br /> <br />,,- <br />