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S; DN INSURANCE COMPANY <br />CERTIFICATE NO.: <br />CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />City of Santa Ana <br />r Dri'm, ant Insurance Services in conjunction with <br />20 Civic Center Plaza, M-28 <br />^7�-`'7-,''zarce Services <br />Santa Ana, CA 92701 <br />Sa7;. Ana, CA 92799-8323 <br />(949) 66M 163 <br />License No: OC 36M I <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Sttkr. r err Rivera <br />TYPE: Saba Classes <br />^S ,actou Street <br />January I - Dtxer <br />�b 2006 <br />Santa Ana, CA 9=1 <br />LOCA71 <br />LOCATION: SoatYweat Senior Center <br />ter <br />This 4 to Certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />irdm-W. Notwithstanding any requirements, tams or conditions of any contract or other document with respect to which this <br />;Tti,=cafe 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: Evanston insurance Company <br />MASTER POLICY NUMBER: 04SEP I00o001 <br />MASiTZR POLICY DATES: EFFECTIVE: JANUARY 1, 2006 EXPIRATION: JANUARY 1, 2007 <br />COWERCIAL Cr1NERAL LIABILITY <br />General Awgpo Ilata $2,000,000 <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />?totVts Q Camplood Operations 1,000.000 <br />pasori1,000.000 <br />� <br />ar'7M-ence <br />c Until 1,000,000 <br />�An, One Fire) 50,000 <br />The limits of insurance apply separately he each event insured by this policy as if a sepveoe policy of insurance has been issued fa the event <br />"Who's sraumd" is amended per include, as so insured, the Perin Of organrs tlim shown in this schedule, but only with respect to liability arising out of the <br />owne'shi7, maimewrce or use of the premix, used by the named msumd (event hoida). This insurance does not apply to: My "accuaenec" which takes place <br />. after th;_rvaa holder ceases to be a tenant in the prmum. <br />_ <br />OTHER ADDITIONAL INSUREDS <br />CAWSWAILft Should the above described policy to cancelled before the expiration due thereof, the issuing <br />company will mail 30 days written notice to the <br />certificate holder and additions insureds listed. <br />AUTHORV ED REPRESENTATIVE: <br />D473.3S JSC: <br />