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EVANSTON 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: PUBLIC ENTITY (ADDITIONAL INSURED) <br />DriverAlliantInsuranceServices City a{ Santa. Ana <br />P. O. Box 28323 20 C.CV./,C Centers, P.Qaza, M-28 <br />Santa Ana, CA 92799-8323 Santa Ana, CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />B2au,Q,Lo Mendez N-~~uf-rcz TYPE: Mr,nir <br />2313 S. Rene Dnive N- .~,ao'f-le~-mil DATE(S): ~/y3~ns _ 1 <br />/3105 <br />2 <br />Santa Ana, CA 92704 . <br />, <br />LOCATION: FP S^e~t{o~Cerrt¢h <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 />a <br />indic <br />ted. Notwithstanding any requirements, terrra or conditions of any contract or other document with respect to which this <br />certi5cate maybe issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms <br />, <br />exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE (.'ARRiF.R; Evanston Insruaace Cor~aay <br />MASTER POLICY NUMBER: OSSEPI000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2005 EXPIRATION: JANUARY I, 2006 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM <br />General Aggregate Limit S 2,000,000 DEDUCIBLE: NONE <br />ProdaCls ~ campletea Operations t,ooo,ooo <br />Personal & Advertsin6lnimy' 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (My One Fire) 50,000 <br />Medical Payments (My One Person) 5,000 <br />The limits of insurance apply separately W each eventowred by this policy as if a separate policy of insurance has been issued far Orat event <br />"Who is insured" is amended to include, ere an insured, the persmr or organization shown in this scheduk, but only with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). Thin insurance does trot apply b: My "accufrence" which fakes place <br />aRer the even holder ceases to'Ix a tenant in that premises. <br />OTHERADDTTIONALINS ED A <br />TO FORT i <br />S <br /> <br />r <br />~ <br />Laura Stitt eedy <br />Avsistan[ City~At[orncv <br />N eTION~ Should the above described polity to cancelled before the expiratlon date thereof <br />the issuin <br />, <br />g company will mail 30 days wriaen notice to the <br />certificate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: ~'""" <br />DATE ISSUED: FebhucUty 23, 2005 <br />