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EVANSTON INSURANCE COMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) Driver Alliant Insurance SelVices Cay 06 San:ta Ana P. O. Box 28323 20 C.i.v.i.e Ce.n.tVt Piaza, M-28 Santa Ana, CA 92799-8323 Santa Anti, CA 92701 (949) 660-8163 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: . M.i.Qhae1. MyeJt6 TYPE: 1 YUdlU.LU-io na.i - T e.nlU.6 1 63 2 7 MilLI.tJte.am Lane. DA TE(S): 7 /12/04 - 12/31/04 CWt-UO.6, CA 90703 LOCATION: CabiUUo Te.nlU.6 C e.n.tVt This is to certifY that the policies of insurance listed below have been issued to the insured named above for the policy period indicated, Notwiths1anding any requirements, terms or conditions of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies descnbed herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEPlOOOOOI MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY 1,2005 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $2,000,000 Products & Completed Operations 1,000.000 Personal & Advertising Injury 1.000,000 Each Occurrence Limit 1,000.000 Fire Damage (Any One Fire) 50.000 Medical Payments (Any One Person) 5.000 The limits of insurance apply separately to each event insured by Ihis policy as if a separate pclicy of insurance has been issucd for Ihat event "Who is insured" is amended to indude, as an insured, the person or organization shown in this sehedule, bUI only with respect 10 liability arising out of the ownership, maintenance or use of the premises used by the named insUTCd (event holder). This insurance does not apply to: Any "occurrencc" which takes place after the event holder ceases ro be 8 tenant in that premises. OTHER ADDITIONAL INSUREDS CANCEl .LA nON: Should the above described policy to cancelled before the expiration date thereof. the issuing company will mail 30 days written notice 10 the certificate holder and additional insureds listed. AUTHORlZED REPRESENTATIVE: ~4~ DATE ISSUED: 5/78/04 ~~M~