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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE , <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver AlIi""t Insurance Services CLty 06 SaVL-ta. Ana <br />P. O. Box 28323 20 C-i..v-i..c. Cen.:te.4 P.ta.za, M-28 <br />Santa Ana, CA 92799-8323 SaVL-ta. Ana, CA 92701 <br />(949) 660-8163 <br />License No: DC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT lNFORMATIO~ <br />L-iA a Sj:aJ1.k TYPE: SCJLap aaUYlg <br /> DATE(S): 2/28/04 - 6{30{0; <br />tV - .J.u05 -0010 LOCATION: LawYl BoWUYlg C en.:teJt <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: Evanston Insurance Company <br />MASTER POLICY NUMBER: 05SEP1000ooI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL UABIUTY OCCURRENCE FORM DEDUCTmLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury 1,000,000 <br />Each Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />The limits of insurance apply separately to each event insured by this policy as jf a separate policy of insurance has been issued for that event. <br />"Who is insured" is amended to include, as an insured, 1he person or organization shown in this schedule, 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). This insurance does not apply to: Any "occurren~" ~~ich ta~es ~ace <br />after the event holder ceases to'be a tenant in that premises. _ ",j \' ~_-4) f\~ lO FO M <br /> OTHER ADDITIONAL INSUREDS /) ~:.2 " -' <br /> -/-__, /../'::/I._X.-J<.-__I <br /> _.Il,),1 .....I:ll sncc<f1 <br /> 'l,t lit> At\(irncy <br />CANCELLATION: Should the above described policy to cancelled before the expiration date thereof. the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTIIORIZED REPRESENTATIVE: <br /> <br />U~~ <br /> <br />DATE ISSUED: <br /> <br />FebkUaJ1.y 25, 2005 <br /> <br />