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<br />DIAMOND STATE INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />\ <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLlC ENTIlY (ADDITIONAL INSURED) <br />Robert F. Driver Company, Inc. City of Santa Ana <br />P. O. Box 28323 20 Civic Center Plaza <br />Santa Ana, CA 92799-8323 M-28 <br />(949) 660-8163 Santa Ana, CA 92702-1988 <br />License No: OC 3686 I <br />NAMED INSURED (EVENT HOLDER): EVENT lNFORMA TION: <br />Joan Dusenbury ITPE: Self Improvement - Class II <br /> DATE(S): July 1. 2002 - Sept. 30, 2002 <br /> LOCATION: 60 Civic Center Plaza <br /> S.A. Jail <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: Diamond State Insurance Company <br />MASTER POLlCY NUMBER: CCL0040 170 <br />MAsTER POLlCY DATES: EFFECTIVE: JANUARY 1,2002 EXPIRATION: JANUARY 1,2003 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit S J ,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 insurnnce apply sepatately to eacli even. insunxl by this poliey as if a sepatate policy of insutance has been issued for that event. <br />"WOO is insu.-ed" is ameoded to include, as an inso.-ed, the pc""n or organization shown in this scliedule, but only with _=. to liability "'''in. out of the <br />ownership, maintenance or use of the premises used by the naOte<! insu.-ed (event holder). This inswance does oot apply to: Any "OCCurrence" whicb takes place <br />after the event holder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLATION: Should the above described policy to cancelled before the expitation date thereof, the isSUing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed. . <br /> <br />AUTIlORIZED REPRESENTATIVE: <br /> <br />DATE ISSUED: <br /> <br />7/25/02 <br /> <br />If:fJ~'-~ <br />