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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />0\ - t1,j <br />t'~ <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Alliant Insurance Services City of Santa Ana <br /> 20 Civic Center Plaza, M-28 <br />P. O. Box 28323 Santa Ana, CA 92701 <br />Santa Ana, CA 92799-8323 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Janet Schermer TYPE: Instructional - Pjano <br />34 Brisbane Way DATE(S): 3/4/01 - 6/10/01 <br />Irvine, CA 92612 LOCATION: F;I ~alv.qnor r.pntpT <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 a1l 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: 02SEPlOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2003 EXPIRATION: JANUARY I, 2004 <br />COMMERCIAL GENERAL LiABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />Genera! Aggregate limit S 1,000,000 <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 insunmce apply separately to each event insnred by this policy as if a S<:pal1lte policy of insurance has been issued for that event. <br />"Who is insured" is amended to include, as an insured, the pc""n or organization shown in this schedule, hut only with respect to liahility arising out of the <br />ownen;hip, maintenance or use of the plenUses used by the named insured (event holder). This insurance does not apply to: Any "OCCUm:nce" which takes place <br />after the event holder ceases to be a tenant in that premises. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLA nON: Should the ahove described policy to cancelled before the expiration date thereof, the issuing oompany will mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />DATE ISSUED: <br /> <br />2120103 <br /> <br /> <br />..,. " lU FORtv! <br />APPRO\- LJ /,., <br />J}j~i1-- <br />L ('<<"SheedY <br />Deputy City Attorney <br /> <br />AUTHORIZED REPRESENTAT1VE: <br />