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<br />. <br />DIAMOND STATE INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />N-2002-100 <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (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 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Cynthia Schienberg TYPE: Self I:mrovement - Class II <br /> DATE(S): Julv 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 lerms, <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 POLICY NUMBER: CCL0040I70 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2002 EXPIRATION: JANUARY 1, 2003 <br />COMMERCIAL GENERAL LlABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 1,000,000 <br />Products & Completed Operations 1,000,000 <br />Personal & Advertising Injury 1,000.000 <br />Each Occurrence Limil 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Penion) 5,000 <br />The limits of insur.mce apply separately to each event insured by this policy as if a separate policy of inswance has been issued for that event, <br />"Who is insured" is amended to incJude, as an insured, the person or otganization shown in this schedule, but only with respect to liability arising out of the <br />ownmhip, maintenance or use of the premises used by the named insured (event bolder). This insurance does not apply to: Any "occurrence" which 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 tbe expimtion date thereof. the issuing company will mail 30 days written notice to the <br />certificate holder and additional insureds listed <br /> <br />AUTIfORIZED REPRESENTATIVE: <br /> <br />f?n~~ <br /> <br />DATE ISSUED: <br /> <br />7/25/02 <br />