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<br />E,?ANS~N INSURANCE COMPANY <br />CERTIFi~E NO.: - <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />? <br />) <br /> <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver Alliant Insurance Services City of Santa Ana <br />P. O. Box 28323 20 Civic Center Plaza, M-28 <br />Santa Ana, CA 92799-8323 Santa Ana, CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Bill Harvey TYPE: Language <br />2905 Palua Place DATE(S): 2/1/03 - 6/30/03 <br />Costa Mesa, CA 92626 LOCATION: P.D. Trainin2 Room <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, tenus 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: 02SEPIOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2003 EXPIRATION: JANUARY 1,2004 <br />COMMERCIAL GENERAL UABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Limit $ 1,000,000 <br />Products & Completed Operations 1.000.000 <br />Personal & Advertising Injwy 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 if a separate policy of insurance has been issued for that event <br />"Who is insured" is amended to include, as an insured. the 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). 1bis insurance does not apply to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br /> OTIIER ADDITIONAL INSUREDS <br />CANCELLA nON: 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 />AUmOR>Zrn"2>=ENTATMC ~~ <br /> <br />Ai'htuy bJ AS TO FORM <br /> <br />DATE ISSUED: <br /> <br />1/22/03 <br /> <br />~V( <br />. aa ShCL'dy , <br />Deputy CilY /,ltorncy <br />