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<br />f'J - Z-ooz_- oqlb <br /> <br />DIAMOND STATE INSURANCE COMPANY <br />, <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBUC 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-18 <br />(949) 660-8163 Santa Ana, CA 92702-1988 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOWER): EVENT INFORMATION: <br /> TYPE: Self Improvement - Class II <br />Samual Largo DATE(S): July 1, 2002 - June 30, 2003 <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 descn'hed herein is subject to all the terms, <br />exclusions and conditions of such policies. Limits shown may have been rednced by paid claims. <br />INSURANCE CARRIER: Diamond State Insurance Company <br />MASTER POLICY NUMBER: CCL0040 170 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2002 EXPIRATION: JANUARY 1,2003 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />G.....I Aggtogate Limit S 1,000,000 <br />Products & Completed Operations 1,000,000 <br />Persona' & Advertising Injury 1,000,000 <br />Eaoh Occum:oce Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />The limits nf ;nsumnce apply separately to each event insured by this policy as if a separate poli<:y of ;nsumnce bas been issued fur that event. <br />''Who is insured" is amended to iaclude, 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 ofthc premises used by the named insURd (event bolder). This insurance does DOt apply to: Any "occwrence" which takes place <br />after the event holder ceases to be a tenant in that prcmisc8. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLA nON: Should the above described policy to cancelled before the expiration date thereof, the issuing company wiU mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br /> <br />AUTHORIZED REPRESENTATIVE: <br /> <br />-/?j];eUrJ. <br /> <br />DATE ISSUED: <br /> <br />7/25/02 <br />