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<br />DIAMOND STATE INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />~ ~ IOO\-IS-(t7 <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 AmI <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 />LicellllC No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: <br />Luz Navejas TYPE: Self Improvement - Class II <br /> DATE(S}: Jul y 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 descnbed herein is subject to all the tenns, <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: CCL0040170 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2002 EXPIRATION: JANUARY 1,2003 <br />COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE <br />Gen<ral Aggregate Limit S J ,000,000 <br />Products & COlDpleted Operations 1.000,000 <br />Personal & Advertising Injul)' 1,000.000 <br />Each Occwrence Limit 1,000,000 <br />Fire Damage (Any 0l1e Fire) 50,000 <br />Medical Payments (Any One PIOSOO) 5,000 <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance bas been issued for that event. <br />"Who is insured" is amended to include, as an insured, the person or organization shown in this schedulo, but only with respect to liability arising out oflhe <br />ownership, maintenance or use of tile ~ses used by the named insured (event bolder). 1bis imunmce 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 />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 />AUTIlORlZED REPRESENTATIVE: <br /> <br />f?~ti-ef/~ <br /> <br />DATE ISSUED: <br /> <br />7/25/02 <br />