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<br />DIAMOND STATE INSURANCE COMPANY <br />CERTWICAtE NO.: <br /> <br />N -WW- I \ lJ7 <br /> <br />CERTIFlCATE OF INSURANCE <br />SPECIAL EVENT lIABILITY PROGRAM <br /> <br />PRODUCER: PUBliC ENTITY (ADDmONAL INSURED) <br />Robert F. Driver Company, Inc. City of Santa Ana <br />P. O. Box 28323 2. . Clvle Center Plaza <br />Santa Ana, CA 92799-8323 M-28 <br />(949) 660-8163 Suu Ana, CA 92702-1988 <br />License No: DC 36861 <br />NAMED INSURED (EVENT HOIDER): EVENt INFORMATION: <br />Javier Saldivar TYPE: Self ~rovement - Class II <br /> DATE(S): July, 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 requimmcnls, terms or conditions of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the insurance affonled by the policies described herem is subject to all the terms, <br />exclusions and conditiOllS of such policies. Limits shown may have been reduced by paid claims. <br />INSURANCE CARRIER: Diamond Stale Insurance Company <br />MASTER POLlCY NUMBER: CCL0040170 ./ <br />MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2002 EXPIRATION: JANUARY I, 2003 <br />COMMERCIAL GENERAL L1ABIUTY 0CCIJRRENcE FORM DEDUCITBLE: NONE <br />Gcaera.l Aggrogate Limit S 1.000,000 <br />ProducIs &: Complclod Operations 1.000.000 <br />PmooaJ &: Advertising Injury 1,000,000 <br />Each Occum:ace Limit 1,000,000 <br />Fa. Damoge (Any Ooc Fin:) 50,000 <br />Medical Paymau. (Any Ooc Person) 5.000 <br />The limils of illSllRlloc lIppIy :lCpIlI3te1y to each event insumI by this policy IS if. sepaqIe ~ of insulllllce has been issued lOr <hat everrL <br />''WOO is insured" is amended to include. &8 lid iD:sun:w:I. Cbo person. or orgsizadoa shown in this schedule. but only with A!SpCCt to liability arisinc out of the <br />o......hip. DIIintenance or use ofdte ""'"""" used by dte named insumI (....t hoIdor). This i_ does ""'apply to: Any "occum:nce" which llIbs plac. <br />aftertb& evem boJder ceases to be a tenant m that pmmiscs. <br /> OTHER ADDITIONAL INSUREDS <br />CANCELLA nON: Should dte ahov. descn'bod policy '" cancollod before tho expiration date dtercof, dte issuJug company will mail 30 days wriltcu ool;c. to dte <br />_ficalehold<<aud_l~listod. <br /> <br />AlITIIORIZED REPRESENTATIVE: <br /> <br /> <br /> <br />1'0 FORM <br /> <br />DATE ISSUED: <br /> <br />7/25/02 <br /> <br />NE LEE SHAW <br />Deputy City <br />