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ACO -Ra CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/29/2011 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER_ IMPORTANT: If the certffkate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain poficles may require an endorsement A staternent on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Self Insured Solutions Administrator, Califomia Contractors Network, Inc. 430 N Vineyard Ave- #102 Ontario, CA 91764 CONTACT NAME: PHONE (i00) 592-0047 FAX Wc,,., E,,V (800) 592-2541 sisoem@selfinsuredsolutions.wm MAIC e – soisunOI A. CnW*mka Contractors Natwcd6 kit.• a ounsin tr New York Marine and Ganaral iem -'Ice Woodward DrAllrig Company, Inc naiRlac Affiliate of California Contractors Network, Inc EIIRJRBID _^` PO Box 336 autlRln u Rio Vista, CA 94S71 – _ -- RYaalO P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY EQUIREMENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. aysA - ADI aliER 7POLICY Err - - PDtK.Y ER► l T A TYPE OF NISURANCE IO�ICY NUMBER D m OD LIMITS COMMERCIAL GENERAL LIAOKITY . EACH OCCURMNCE $ --- 77 ' CLAIM$ -MADE (OCCUR J I DAA4AOE To RENttD---'-- ... _ �MISE114 MwnEA1sI__�s MED EXP (My— ( ❑ ❑ PERSONAL A ADV RYIEJRY S GEN'LAGGRE UMR ►ER: I GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS - COMP/OP AGG $ OTHER S AUTOMDeKE LIASKM COMEHKD SIIIGIE L"T $ (E. aaHant) ANY AUTO BODILY INJURY (Per Person) $ ANY OWNED SCHEDLIRLD AVMS AUTOS AUTOS a BODILY MIURY iPer accident) $ HIRED AUTOS NOM OWNED M WRTYDAIRAGE $ .- Auto (Par a�arR) UMBRELLA UAa OCCUR EACH OCCURRENCE $ EXCESS UAa C1AaAS MADE AGGREGATE $ DED RETENTION $ ' WORXERSCOMMNSATION V WC STATU- OTH -- X AND EMPLOYERS' UAIIUTY TORY UMITS ER A -TIN BN MTH AONUET0"AAERJWC TM *FFK1/MEMKFtMLUMDT j MIANETrSOgo2p Oy2?/IM 02AII/l019 E.LEAOIAooDENr SS,00D,000.00 (M&WatnryInNH) LLDISEASE EAlkWU EE SS,00000000 aYw DESO"rnoN Or orFMTIOM Mbw I.L.Ce5[AfE - POLICY LAWSS,000,000 00 EXCESS WORKERS COMPENSATION WC201K"00131 OE/27Je"n 01AUN19 ANO EMPLOYER5 LUUMUTY 101 Applicabis to WC Statutory Limits and EmPbyws Uff its DESCRN __ nopi OF o►ERATIONs / LOCATION / VEHKLES IAlbdt ACORD _ 10L Add iomal R*merks Schadtda, if awn Bata Is SEMwiMI Proof of insunnu CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. • • A1fT1aORUEO REYRE.SJ:NTATTVE --. - _.. L Bell O 19MZOIO ACORD CORPORATION. An rights reserved ACORD 25 (2014/01) The ACCORD name and logo are registered marks of ACORD