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JONECOV-02 DADACAYA A�Ro CERTIFICATE OF LIABILITY INSURANCE F DATE(MYYY) _ 6/28/12012012 THIS CERTIFICATE IS 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 certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#OE67768 NAME Celeste Garcia IDA Insurance Services-ORG i&:!�ieste.garcla@ioausa.com ce 130 Vantis,Suite 260 A c No :(949)297-5962 A C N,: (949)297-5960 Aliso Viejo,CA 92656 AooResieste.garcia ioausa.com INSURER(S)AFFORDING COVERAGE NAICO INSURERA:OneBeacon Insurance Company 21970 INSURED INSURERB:Golden Eagle Ins Corp 10836 Jones Covey Group,Inc. INSURERC:Granite State Ins CO 23609 9596 Lucas Ranch Rd Ste 100 INSURER D: Rancho Cucamonga,CA 91730 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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. INSR TYPE OF INSURANCE LTR INSR POLICY NUMBER POLICY MMIDO/YWY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A X COMMERCIAL GENERAL UABILTTY X 7930001440001 7/1/2912 7/1/2813 pREMISEs Ea omurrenm S 50,000 CLAIMS-MADE 1XI OCCUR MED EXP(My one person) $ 5,000 PERSONAL S ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 5,000,000 POLICY X JECT F1PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,008,808 B X ANY AUTO BASS63096 7/1/2012 7/1/2013 BODILY INJURY(Per person) $ ALL OWNED SCHALTEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PRO AMAGE $ HIRED AUTOS H AUTOS (Per acdtlent UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 2,000,000 A X EXCESSUAB CLAIMSMADE 930001460001 7/1/2012 7/112013 AGGREGATE $ 2,000,000 DED I X I RETENTION$ S WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY V LIMITS ER C ANY PROPRIETOR/PARTNER/IXECUTNE V/N C009970790 2/1/2012 2/1/2013 El.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) El.DISEASE-EA EMPLOYE $ 1,000,000 If yyeess describe under DESCRIPTIONOFOPERAT10NS babes E.L DISEASE-POLICY DMIT $ 1,008,008 A Professional Liab 930001440001 7/1/2012 7/1/2013 Limit: 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Costco Wholesale Gas Station Service f O/ 999 Lake Drive ri L' A, Issa uah WA 98027 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD