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7 ® • • DATE(MM/DDNYYY) A�h1 CERTIFICATE OF LIABILITY INSURANCE 3/14/2016 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms 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). CONTACT Heidi Gable PRODUCER NAME: TLB Insurance Services, Inc. PHONE (925)395-2600 FAX (925)25Ma24856 No CA License #0382095 pppRlL g;heidi-gableBleavitt.com 3000 Oak Road, Suite 210 INSURERS AFFORDING COVERAGE Walnut Creek CA 94597 INSURERA Admiral Insruance Company INSURED INSURER B:Inte on National Insurance Co an Walton Engineering, Inc. INSURERC:State C ensation Ineuraace Fund P.O. Box 1025 INSURERD Martford Casualty Insurance Company 29424 INSURERE; West Sacramento CA 95691 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 PRG w/ 15-16 WC REVISIONNUMBER: 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. INSRL UBR POLICYEFF POLICY EXP LIMITS L TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMDD1YYYY1 MIWDD1YYYY1 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS-MADE OCCUR REMISE ER occurrence $ 50,000 X Incl. Pollution Liab. FBIECC1358703 3/6/2016 3/6/2017 MED EXP(Any one person) $ 5,000 X incl. Professional Liab. PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 21000,000 X POLICY� PRO-JECT LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: EMPL BENEFITS UAB $ COMB NEO AUTOMOBILE LIABILITY LE UNI $ 11000,000 Ea acdtlent B X ANY AUTO BODILY INJURY(Perperson) E ALLOWNED SCHEDULED 12003162 3/6/2016 3/6/2017 BODILY INJURY(Per acrJtlenO $ AUTAUTOS HREDSAl1TOS X NN-OWNED PR�amC�t�MAGE $ X AUTOSUnlnsuretl matodalwmbiiretl $ 500,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ 10,000,000 A X EXCESS UAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I I RETENTION$ FEIMS1358803 3/6/2016 3/6/2017 $ WORKERS COMPENSATION X I STATUTE I ORH AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ 11000,000 OFFICERIMEMBER EXCLUDED? NIA C (Mandatory In NH) 911333915 30/1/2016 30/1/2017 E.L.DISEASE-EA EMPLOYE 1 $ ,000,000 HyesdasonbeuMW E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below D Inland Marine 57UUMZC1966 3/6/2016 3/6/2017 Limit $ 300,000 Rented, Leased or Borrowed Dec"C' I It DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N mane space la required) JAN v 5 2017 ENVIRONMENTAL HEAL] DEPARTMENT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To Whom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Dennis Cote/JUBAUP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(901401)