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AC n ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/6/2016 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 policy(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). PRODUCER CONTANAME:CTAllBethany Kaiser 25 N.Cedar Ave.t Insurance Services, Inc. P"°NE E.Q.559-437-3380 FAX 75 559-437-3385 7525 Suite 101 E ffip& .bkaiser@alliant.com Fresno CA 93720 INSURE S AFFORDING COVERAGE MAIC s INSURER A:National Specialty Insurance Com an 122608 INSURED INSURERB:Commerce&Industry Ins Co 19410 Woodward Drilling Company,Inc. INSURERC:State National Ins Co, Inc. 12831 P.O. Box 336 Rio Vista CA 94571 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1654748287 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 POLICY EFF POLICY EXP LIMITS LTR INSO WVD POLICY NUMBER MM/DD MMID C X COMMERCIAL GENERAL LIABILITY Y MDF0165365 8/20/2016 8/20/2017 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTEIT__ CLAIMS-MADE FX OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY❑JET LOC PRODUCTS-comp/op AGG $4,000,000 OTHER: S&A POLLUTION $1,000,000 C AUTOMOBILE LIABILITY YMEA0165365 8/20/2016 8/20/2017 Eaaccident $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ AAIL/LTOS OWNED SCHEDULEDOS BODILY INJURY(Per accident) $ AUT NON-OWNED E DAMAGE $ HIRED AUTOS AUTOS Per agent A X UMBRELLA LIAB X OCCUR Y NFF0165365 8/20/2016 8/20/2017 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTION$$10,000 S&A Pollution-Occ $4,000,000 B WORKERS COMPENSATION WC62716226 10/1/2015 10/1/2016PER AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVEE.LEACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below El DISEASE-POLICY LIMIT $1,000,000 C Scheduled Equip MDF0165365 8/20/2016 8/20/2017 Limit 52.416,985 Leasd/Rentd Equip Limit $50.000 Special Form Ded $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as an Additional Insured to apply as respects to General Liability,Automobile Liability per attached forms CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE San Joaquin County Environmental Health Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1868 East Hazelton Ave ACCORDANCE WITH THE POLICY PROVISIONS. Stockton CA 95205 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD