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P5260028002
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<br />ACORV CERTIFICATEF LIABILITY INSURANCE
<br />DATE (MMIDDNYYY)
<br />03/27/2014
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER LIC #OB29370 1-925-244-7700
<br />CONTACT
<br />NAME: Certificates Department
<br />Edgewood Partners Insurance Centers (EPIC)
<br />PHONE (925) 244-7700 1Fa (925) 901-0671
<br />{A1C, No. €xt): (_., NSF
<br />[San Ramon Branch]
<br />P. O. Box 5003
<br />E-MAIL EPICcerts@edgewoodins.com
<br />ADDRESS: .. ..
<br />San Ramon, CA 94583
<br />_ INSURER(S) AFFORDING COVERAGE I NAIC_ #
<br />110172
<br />i MED EXP (Any one person) I$ 5,000
<br />INSURER A:WESTCBESTER SURPLUS LINES INS CO
<br />INSURED
<br />INSURER B: PEERLESS INS CO 24198
<br />Gettler-Ryan Inc.
<br />STATE COMPENSATION INS FUND 135076
<br />INSURER C : ,
<br />6805 Sierra Court, Suite G
<br />INSURER D: 1
<br />Dublin, CA 94568
<br />INSURER E:
<br />'GENERALAGGREGATE $ 2,000,000
<br />INSURER F: I
<br />-11- KIIIaaQCD• RRQQQQ51 RFVISInN NI IMRFP.
<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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR j TYPE OF INSURANCE IADDL'SUBR, POLICY EFF POLICY EXP
<br />LTR . ' I R: POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS
<br />A
<br />GENERAL LIABILITY
<br />624014484007 04/01/1'
<br />04/O1/15':EACH OCCURRENCE ;$ 1,000,000
<br />X !COMMERCIAL GENERAL LIABILITYI
<br />1
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence) i $ 50, 000
<br />I
<br />I
<br />CLAIMS -MADE X I OCCUR
<br />I
<br />I
<br />i I
<br />i MED EXP (Any one person) I$ 5,000
<br />;PERSONAL &ADV INJURY I $ 1,000,000
<br />'GENERALAGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />I
<br />PRODUCTS - COMP/OP AGG I $ 2, 000, 000
<br />POLICY I X I PRO- I I LOC
<br />I
<br />1 ;$
<br />B
<br />AU TOMOBILE LIABILITY
<br />iBA8404396
<br />I 04/01/1
<br />04/01/15
<br />COMBINEDSINGLELIMIT
<br />1,000,000
<br />X ! ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accident)
<br />$
<br />AUTOS AUTOS
<br />ANON -OWNED
<br />I
<br />IPROPERTYDAMAGE
<br />$
<br />X HIRED AUTOS X I AUTOS
<br />, (Per acciden)
<br />$
<br />A
<br />UMBRELLALULB x OCCUR
<br />G24014502007
<br />04/01/1'
<br />04/O1/151
<br />EACH OCCURRENCE_
<br />$ 4,000,000
<br />X
<br />EXCESS LIAR CLAIMS_ -MADE_
<br />AGGREGATE__
<br />$4,000,000
<br />1
<br />I DED I X I RETENTION $ 0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />905122914
<br />04/01/1
<br />04/01/15'
<br />% LM OTHJ
<br />TORY LIWC MlT� BR
<br />AND EMPLOYERS'LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />_OR,
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICERIMEMBER EXCLUDED? Y(Mandatory in NH)
<br />N/A
<br />E.L.DISEASE - EA EMPLOYE$
<br />1,000,000
<br />If yes, describe under
<br />I
<br />1
<br />1, 000, 000
<br />.
<br />DESCRIPTION OF OPERATIONS below
<br />IIIi
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />A
<br />Professional Liability
<br />G24014484007
<br />04/01/19
<br />04/01/15 Per Claim 1,000,000
<br />B
<br />Rented/Leased Equipment
<br />CBP8404796
<br />04/01/1&JI
<br />04/01/15 Per Item 100,000
<br />A
<br />Pollution I
<br />iG24014484007
<br />04/01/1
<br />04/01/15 Per Occurrence 1,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />ADDITIONAL INSURED: Belshire Environmental Services, Inc.
<br />CERTIFICATE HOLDER L;ANL:tLL.AIIUN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Environmental Services, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />25971 Towne Center Drive AUTHORIZED REPRESENTATIVE Q
<br />Foothill Ranch, CA 92610 67i�_
<br />USA (��"'
<br />© 1988-2010 ACORD CORPORATION. All rights reserVea.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />kstubbs
<br />38999951
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