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ACOWEP® CERTIFICATE OF LIABILITY INSURANCE DA7E (MMIDDIYYYY) 121312019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R143HTS 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 have ADDITIONAL INSURED provisions or 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 endomement(s). PRODUCER E;Eat Lisa Salciccia Andreini & Company-San Mateo PHON u E , 650 3784238 aC No): 65Ow3784361 220 West 20th Ave E-MAIL San Mateo CA 94403 ADDRESS: isalciccia andreini.com INSU AFFORDING COVERAGE NAtCS INSURER A : Insurance Company Of the West 27847 INSURED CHARLA INsuRERB : Crum &ForsterSpecialty Ins Co 44520 Charles E. Thomas Company, Inc INsumRcF Federal Insurance Company 20281 13701 So Alma Avenue Gardena CA 90249 tNSURERD : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 803274522 REVISION NUMBER: 1 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. r[3 TYPE OF INSURANCE ADD SUR POLICYNUMBER MMIPOLDD EFF MPPMIDD EXP LIMITS X COMMERCIAL. GENERALUABILITY EPI(129203 12/1/2019 12/112020 EACH OCCURRENCE 32,000,000 _ ® PEM AMAGSES Ea ENTED occurrence $ 1000000 CLAIMS-MADE OCCUR MED EXP (Any one person) $ 10,000 X CPL-Pollution PERSONAL & ADV INJURY $ 2,0006000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,Q0G POLICY ® FRI LOC PRODUCTS - COMPIOP AGG $ 2,000,000 OTHER: CPL - erOccurrancs $ 2,000,000 C AUTOMOBILELIABILITY 73612365 12/1/2019 12/1/2020 COMBINEDSINGLELIMIT $ 1 ,000,000 Ea accident _ X ANY AUTO BODILY INJURY (Per person) S Fn OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS PROPERTYOAMAGE HIRED NON40WNED Pe PEaccident) . $ AUTOS ONLY AUTOS ONLY X Com $1,000 X coli $1 ,000 $ B UMBRELLAUA11 rd OCCUR EFX114105 12/1/2019 12/112020 EACH OCCURRENCE $ 4,00D,00D X EXCESSLIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED X RETENTION $ S A WORKERS COMPENSATION WPL504465501 12/1/2019 12/1/2020 1 ER AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORIPARTNERIEXECUTIVE F---1N / A E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED9 E.L. DISEASE - EA EMPLOYEE $ 1 ,000tODO (Mandatory In NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1 ,000,000 DESCRIPTION OF OPERATIONS below ccwence $2000s000 B Errors & Omissions EPK129203 12/1/2019 12/1/2020 Aggregate $2,000,000 Claims Mede DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remadts Schedule, may he attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THffJEOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I i Evidence of Insurance AUTHORIZED REPRESENTATIVE i © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD E i