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JONECOV-02 DADACAYA Ac� R5 CERTIFICATE F LIABILITY ISU NCE DATE(MM/DD,YYYY) �✓' 6/28/2012 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 License#OE67768 NAME: Celeste Garcia IDA Insurance Services-ORGFAX PHONE 130 Vantis,Suite 250 A/c No Ext:(949)297-5962 (A/CN,: (949)297-5960 Aliso Viejo CA 92656 leste. arcia loausa.com � ADDRESS: ceDDRg INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:OneBeacon Insurance Company 21970 INSURED INSURER B:Golden Eagle Ins Corp 10836 Jones Covey Group,Inc. INSURER C:Granite State Ins Co 23809 9595 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MWDD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 DAMAGE TO REN I I.IJ A X COMMERCIAL GENERAL LIABILITY X 7930001440001 7/1/2012 7/1/2013 PREMISES Ea occurrence $ 50,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 5,000,000 POLICY X PRO LOC $ /ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 000 Ea accident $ s r B X ANY AUTO BA8863096 7/1/2012 7/1/2013 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESS LIAB CLAIMS-MADE 7930001450001 7/1/2012 7/1/2013 AGGREGATE $ 2,000,000 DED I X I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X C009970790 2/1/2012 2/1/2013 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Professional Liab 7930001440001 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) I i 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: t 999 Lake Drivel%' / =� 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