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--l'ses"N KAISE4 OP ID:BILL <br /> DATE(MWDDrfm <br /> CERTIFICATE 0 <br /> FMY&kt"gU NCE 07/1212017 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORAAATI0*4 &UN THE CERTIFICATE HOLDER.THIS <br /> R <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AM RAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE AgjCQNTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 201z <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may req dorsem.ent. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsemengs). ONMPKITAI WrA,:.-. <br /> PRODUCER =WMA�A641-L-r'IL-I r-1 <br /> Brown a Brown Ins Svc of CA 209-465 <br /> PHONE I WC,No), -8737 <br /> PO Box 200 tkRNNj�);Ift-AW5671 " <br /> E_ AIL <br /> DRES <br /> Stockton,CA 95201 ADM s:bjohnsQbbstockton.corn <br /> Greg Williamson -INSURER(S)AFFORDING COVERAGE MAIC S <br /> INSURERA:Adrnlral Insurance Company 124856 <br /> INSURED Kaiser Commercial Petroleum INSURER B:Financial Indemnity Co. <br /> Greg Kaiser INSURER C-Sta!A_qqMPtnS8tIOj.Ins Fund <br /> P.O.Box 1058 <br /> Linden,CA 95236 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 POUCIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE JADDL US - I POLICY OFF UMTS <br /> LTR I INSO POLICY NUMBER 1MMIDDrYYYYI (AM DfYYYY) <br /> A X COMMERCIAL GENERAL LIABILITY <br /> EACH OCCURRENCE Is 11000,000 <br /> -DWOh TO NhN I hU <br /> CLAIMS-MADE OCCUR FEIECCID673-03 061081201710610812018 PREMISES IEa occurrence) 1$ 60,000 <br /> MED EXP—(An 9 —n $ 6,000 <br /> gp <br /> PERSONAL&ADV INJURY $ 1,000,091 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00( <br /> POLICY 0 PRO- F-] <br /> JECT LOC i PRODUCTS-COMPIOP AGG S 2,000,0011 <br /> 1,000,00( <br /> OTHER: iEmp Ben. <br /> AUTOMOBILE LIABILITY E!BIN )SINGLE LIMIT <br /> .r <br /> �gd!.nj 11000100( <br /> B ANY AUTO ICCFICR125949112 0610812017 0610812018 BODILY INJURY(Per person) $ <br /> L OWNED V,SCHEDULED BODILY INJURY(Per accident) 5 <br /> AUTOS AUTOS <br /> NON-OWNED 'pR0 '�iDAMAGE <br /> X HIRED AUTOS AUTOS Per:Td I Is <br /> UMBRELLA LIAB i <br /> HOCCUR i EACH OCCURRENCE $ <br /> EXCESS LLAB CLAIMS-MADE <br /> AGGREGATE <br /> DED RETENTION <br /> WORKERS COMPENSATION PER ,oTFF- <br /> AND EMPLOYERS!LIABILITY YIN STATUTE 1 0 <br /> C ANY PROPRIETORIPARTNERIEXECUTFVE 1839765-17 08101/2017 08RI112018 E.L.EACH ACCIDENT S 11000100( <br /> OFFICERIMEMBER EXCLUDED? El NIA <br /> (Mandatory in NH) <br /> If Y4 describe Linder E.L.DIS00 <br /> EASE-EA EMPLOYEE $ 1,0 ,00C <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 11000100C <br /> A_Professional Llab IECC19673-03 1 0610812017 06108/2018 <br /> A Cont!s Pollution FEIECC19673-03 06/08120171 0610812016 <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Rimmift ScheduK may be attached V am space is required) <br /> License#859535 <br /> CERTIFICATE HOLDER CANCELLATION <br /> CSLB1 I I <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Contractors State License ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Board <br /> Workers Comp Unit AUTHORIZED RSPRO <br /> P.O.Box 26000 8ENTATive <br /> Sacramento,CA 95826 Greg Williamson <br /> 0 1988-2014 ACORM"PORATION. AM rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />