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DATE(MM/DD/YYYY) AC40RO® CERTIFICATE OF LIABILITY INSURANCE 07/06/2021 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 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 endorsement(s). PRODUCER CONTACT NAME: ACW GROUP, LLC dba:AKAMINE CHRISTMAN WALL INSURANCEpC.N E 760-485-3710 A/X No:760-262-3673 79-220 CORPORATE CENTER DR., SUITE 102-F ADDRESS: bhoskins@acwgroup.com LA QUINTA, CA 92253 INSURERS AFFORDING COVERAGE NAIC# INSURERA: U.S. SPECIALTY INSURANCE COMPANY INSURED INSURER B: State Compensation Insurance Fund WEST COAST EXPLORATION, INC INSURER C: INSURER D: P.O. BOX 133 INSURER E ESCALON CA 95320 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. INSfl TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A COMMERCIAL GENERAL LIABILITY X U19AC81810-06 04/26/21 04/26/22 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT CLAIMS-MADE FXI OCCUR PREMISES fEa occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1 PRO- POLICY F—] LOGPRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION 9282808-2020 09/01/20 09/01/21 X STATUTE EORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N 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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) San Joaquin Environmental Health Department, has been Additional Insured per the attached endorsement for work performed on behalf of the named insured as required by way of written contract. Note: Additional Insured status is subject to all policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION San Joaquin Environmental Health SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1868 E Hazelton Ave, ACCORDANCE WITH THE POLICY PROVISIONS. Stockton, CA 95205 AUTHORIZED REPRESENTATIVE / ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD