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AC R�°� CERTIFICATE OF LIABILITY INSURANCE °ATE (1112 20 �..�� 6/11/2020 THIS CERTIFICATE IS ISSUED ASA 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 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(les) 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), PRODUCERNAME: Sub Worthington L/P Insurance Services , LLC PHONE 916 -844-0400 FNG No : 11249 Gold Country Blvd #160 EMAIL sue . worthington@lpins . net ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC A Gold River CA 95670 INSURER A : Associated Industries Insurance Compan3 23140 INSURED INSURERB : Ohio Security Insurance Company 24082 Savidge Construction, Inc , INSUpaO4C ; CQlQpV Fplanrpnoo Co. 39993. INSURER D : Everest Premier Insurance ComanY Coma16045 4401 Sonja Court INSURERE : Colon - specialty Insurance Cc 36927 Placerville CA 95667 INSURER F : COVERAGES CERTIFICATE NUMBER: 19-20 GL/AU/UM/WC/Poll 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IP POLICYEXF LTR TYPE OF INSURANCE POLICY NUMBER MMIDEINPOLICY YYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000 , 000 A CLAIMS-MADE a OCCUR DAEAGEN E. MIS0 _S IFn ocoorenW1 $ 100 , 000 5102920503 10/1 /2019 10/1 /2020 MET) EXP (Any one person) S 51000 X $5 , 000 Ded BI/PD/PAI PERSONAL & ADV INJURY S 100000000 GENLAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE S 2 . 000 , 000 POLICY O JEa a LOC PRODUCTS - COMPIOPAGG $ 2 , 000 , 000 OTHER'. S AUTOMOUILELIABILITY COMBINED SINGLE LIMIT $ 1 , 000 , 000 (Ed accident) B X ANYAUTO BODILY INJURY (Perperson) S ALL OWNED GCHEDULED 056296'111 10/1/2019 10/1/2020 BODILY INJURY (Per accident) $ AUTOS AUTOS s2 XX NON OWNED PROPERIYDAMAGE $ HIRED AUTOS AUTOS Per cowman S MaRELL-A LIAR X OCCUR EACH OCCURRENCE S 5 , 000100° O X EXCESS LIAR CLAM M3-MADE AGGREGATE S 51000 , 000 RETENTION $ X3174553 10/1/2019 10/1/2020 $ WORKERS COMPENSATION None X PER OTH AND EMPLOYERS' LIABILITY YIN STAT TE P ANY PROPRIETORIPARTNERIEXECUTIVE EL" EACH ACCIDENT S 1 000 , 000 D MFandston, In NH)FICERIMEMBER EXCLUDEDy NIA 00013760191 10/1/2019 10/1/2020 ( N EL DISEASE - EA EMPLOYEE S 1 , 000 000 If escdhe undOF OF OE%RIE50RIPTIDN OF OPERATIONS balpw E . DISEASE - POLICY LIMIT $ 11000 . 000 E Pollution-Claims Made CSF4223163 10/1/2019 10/1/2020 Ea Candiaoiqq $SNu' 1/$2Mi1 B Rented/Leased Equipment 1492056296711 10/1/2019 10/1/2020 ed 51 ,000 A $400 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES (ACORD 101, Additional Remarks Schedule, may be atlaeHed it more apace Is mqulmd) Job : ARCO, 2510 S State Hwy 99 , Stockton CA 95205 : when Named insureds operations a e performed for City of Stockton pursuant to a valid written contract or agreement executed by Named Insured prior to loss . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Stockton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2510 S State Hwy . 99 ACCORDANCE WITH THE POLICY PROVISIONS. Stockton , CA 95205 AUTHORIZED REPRESENTATIVE pp� Sue Worthington/-SUE Std 4,�Itat - © 19884014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101 ) The ACORD name and logo are registered marks of ACORD INS025 (201401)