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RLUtl v cv <br />NOV 2 2 2016 <br />ACORD� CERTIFICATE OF LIABILITY INSURARONMENT LMS'' <br />117!2016 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TH R. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />NAME: Tawn a Gatvan <br />Tom Michael insurance Agency Inc. <br />Fa% <br />: (209) 667-1511 Arc Ne); (209► 667.1581 <br />2930 Geer Rd. PMB #158 <br />EAlMAIL <br />Turlock, CA 95382 <br />ADDRESS: tlm@tmLq2ency.com <br />License #: OC60289 <br />_ INSURER(SIAFFORDING COVERAGE _ _ NAIC t <br />INSURER A: Rockhill n n e C o. <br />INSURER B: State Compensation Insurance Fund 35076 <br />INSURED <br />TERRY D HAMILTON <br />SHARON HAMILTON <br />INSURERC: <br />1502 Westbrook Ci <br />INSURER D: <br />Modesto, CA 95358-1086 <br />INSURER E <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 00000000-430880 REVISION NUMBER: 2 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN iSSUEO 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />!NSR ADDLISUB I POLICY EFF POLICY EXP <br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYyyy LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />N <br />N E N V P006721-04 <br />11103/2016 11/0312017 <br />EACH OCCURRENCE S 1,000,000 <br />CLAIMS -MADE C OCCUR <br />ED <br />PREMISE (Ea qocurnarce)s 60,000 <br />MED EXP (Arty one person) S 5,000 <br />PERSONAL & ADV INJURY S 1,000,000 <br />GEML AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE 5 2.000.000 <br />x POLICY —1 IE� LOC <br />_ <br />PRODUCTS - COMPIOP AGG S 2,000,000 <br />$ <br />OTHER. <br />AUTOMOBILE LLASIUTY <br />BINED SINGLE LWIT $ <br />Ea ecadenl _ <br />ANY AUTO <br />BODILY INJURY (Per person) $ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) s <br />_ <br />HIRED NON -OWNED <br />PROPERTY DAh9AGE $ <br />AUTOS ONLY AUTOS ONLY <br />Per acciden! <br />UMBRELLA UAB <br />HCLXM&MAoe <br />OCCUR <br />EACH OCCURRENCE S <br />AGGREGATE S <br />EXCESS LIAR <br />i DED RETENTIONS <br />$ <br />B <br />B <br />WORKERS COMPENSATION <br />N y047473-1fi :03�01rzo16 Q$10112017 <br />�( PER OTH• <br />STATUTE ER <br />AND EMPLOYERS' LIABILITY YIN <br />£.L EACH ACCIDENT $ 1,000,000 <br />ANY PROPRIETORMARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />NIA <br />E.L. DISEASE - EA EMPLOYEE S 1,000,000 <br />describe under <br />DESCRIPTION OF OPERATIONS below <br />I <br />E.L. DISEASE - POLICY LIMIT S 1,000,000 <br />1 <br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Addlboml Remarks Schedule, may be aneched if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />Pnnted by TMG on November 17, 2016 at 02:48PM <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Rodney D, Gaede and Linda D. Gaede <br />Trustees of the Rodney and Linda Gaede Family Trust <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS- <br />8476 E. KeWeman Lane <br />AUTHORIZED REPRES TATIVE <br />Lodi, CA 45240 <br />(TMG) <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />Pnnted by TMG on November 17, 2016 at 02:48PM <br />