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�►��o® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 03/02/2022 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 Shala Pearson NAME: TLB Insurance Services a/ FA c No Ext): (916) 790-5863 C I� No): (888) 329-8842 CA License #0882095 E-MAIL shala- pearson@leavitt. com ADDRESS: 2358 Maritime Dr, Ste 100 INSURER(S) AFFORDING COVERAGE NAIC # Elk Grove CA 95758 INSURERA : Admiral Insurance Company 24856 INSURED INSURER B : Travelers Property Casualty Company of America 25674 Walton Engineering , Inc. INSURER C : State Compensation Insurance Fund 35076 P.O. Box 1025 INSURER D : Travelers Property Casualty Company. 36161 INSURER E : West Sacramento CA 95691 INSURER F : COVERAGES CERTIFICATE NUMBER : 22/23 Master 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS , INSR ADD UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000, 000 DAMAGE CLAIMS-MADE F OCCUR PREM SESOEa occurrence $ 501000 X Inc. Pollution Liability MED EXP (Any oneperson) $ 53000 A X Inc. Professional Liability FEIECC1358708 03/06/2022 03/06/2023 PERSONAL & ADV INJURY $ 15000, 000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,0001000 POLICY ❑X JECT F�] LOC PRODUCTS - COMP/OPAGG $ 2 ,0001000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 19000, 000 Ea accident X ANYAUTO BODILY INJURY (Per person) $ B OWNED SCHEDULED 810BL785302 03/06/2022 03/06/2023 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Uninsured motorist $ 1 ,000, 000 UMBRELLA LIAR �V " """ "" �" ' y"" "" " t 10 , 000 , 000 OCCUR EACH OCCURRENCE $ A X EXCESS LIAB CLAIMS-MADE FEIEXS1358808 03/06/2022 03/06/2023 AGGREGATE $ 10 , 000 , 000 DED I X1 RETENTION $ 0 $ WORKERS COMPENSATION X PERSTATUTE EORH AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 130003000 C' OFFICER/MEMBEREXCLUDED7 N / A 9113339 10/01 /2021 10/01 /2022 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 120001000 If yes, describe under 1 ,000, 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Inland Marine D Leased/Rented/Borrowed 6608K816207 03/06/2022 03/06/2023 Limit $3003000 Deductible I, (1 . $2, 500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) SEP 0 0 2022 FNVIRONMENTAL HEALTH PFRMITISERVICES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN To Whom it May Concern Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved . ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD