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AC40RBI�® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)
<br /> 03/06/2024
<br /> THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 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( ies) 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 CONTACT Shala Pearson
<br /> NAME:
<br /> TLB Insurance Services PHONE (916) 790-5863 FAX (888) 329-8842
<br /> AIC No Ext) : A/C, No
<br /> CA License #OB82095 E-MAIL shala-pearson@leavitt. com
<br /> ADDRESS:
<br /> 2358 Maritime Dr, Ste 100 INSURER(S) AFFORDING COVERAGE NAIC #
<br /> Elk Grove CA 95758 INSURERA : Westchester Surplus Lines Insurance Company 10172
<br /> INSURED INSURER 8 : Travelers Property Casualty Company of America 25674
<br /> Walton Engineering , Inc. INSURER C : Service American Indemnity Company 39152
<br /> P. O. Box 1025 INSURER D : Travelers Property Casualty Company. 36161
<br /> INSURER E :
<br /> West Sacramento CA 95691 INSURER F :
<br /> COVERAGES CERTIFICATE NUMBER: 24/25 All Lines 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 POLICIES , LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br /> INSR AUUL bUt3K POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000,000
<br /> CLAIMS-MADE ❑X OCCUR
<br /> DAMAGE 1" RENTED 50 , 000
<br /> PREMISES Ea occurrence $
<br /> X Inc. Professional Liability MED EXP (Any one person) $ 51000
<br /> A G47393735002 03/06/2024 03/06/2025 PERSONAL & ADV INJURY $ 1 ,000, 000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: I GENERAL AGGREGATE $ 21000 , 000
<br /> POLICY PRO- LOC PRODUCTS - COMP/OP AGO $ 2, 000 , 000
<br /> JECT
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000 , 000
<br /> Ea accident
<br /> X ANYAUTO BODILY INJURY (Per person) $
<br /> B OWNED SCHEDULED 81081.785302 03/06/2024 03/06/2025 BODILY INJURY (Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED �/ NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY X AUTOS ONLY Per accident
<br /> Uninsured motorist $ 1 , 000, 000
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE 103000, 000
<br /> $
<br /> A X EXCESS LIAB CLAIMS-MADE 647393747002 03/06/2024 03/06/2025 AGGREGATE $ 103000, 000
<br /> DED I X RETENTION $ 0 $
<br /> WORKERS COMPENSATIONX STATUTE EORH
<br /> AND EMPLOYERS' LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E. L. EACH ACCIDENT $ 1 , 000 , 000
<br /> C OFFICER/MEMBER EXCLUDED? NIA SAMTWC10020102 10/01 /2024 10/01 /2025
<br /> (Mandatory in NH ) E, L. DISEASE - EA EMPLOYEE $
<br /> D 1 , 000 , 000
<br /> yes, describe under
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 , 000 , 000
<br /> Pollution Liability
<br /> A 647393735001 03106/2024 03/06/2025 Limit 1 , 000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required )
<br /> is included as an additional insured when required by written contract as respects General Liability and Auto
<br /> Liability per forms CG2010 0704 , CG2037 0704 , CAT353, CAT474 . Insurance is Primary and Noncontributory form ENV3251 1218, Per Pproject Aggregate
<br /> applies per form ENV7124 0314 . Waiver of Subrogation , when required in written contract applies to General Liability, Auto Liability and Work Comp per
<br /> forms ENV3143 0305 , CAT35302153 10217718 ,
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS .
<br /> AUTHORIZED REPRESENTATIVE
<br /> © 1988-2015 ACORD CORPORATION . All rights reserved .
<br /> ACORD 25 (2016103 ) The ACORD name and logo are registered marks of ACORD
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