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A ® CERTIFICATE DATE(MMIDDNYYY) <br /> OF LIABILITY INSURANCE 11/13/2009 <br /> PRODUCER (209)334-4242 FAX: (209)369-0684 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Mid-Central Valley Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 301 S. Ham Lane, Suite F HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> P.O. Box 490 <br /> Lodi CA 95241 <br /> - <br /> INSURED INSURERS AFFORDING COVERAGE NAIC# <br /> ._. .. _,_�_ <br /> INsuRERA Western Security Surplus Ins <br /> Linden-Peters Chamber of Commerce M--�-- - - <br /> I INSURERS: <br /> P. 0. Box 557 - -- <br /> INSURER C: <br /> Linden <br /> IN D_ <br /> CA 95236 INSURER E. <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH <br /> POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> POLICY EFFECTIVE POLICY EXPIRATION i <br /> POLICY NUMBER LIMBS <br /> !-GENERAL LIABILITY <br /> ' EACH GCCURRENCE i S 1,000,000 <br /> X i COMMERCIAL GENERAL LIABILITY f DAMAGE TO RENTED - <br /> 1 PREMISES LEoopcunencel S 100,000 <br /> A X CLAIMS MADE X OCCUR NC951010 <br /> 11/1/2009 1 11/1/2010 1 MEDEXP(Any one person) ;$ 5,000 <br /> _._. <br /> j <br /> PERSONAL BADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GENT AGGREGATE LIMIT APPLIES PER <br /> pRp_ ( PRODUCTS-COMPlOP AGG:S IACluded <br /> X POLICY ..._._..4. <br /> LOC i (-___.__ - <br /> ;AUTOMOBILE LIABILITY <br /> ANY AUTO COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ALL OWNED AUTOS <br /> SCHEDULED AUTOS BODILY INJURY <br /> r i HIRED AUTOS ! I (Per person) 1$ <br /> NON-OWNED AUTOS BODILY INJURY <br /> i (Per accident) S <br /> PROP <br /> ERTDAMAGE <br /> (Peraccident) $ <br /> } <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> _.._._ -- - 1-. <br /> . i ANY AUTO i � __.. <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY. AGG r$ <br /> EXCESS I UMBRELLA LIABILITY <br /> EACH OCCURRENCE i$ <br /> . <br /> OCCUR CLAIMS MADE j AGGREGATE <br /> $ <br /> DEDUCTIBLE - <br /> S <br /> RETENTION S - <br /> S <br /> WORKERS COMPENSATION $ <br /> AND EMPLOYERS'LIABILITY ' WC STATU- <br /> ANY PROPRIETORIPARTNERIEXECUTIVE YIN I-TDBY_LIMITS.� ER <br /> I OFFICERIMEMBER EXCLUDED? ❑ I f L E L EACH ACCIDENT J'$ <br /> ; (Mandatory to andNH) I I I E L_DISEASE _EA EMPLOYEE S <br /> I If yes,desaibe under <br /> SPECIAL PROVISIONS below II <br /> OTHER I E L.DISEASE-POLICY LIMIT I S <br /> ' <br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES!EXCLUSIONSADDED BY ENDORSEMENTI SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> San Joaquin County DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 <br /> 1810 E. Hazelton Ave. Dnvs WRITTEN <br /> Stockton, CA 95201 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> 2P 11!j <br /> ACORD 25(2009101) O <br /> INS025t200e0I) ©1 -2009 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />