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ACORD CERTIFICATE OF LIABILITY INSURANCE --' DATE(MM DD/YY) <br /> # ID:MDA 06/01//2010 <br /> i PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> HUB International ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 1750 East Glendale Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Phoenix, AZ $5020-5505 <br /> INSURERS AFFORDING COVERAGE <br /> ( Phone: 602-395-9111 Fax: 602-395-0222 f —' <br /> INSURED: <br /> INSURER A: Philadelphia Indemnity insurance Company <br /> Muscular Dystrophy Association, Inc. INSURER 6: -' <br /> j 3300 East Sunrise Drive INSURER C: -���- <br /> Tucson, AZ 85713 ,I IN' SURER D. _ <br /> i R E:?NSURE <br /> COVERAGES E <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',AHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> S <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS,AND CONDITIONS GFS <br /> i POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY CLAIMS PAID, <br /> ILTR TYPE OF INSURANCE v POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR POLICY NUMBER DATE;MWDDIYY`, I lMtTS <br /> A DATE MFAIDD/YY' <br /> A GENERAL LIABILITY PHPK539039 04/01/1 1 L EACH 0--,JRRETNCE <br /> $1 000 000 <br /> g 04101 f 1 9 <br /> XC MMFar,A R ENE '`LAR- i <br /> FIRE DAMAGE� y nr:z!ire 3000M <br /> t1 I° nlA1S A..i...'_ <br /> MED aXP:Any per,.on; <br /> cR )N „8 A ✓thuUR l $ ''W0,000 <br /> w <br /> I [ <br /> GEN'L AGGREGATE 3ENERAL.:^vGkEcUA'E 1 $ 2,000.00G. <br /> LIMIT APPLIES PER:! ! f <br /> II i PRODUCTS-COMP/OP AGG --y <br /> Cy� I JE T X��� <br /> F i <br /> SUTOMOBiLE L1ABILtr.• W <br /> :;OMBlNED SINCL=I.IM;"' <br /> ANY A".' l # cEa as c-h <br /> I 7 e <br /> f ! <br /> ALL OANEDAUTOS <br /> i� �GD�r hR i' S <br /> II SCHEDULED AuTS <br /> HIRED AUTOS ( �. <br /> I BOD t Y N UP e $ " <br /> f NON-OWNED AUTOS <br /> '— 'PROPERTY DAMAGE <br /> i f le,accede^:`. <br /> j � I GARAGE DABi:_i;?' --- V ----I-------- }- — <br /> ANY AUTC A, 0N`--FA ACCIDENT <br /> i <br /> sTHF. ri::N -A ACC I <br /> ( I <br /> ON— <br /> EXCESS <br /> I <br /> "'--� ! i <br /> � t�XGE55 LiABIt`T`:' AGG i F <br /> ` d .._A:R?S MADc. 7 –t EACH OCCURRENCE <br /> OCC f? <br /> $ <br /> SDEDUC sB _ <br /> RETENTION <br /> WORKERS COMPENSATION AND <br /> EMPLOYERS LIABILITY ' j v Eke + I <br /> ! �E..EACH AcaDErr �---� <br /> E-.DISEASE-EA EMPLOYEE $ —'"'1 <br /> GTHER — -- E DISEASE-pGCiC!LIMir $ <br /> S I <br /> I <br /> DESCRIPTION OF OPERATIONSILOCAT(ONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMEN I ISPECIAL PROVISIONS I <br /> r j <br /> I Additional Insured—State or Political Subdivisions—Permits Endorsement CG 20 12(11 85) <br /> The Certificate holder is added as additional insured as respects to their interest in the Mokelumne Fill the Boot®taking place on June 12`h I <br /> 12010 at the intersection of East Highway 88&Elliott Road,Lockford,CA. <br /> i <br /> "CANCELLATK)N EXCEPTION:10 DAY NOTICE FOR NON PAY' j <br /> CERTIFICATE HOLDER _ s ADDITIONAL INSURED:INSURER LETTER. CANCELLATION +j <br /> SHOULD ANY OF THE ABOVE pES6RIBED POLICIES BE CANCELLED BEFORE THE EXPIRATRION <br /> San Joaquin County Public Works CAL TRANS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL "30 DAYS WRITTEN <br /> i 1810 East Hazelton Avenue PCI BOX 2048 NOTICE TO THE CERTIFICATE HOLDER TO THE LEFT.BUT FAILURE TO DO SO SHALL <br /> Stockton,CA 9520' IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS <br /> i Stockton,CA 95201 REPRESENTATIVES <br /> (209)481-2702 209)948-7543 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25-S 47/97) ^- <br /> @ACORD CORPORATION 1988 <br />