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AC40RVCERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YYYY) <br /> 8/13/2010 — <br /> PRODUCER (916)784-9070 FAX: (916)784=0158 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION - <br /> All-Cal Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 505 Vernon Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Roseville- CA 9567$ INSURERS AFFORDING COVERAGE NAIC# <br /> ---------- <br /> INSURED � ----..-. .---_-- <br /> NSURERA Nonprofits_Ins Alliance of CA <br /> Firefighters Burn Institute INSURER&Fidelity And Deposit Company <br /> 3101 Stockton Blvd. - — - ------- <br /> INSURERc:North American Elite <br /> IINSURER O:r <br /> Sacrame to CA 95820 - -- - ---_ <br /> COVERAGES <br /> INSURER 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 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 OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR DD'4--- POLICY NUMBER ------ - ------- <br /> I---- f POLICY EFFECTIVE POLICYEXPIRATIONT LIMITS <br /> LEACH OCCURRENCE $ 1,000,000 <br /> GENERAL LIABILITY <br /> �.X 1 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED - T -- <br /> f--- PREM! ESSEaoccurrens� _I S 500s000 <br /> A X <br /> CLAIMS MADE !_X 'OCCUR�2009-14425NPO 11/7/2009 11/7/2010 IMEOEXP(Anone <br /> person) 13 20,ODD <br /> --- --mo <br /> X FULL-LIQUOR LIAB. l PERSONAL&ADV INJURY $ 1 000 000 <br /> 51,000,0 /1,000,00 <br /> r---'-"- - -)q_0 GENERALAGGREGATE $ 2,000,000 <br /> PRO- i DUC- -- - <br /> X POLICY : LOC I I TS•COMPIOP AGG 2,000,000 <br /> L AGGREGATE LIMIT APPLIES PER: <br /> PRO <br /> IMPROPER SEXUAL COND <br /> $ 2R0,000 <br /> j AUTOMOBILE LIABILITY <br /> I COMBINED SINGLE LIMIT I <br /> ANY AUTO I (Ea accident) ;$ 11000,000 <br /> A ��ALL OWNED AUTOS 2009-1442SNP0 11/7/2DD9 � 11/7J2010 �-- —_- <br /> ' BODILY INJURY S <br /> �I SCHEDULED AUTOS (Per person) <br /> (Per INJURY <br /> X HIRED AUTOS - - --- <br /> I(Per ac INJURY <br /> X 1 NON-OWNED AUTOS j( accident) � S <br /> j PROPERTY DAMAGE S <br /> (Per accident) - <br /> _qAAI1Y <br /> ANY AUTO AUTO ONLY-EA ACCIDENT <br /> r------- --- $ -- <br /> ~' I I, OTHER THAN EA ACC - <br /> AUTO ONLY: AGG $ <br /> r -ABILITY <br /> LEX-CESS ! _ . <br /> EXC-ESS/UMBRELLA U I EACH OCCURRENCE S 4,00 0,000 <br /> �X 1 OCCUR CLAIMS MADE AGGREGATE <br /> $ 4000 <br /> 11/7/2009 11 7 <br /> RETENTION $ 10 00 1 <br /> A _ DEDUCTIBLE J J2010 -- <br /> 2009-19425UM8 S <br /> WURKERB COMPENSATION ' $ <br /> i ! WC STATU- 0TH-; <br /> AND EMPLOYERS'LIABILITY Y!N E I TORY I IMITS I <br /> ANY PROMEMBERIEXCLU RJEJCECUTIVE E.l EACH ACCIDENT <br /> OFFICER/MEMSER EXCLUDED? S <br /> (Mandatory In NH) S- -- - - ---- ------ <br /> Ifyea,describe under E DISEASE-EA EMPLOYEE S <br /> SPECIAL PROVISIONS below E. IDL SEASE-POLICY LIMIT!$ <br /> B OTHEREMPLOYEE DISHONESTY ;CCP 0060574 06 2/19/2010 2/19/2011 !LIMITS <br /> FORGERY/ALTERATION 100,000 <br /> DEDUCTIBLES 11000 <br /> C MONEY SECURITIES :CWB 000 3844 06 14425 Ill 7/2009 I11Z7/2010 _ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 250 <br /> WOODBRIDGE FIRE DISTRICT, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED ADDITIONAL INSURED FOR <br /> THE BOOT DRIVE HELD ON SUNDAY, SEPTEMBER 26, 2010 AT THE INTERSECTION OF MOXSLUMNE ST AND LOWER SACRAMENTO RD IN <br /> WOODBRIDGE, CA. FORM CG 20 26 APPLIES. <br /> *10 DAY NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM <br /> CERTIFICATE HOLDER CANCELLATION <br /> (2 0 9)369-4568 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> WOODBRIDGE FIRE DISTRICT DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 <br /> MIKE, KIRK.LE _ DAYS WRITTEN <br /> 400 E AUGUSTA ST NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$O$HALL <br /> WOODBRIDGE, CA 95258 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES, - <br /> AUTHORIZED REPRESENTAT{V <br /> ACORD 26(2009/01) 01 •2009O O PORATION. All rights reserved. <br /> INS025(zoosol) The ACORD name and logo are registered mar s o ACOR <br />