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I <br /> A CERTIFICATE OF LIABILITY INSURANCE 2/8i 0 ice' <br /> PRO R (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 95678 ;INSURERS AFFORDING COVERAGE `NAIC# <br /> INSURED INSURERwNonprofits Insurance Alliance <br /> Firefighters Burn Institute INSURER B:Fideli.ty And Deposit Company <br /> 3101 Stockton Blvd. INsuRER c:North American Elite Ins <br /> INSURER D: <br /> $ac=ax to CA 95820 INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTAN DING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADIM POLICY NUMBER POLICY EFFECTIVE 2M(UMfD2W=1 POLICY EXPIRATIONq TYPE OF INSURANCE LIMITS <br /> GENERAL LIABILITYEACH OCCURRENCE I$ 1,000,000 <br /> IMNITEU <br /> X ;COMMERCIAL GENERAL LfABILr"Y PREMISES(Ea o=wuncal i S 500,000 <br /> A CLAMS MADE i,X!OCCUR. 2010-24425NP0 11/7/2010 11/7/2011 MED EXP(Aryonepamon: S 20 000 <br /> i XYID> wmm SEXUAL COND PERSONALBADV INJURY 1$ 11000,000. <br /> $250,000 / $250,000 GENERAL AGGREGATE is 2,000,00 <br /> I { GERL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 2,000,000 <br /> E i X I POLICY PELT O FULL LIQUOR LIAR. <br /> 1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE OMIT <br /> ANY AUTO I(Ea acddarw) ----- $ 1,000,00 0 <br /> A i ALL OWNED AUTOS 2C'10-14425NPO 111/7/2010 11/7/2011 BODILY INJURY S <br /> i T1 SCHEDULED AUTOS (Par Perron) <br /> X HIRED AUTOS BODILY INJURY <br /> d X i NON-OWNED AUTOS (Per aedlent) S <br /> PROPERTY DAMAGE $ <br /> (Peracddent) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 13 <br /> _ ANY AUTO iOTHER THAN EA ACC 3 S <br /> AUTO ONLY: AGG $ <br /> j <br /> EXCESS IUMBR ELLA LIABILITY ! EACH OCCURRENCE S _4,000 000 <br /> I X OCCUR CLAIMS MADE 1 AGGREGATE i 4 000 000 <br /> $ <br /> A 1 DEDUCTIBLE 2010-14425UbG 11/7/2010 11/7/2011 s <br /> X RETENTION S 10,000. $ <br /> WORKERS COMPENSATION i YJC 3TATU- I <br /> AND EMPLOYERS'LIABILITY YIN ER <br /> ANY PROPRETORMARTNER/EXECUTIVE E.L.EACACCIDENT S <br /> OFFICERIMEMSER EXCLUDED? C� i <br /> NMyaansd In j L E.L.DISEASE-EA EMPLAYndor E�S _ <br /> SPECIAL PROVISIONS belay E.L.DISEASE-POLICY LIMIT I$ <br /> H ERE�LOYBE DISHONESTY CCP 0060574 07 2/19/2011 12/19/2012 LItII2s 100,000 <br /> FORGERY ALTERATION i DEDUCTIBLES 1,000 <br /> C MONIES SECURITIES cNB 000 3844-07 14425 111/7/2010111/7/2011 .T _ & C' nno DED — $250 <br /> DESCRIPTION OF OPERATIONS&OC ATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI8PECI AL PROVISIONS <br /> FARMINGTON FIRE DEPARTMENT, THE STATE OF CALIFORNIA DEPARTMRNT OF TRANSPORTATION, AND SAN JOAQUIN DEPARTMENT OF PUBLIC) <br /> WORKS, THEIR OFFICERS, AGENTS, OFFICIALS, MA?LOY8ES, AND VOLUNTEERS ARE NAMED ADDITIONAL INSURED REGARpIIdG THE <br /> FARbaNGTON BOOT DRIVE AT RIGRMY 4 AND ESCALON-BELL'TA ON FEBRUARY 18-21, 2011. FORM CG 20 12 APPLIES { <br /> *10 DAY NOTICE OF CAMELLATION FOR NOW-PAYMENT OF PPM41 M <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER VALL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> FARMINGTON FIRE BEPARTAMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL <br /> P.O BOX 73 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> FARMINGTON, CA 95230 REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE I <br /> � ..- � . 6w) <br /> ACORD 25(2009101) 019$MOS AGORD CORPORATION. AN rg served. <br /> INS025(20MI).01 The ACORD name and logo are registered marks of ACORD <br />