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a`,�V® CERTIFICATE OF LIABILITY INSURANCE z�i2/2o12
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY DR 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the berms and conditions of the policy,Certain policies may require an endorsement. A statement on th)s certificate does not confer rights to the
<br /> certificate holder In ilau of such endorsemant(s).
<br /> PRODUCER All-Cal Agenoy
<br /> All-Cal Insurance Agency PHONE (916)784-9070 (916)784-0158
<br /> 505 Vernon Street MIA
<br /> INS AFFORDINa COVERAGE NUC N
<br /> Roseville CA 95678 UOURERA:Non rofits Ina Alliance of CA
<br /> MSURED muREReXidelity And Deposit Company
<br /> Firefighters Burn Institute WSURERC:
<br /> 3101 Stockton Blvd. INSURER o:
<br /> INSURER E:
<br /> Saaramento CA 95820 1 INSURER F;
<br /> COVERAGES CERTIFICATE NUMBER:CL11102402462 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. N07WTHSTANDING 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 DESCRI13EO HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> LTR TYPE OF INSURANCE P NUMBER EFF LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
<br /> 0 RENTED
<br /> X COMMERCiAL GENERAL LIABILITY P I S 500,000
<br /> A cwMs-MADE ❑X occua X :011-14a2sxPo 1/7/2011 1/7/2012 M��,(ft ) $ 20,000
<br /> X nOlkOPER SEXUAL CONDUCT PERSONAL a ADN INJURY $ 1,000,000
<br /> $250,000 / $250,000 GENERAL AGGREGATE $ 2,000,000
<br /> GE7IL AGGREGATE LIMIT APPLIES PER PRODUCTS•COMPNP AGG S 2,000,000
<br /> X POLICY PRO- LOC FULL LIQUOR LIABILITY S 1,000,000
<br /> AUTOMOBILE LIADIUTY COMSIVE)SINGLE
<br /> nt
<br /> ANY AUTO
<br /> BOOILY INJURY(Par penon) $
<br /> ALL OMED SCHEDULED BODILY INJURY(Per ecddent) $
<br /> AUTOS r0-OVW4EO PROPER S
<br /> WRED AUTOS AUTOS
<br /> $
<br /> X UMBRELLA LIABOCCUR EACH OCCURRENCE $ 4,000,000
<br /> A EXCESS LIA9 CLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DEO X I REJENTIONS 10,00 2Di1-14425ul4B 1/7/2011 1/7/2012 S
<br /> WORKERS COMPENSATION I STAJ�JIPT OTH
<br /> AND EMPLOYERS'UABILITY Y I N
<br /> ANY PROPRIETORIPARTNER/EXECUTME❑ N/A E.L.EACH ACCIDENT S
<br /> MI
<br /> OFRCERE.MBER EXCLUDED')
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
<br /> Nyee.�rmc,,0s under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
<br /> 8 EMPLOYEE DISHONESTY CCP 0060574 07 /19/2011 /19/2012 LIMITS 100,000
<br /> FORGERY/ALTERATION DEDUCTIBLES 1,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.AddIdand Ranaft Shcedule,B more apce Is required)
<br /> MONIES t SECURITIES, POLICY # CFTB 000 3844-08 14425, Err. 11/7/1011, BRP. 11/7/2012, Ln4IT $25,000,
<br /> DEDUCTIBLE $250
<br /> PARbaNGTON FIRS DEPARTWZNT, THE STATE OF CALIFORNIA DEPARTMZNT OF TRANSPORTATION, AND SAN JOAQUIN
<br /> DEPARTMENT OF PUBLIC WORKS, THEIR OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED
<br /> ADDITIONAL INSURED REGARDING THE FARt4INGTON BOOT DRIVE AT HIGBFD►Y 4 AND ESCALON-BELLOTA ON FEBRUARY
<br /> 17-20, 2012. FORM CG 20 12 APPLIES.
<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 /> FARMINGTON FIRE DEPARTAWNT ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> ATTN: CONNI BAILEY
<br /> P.O. BOX 73 I►UTHORlZEDREPREtrENTATrvE
<br /> FARMINGTON, CA 95230
<br /> J_
<br /> ACORD 26(2010106) © -2010 A O ORATION. AN rights reserved.
<br /> INS025(201005).01 The ACORD name and logo are registered ma f ACORD
<br />
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