Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2012_PS-1200001 thru PS-1200500_ - PS-12-00496

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.4co" CERTIFICATE DATE(MM/DDNwy) �,.� RTIFICATE OF LIABILITY INSURANCE 2/10/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES aELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. radPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the Policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER NAME: All-Cal Agency All-Cal Insurance Agency PIIOME . (916)784-9070 1FAX 505 Vernon Street F4ML .(916)784-0158 INSU AFFORDING COVERAGE MAIC 0 Roseville CA 95678 INSURER A:NO rofits Ins Alliance of CA INSURED wsuRERB:F:Lde1±tv And Deposit Company Firefighters Burn Institute INSURER C: 3101 Stockton Blvd. INSURER D: INSURER E: Sacramento CA 95820 INSURER F: COVERAGES CERTIFICATE NUMBER:CL11102402462 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE MIR POLICYNUMBER MPOLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE ; 1,000,000 X COMMERCIAL GENERAL LIABILITY P I oxurence S 500,000 A CLAIMS-MADE F N MED D(P(Any one person) ; 20'#000 X IMPROPER SKIWAL CO1wuCT PERSONAL BADVINJURY $ 1,000,000 $250,000 / $250,000 GENERAL AGGREGATE $ 2,000,000 GENLAGGREGATE LIMIT APPUESPER PRODUCTS-COMPIOPAGG ; 2,000,000 X POLICY PRO LOC FULL LIQUOR LIAISLITY $ 1,000,000 AUTOMOBILE UAMUTY i acdderd ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) ; HIRED AUTOS SOµS PROPERTY DAMAGE -Per accident) S X I UMBRELLA LIAROCOM EACH OCC $ 4,000,000 A EXCESSLIAB CLAIM94AADE AGGREGATE ; 4,000,000 DEC) I X I REfENRON 10,00C X 2011-144250248 1/7/2011 1/7/2012 YiOAKERe COMPENSATION IAC $ STATU- OTH- AND EMPLOYER$LIABILITY � ANY PROPRIETOMPARTNERIEXECUTIVE YIN I FR OFFICEP MEMBER EXCLUDED? 0 N I A E.L.EACH ACCIDENT ; (M dmx in and E.L.DISEASE-EA ENPLOYE S It yes,descrira under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S B EMPLOYEE DISHONESTY CCP 0060574 OB /19/2012 /19/2013 LIMITS 100,000 FORGERY/ALTERATION DEDUCTIBLES 1,000 DESCR1Fn OF MONIES& SECURITIRS,APOLICYiCLES COB 00ch 0038 4-0101. 088 1444225,s Schakda FF. X11/7 2011ffmare ', P". 11/7/2012, LIMIT $25,000, DEDUCTIBLE $250 WOODBRIDGE FIRE DISTRICT, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED ADDITIONAL INSURED FOR THE BOOT DRIVE HELD ON MAY 6, 2012 AT TM INTERSECTION OF MOFMLMM ST AND LOWER SACRAMENTO RD IN WOODBRIDGE, CA. FORM CG 20 26 APPLIES. CERTIFICATE HOLDER CANCELLATION (209)369-4568 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WOODBRIDGE FIRE DISTRICT ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: ADAM HARNAGE 400 E AUGUSTA ST AUTHORREDREPRESENTATIVE WOODBRIDGE, CA 95258 ACORD 26(2010106) ©1V040-1 b ORPORATIONAllrightsreserved. INS025t2oiampi The ACORD name and logo are registered marACO