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ACC)RU CERTIFICATE
<br /> DAE(MMIDDIYYYY)
<br /> OF LIABILITY INSURANCE
<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 OR 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 /> 'PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> ..APORTANT: If the certificate holder is an ADDITIONAL INSURED,the Policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACTNAME: All–Cal Agency
<br /> All-Cal Insurance Agency P=HON E (926)784-9070 F°x��,,c9is)7sa-ossa
<br /> 505 Vernon Street
<br /> INSu AFFORDING COVERAGE NAICN
<br /> Roseville CA 95678 INSURER A:Non rofits Ins Alliance of CA
<br /> INSURED iNsuRERa:F:Ldelitv And Deposit Company
<br /> Firefighters Burn Institute INSURER C:
<br /> 3101 Stockton Blvd. INSURER 0:
<br /> INSURER E:
<br /> Sacramento CA 95820 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. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO MICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> im TYPE OF INSURANCE POLICY NUMBER POLICY
<br /> EFF MPOUCif MIDDIYYYYI LIMITS
<br /> GENERAL LIABILITY
<br /> EACH OCCURRENCE $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY —PREMI 17 $ 500,000
<br /> A CLAIMSMADE Fx OCCUR X 2011-1442SNPo 1/7J2pi1 1/7/2012 MED EXP Ww one person $ 20,000
<br /> X ndPROPZR SEXUAL CONDUCT PERSONAL BADVINJURY $ 1,000,000
<br /> $250,000 / $250,000 GENERAL AGGREGATE $ 2,000,000
<br /> GENLAGGREGATE UMITAPPLIES PER: PRODUCTS-COMPA)PAGG $ 2,000,000
<br /> X PoucY PIMCT LOC FULL LIQUOR UNBILITY $ 1,000,000
<br /> AUTOMOBILE LIANUITY C NED ING M
<br /> ecciden
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> ALL OIANED SCHEDULED
<br /> AUTOS AUTOS BODILY INJURY(Per acddenl) $
<br /> HIRED AUTOS AAUTOSWNED PRO TY DAMAGE a
<br /> $
<br /> PEXCENUAB
<br /> UMBRELLA LIAB OCCUR
<br /> EACH OCCURRENCE ; 4,000,000
<br /> A CUUMS-MADE AGGREGATE ; 4,000,000
<br /> DED x RETENTION 10,000 X 2011-14425MM 1/7/2011 1/7/2012 $
<br /> WORKERS COMPENSATION VVC STATU oTH-
<br /> AND EMPLOYERS'LIABILITY YIN
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE
<br /> OFFICERIMEMBER EXCLUDED? NIA EL EACH ACCIDENT $
<br /> (Mande wy in NN) 1-1
<br /> If yes,describe under EL DISEASE-EA EMPLOYE $
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B EMPLOYEE DISHONESTY CCP 0060574 08 /19/2012 /19/2013 LIMITS 100,000
<br /> FORGERY/ALTERATION DEDUCTIBLES 1,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,A40donal Remarks Schedule,if moreIs requi ad)
<br /> MONIES 6 SECURITIES, POLICY 1) CNB 000 3844-08 14425, EFF. 11/7 2011, EXP. 11/7/2012, LIMIT $25,000,
<br /> DEDUCTIBLE $250
<br /> THE COUNTY OF SAN JOAQUIN, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED
<br /> ADDITIONAL INSURED FOR THE BOOT DRIVE HELD ON MAY 6, 2012 AT THE INTERSECTION OF MDEELUMNE ST AND LONER
<br /> SACRAMENTO RD IN WOODBRIDGE, CA. 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 /> COUNTY OF SAN JOAQUIN ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 1810 E HAZELTON AVE
<br /> STOCKTON, Cpl 95205 AUTHORIMD REPRESENTATIVE
<br /> ACORD 26(2010105) ®1 - 1 ORATION. All rights reserved.
<br /> INS025(2o1ao5).o1 The ACORD name and logo are registered ma of A *
<br />
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