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.ACORDM <br /> CERTIFICATE F� <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO RMAT E OOF LIABILITY INS U <br /> AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED B RANGE DATE(MM/DD/YYyy) <br /> NOT CONSTITUT11 E A CON11 T11 RACT BE NFERS ID:AW 5/10/2012 <br /> NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT <br /> IMPORTANT:If the certificate holder is an ADDITIONAL HE INISURED, he INSURER(S),AUTHORIZED Y THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES <br /> REPRESENTATIVE OR PRODUCER, <br /> endorsement(s). policy,certain policies may Poltcy(les)must be endorsed.If SUBROGATION IS WAIVED, AND THE CERTIFICATE HOLDER. <br /> y require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of <br /> PRODUCER subject to <br /> California Resident License#0757776 NAM :CONTACT such <br /> HUB International Insurance Services Inc. (ac,No Ext).- 602 <br /> Marinello <br /> 2375 East Camelback Rd Suite 250 PHONE <br /> - 749-4110 FAx <br /> Phoenix, AZ 95016 E-MAIL (A/C,No): 866-215-0963 <br /> ADDRESS& danielle.marinello@hubinternational.com <br /> Phone: 602-395-9111 Fax: 60-2-3-95-0424224 PRODUCER <br /> CUSTOMER ID# <br /> INSURED <br /> Muscular D Stroh INSURER(S)AFFORDING COVERAGE <br /> Y P Y Association, Inc. INSURER A: Philadelphia Indemnity Insurance Company NAIC# <br /> 3300 East Sunrise Drive <br /> Tucson, AZ 85718 INSURER B: 18058 <br /> INSURER C: 25674 <br /> INSURER D: <br /> INSURER <br /> NSURER E <br /> INSURER F: <br /> THIS IS TO CERTIFY THAT THE POLICI IES INSURANCE LIST D BELOW HAVE BEEN INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT <br /> CERTIFICATE MAYBE ISSUED N ISSUED TO THE INSURED REVISION NUMBER: <br /> EXCLUSIONS AND C OR MAY PERTAIN,THE:INSURANCE AFFORDED BY THE P NAMED ABOVE F <br /> INSR ONDITIONS OF SUCH P OR OTHER DOCUMENT OR THE POLICY PERIOD <br /> OLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY SCID CLAIMS. WITH RESPECT TO WHICH THIS <br /> Po DESCRIBED HEREIN ARE SUBJECT TO ALL THE TERMS, <br /> LTR TYPE OF INSURANCE <br /> ADDL S116R <br /> A GENERAL LIABILITY INSR "VD POLICY NUMBER POLICY EFF <br /> MM/DD/Yyyy POLICY EXP <br /> X COMMERCIAL GENERAL LIABILITY PHPK847153 MM/DD/YYYY LIMITS <br /> 04/01/2012 04/01/2013 <br /> CLAIMS-MADE EACH OCCURRENCE <br /> X OCCUR DAMAGE TO $1,000,000 <br /> RENTED <br /> X BI/PD Ded:$50,000 PREMISES(Ea Occurrence) $ 300,000 <br /> MED EXP(Any one person) $ 15,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY <br /> $1,000,000 <br /> POLICY PROJECTGENERAL AGGREGATE <br /> AUTOMOBILE LIABILITY X LOC <br /> PRODUCTS-COMP/OPS $2,000,000 <br /> ANY AUTO AGG $2,000,000 <br /> ALL OWNED AUTOS $ <br /> COMBINED SINGLE LIMIT <br /> SCHEDULED AUTOS (Ea accident) $ <br /> HIRED AUTOS BODILY Injury(Per person) $ <br /> NON-OWNED AUTOS BODILY INJURY(Per accident) $ <br /> PROPERTY DAMAGE <br /> (Per accident) $ <br /> UMBRELLA LiAB OCCUR <br /> EXCESS LIAB CLAIMS- <br /> MADE $ <br /> DEDUCTIBLE EACH OCCURRENCE <br /> RETENTION AGGREGATE <br /> WORKERS <br /> AND EMPLOYERS'LIABILITY <br /> ION $ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) WC STAT- <br /> T OTH <br /> TORY LIMI <br /> If yes,describe under ER <br /> DESCRIPTION OF OPERATIONS below E.L.EACH ACCIDENT <br /> E.L.DISEASE—EA EMPLOYEE $ <br /> CRIPTION OF OPERATIONS/LOCATIONS/VEHICLESE L DISEASE—POLICY LIMIT <br /> (Attach ACORD 101,Additional Remarks Schedule,if more space is required) $ <br /> itional Insured—State or Political Subdivisions— <br /> Permits <br /> nt <br /> Certificate holder is added as additional insured as respects to thelrenterG 20 12(11 8$) <br /> sections of Highway 88&Elliott,and Tully Road in Lockeford,CA. <br />'IFICgTE HOLDER <br /> est in the Mokelumne Fill the Booty taking place on May 12Th,2012 at the <br />;quiz County CANCELLATION <br />.t Hazelton Ave. Cal-Trans <br /> 1,CA 95205 1976 East Charter Way <br /> 8-3121 Stockton,CA 95202 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> (209)946-7543 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WIL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br />