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�`©® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 1./14/2Q13
<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 /> 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 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 CONTACT DiAnna Martin
<br /> AME:
<br /> IC
<br /> All-Cal Insurance Agency PHONE (916)784-9070 FAX Nol:(916)784-0158
<br /> 505 Vernon Street E-MAIL
<br /> ESS:diannaQall-cal insurance.coinDR
<br /> INSURE AFFORDING COVERAGE NAIC#
<br /> Roseville CA 95678 INSURER A.-Nonprofits r Ins Alliance of CA NIAC
<br /> INSURED INSURER B:Fidelity And Deposit Company
<br /> Firefighters Burn Institute INSURER C:
<br /> 3101 Stockton Blvd. INSURER D;
<br /> INSURER E:
<br /> Sacramento CA 95820 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:CL12121203083 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 WITH RESPECT TO WHICH 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 /> INSLTR TYPE OF INSURANCE DDL SUBR POLICY NUMBER MM DD/YYYY NlPOLICY EFF -POLICY YY LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> IV-
<br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RE T
<br /> PREMISES Ea occurrence $ 500,000
<br /> A I CLAIMS-MADE a OCCUR X 2012-14425NP0 1/7/2012 11/7/2013 MED EXP(Any one person) $ 20,000
<br /> X IMPROPER SEXUAL CONDUCT PERSONAL&ADV INJURY $ 1,000,000
<br /> $250,000 / $250,000 GENERAL AGGREGATE $ 2,000,000
<br /> GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> POLICY PRO. LOC
<br /> X FULL LIQUOR LIABILITY $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED 51 GLE LIMIT
<br /> Ea dent
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> AUTOS SCHEDULED
<br /> AUTOSBODILY INJURY(Per accident) $
<br /> NON-OWNEDReO��tDAMAGE $
<br /> HIRED AUTOS AUTOS (Per
<br /> P
<br /> $
<br /> X UMBRELLA LIAROCCUR EACH OCCURRENCE $ 4,000,000
<br /> A EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DED I X RETENTION$ 10,00 2012-14425-UME 11/7/2012 11/7/2013 $
<br /> WORKERS COMPENSATION I WC STATU- I OTH-
<br /> AND EMPLOYERS'LIABILITY Y 1 N
<br /> I TORY LIMITS ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE
<br /> OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> S JEMPLOYEE DISHONESTY CCP 0060574 08 /19/2012 /19/2013 LIMITS 100,000
<br /> FORGERY/ALTERATION DEDUCTIBLES 1,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
<br /> MONIES & SECURITIES, POLICY # CWB 000 3844-08 14425, EFF. 11/703.1, EXP. 11/7/2012, LIMIT $25,000,
<br /> DEDUCTIBLE $250
<br /> FARMINGTON FIRE DEPARTMENT, THE STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION, AND SAN JOAQUIN
<br /> DEPARTMENT OF PUBLIC WORKS, THEIR OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED
<br /> ADDITIONAL INSURED REGARDING THE FARMINGTON BOOT DRIVE AT HIGHWAY 4 AND ESCALON-BELLOTA ON
<br /> FEBRUARY 15-18, 2013. FORM CG 20 26 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 DEPARTAMENT ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> ATTN: CONNI BAILEY
<br /> P.O. BOX 73 AUTHORIZED REPRESENTATIVE
<br /> FARMINGTON, CA 95230
<br /> ACORD 25(2010105) 0/19 - D C RPORATION. All rights reserved.
<br /> INS025(201005).01 The ACORD name and logo are registered m* A
<br />
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