|
Jan 28 13 03:39p Thornton Fire District 2097942946 p,6
<br /> ACC LIABILITY INSURANCE 1/2/2013
<br /> �- CERTIFICATE �I= L �
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> DED BY THE POLICIES
<br /> BE1.0WCERTIFICATE DOES CERTIFICATE OFF INSURANCET AFFIRMATIVELY RNEGATIVELY DOES NOT CONS�TITUTE�A END OR ALTER THE CONTRACT SETWE-EN COVERAGEE WUINGFINSURER($), AUTHORIZED
<br /> BELOW, THIS CERT
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> INFORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject ba
<br /> the terms and conditlons of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights tothe
<br /> certificate holder in lieu of such andorseme s).
<br /> PROfltSCER otaTAc p Mal-tin
<br /> All-Cal Insurance Agency PHONE (9163 78+4-9070 FAXfftN
<br /> 505 Vernon StrQet ADD .dianna 11 all-Cal insnrancs -0=
<br /> INS AFFORDING COVERAGE MAIC#
<br /> Roseville CA 95678 INSUREftAgRK1 rofits' Ins Alliance of GA NZAC
<br /> INSURED INIURIB IBRicla.it: And. I}e sit COM
<br /> Firefighters Burn Institute INSURER C,
<br /> 3101 Stockton Blvd. INSURERD:
<br /> INSURER E:-
<br /> .Sacramento CA 95820 INSURER F:
<br /> COVERAGES CERTIFICATE NUN13ER:CL12121203083 REVJSION NUMBER:
<br /> THIS IS M CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NorMTHSTANDING ANY REOIAREM04T,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY ISE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS.
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> lLStt POLICY EFF POLICY EXP IURTS
<br /> TR iYAE OF t NSURANC6 A POLICY NUMBER M
<br /> GENERRLLtABILiTY E,gCHOCCURFtENICE $ 1,000,000
<br /> 300,000
<br /> X COMMERCIAL GENERAL LABILITY P $
<br /> A CL4JMS-MADE Fx— OGCUR R 2012-1442SNPo 1/7/20]2 iI712013 NED EXP ormpwacn �S 24,000
<br /> X IMPPOPIIi szxuAL CabTD=T PERSONAL&ADV INJURY $ 1,a00,000
<br /> $250,000 / 2250,000 GENERAL AGGREGATE $ 2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: PR000CTS-CONPIO P ASO S 2,000,000
<br /> x POLICY PRO- LOC FULL LIQUOR LIABILITY $ 1,020,000
<br /> F-71MT F7coMINEFORGEE EIMrr
<br /> AUTOMOMLE LIAMLITY FEescCjdWj
<br /> BODILY INJURY(Per person) S
<br /> ANY AUTO
<br /> ALL OVMED SCHEDULED BOOZY INJURY(Par acradent) $
<br /> - AUTOS NDu—0 D _ r _ PRO
<br /> r eY D11MIt $
<br /> HIRED AUTOS I
<br /> AUTOS
<br /> $
<br /> X UIMBRELLA LMSHCLAIMSAMDE
<br /> OCCUR EACH OCCURRENCE S 4,000,000
<br /> A EXCESS LUIB AGGREGJ4TE $ 4,000,000
<br /> �g,RiON$ 101000 2012-14425-UM 11/7/2012 11/712013 - $
<br /> DED X R
<br /> WC 0A U-
<br /> WORKERs COMPENSATION
<br /> AND EMPLOYERS LIABILITY
<br /> ANY?ROPRIETORIPARTNER►EXECUFIVE Y i N EL EACH ACCIDENT. $
<br /> OFFICERIMEMBBt EXCLUDED? NIA
<br /> E
<br /> (Mandatory In NH) I L DISEASE•EA EMPLOYEE 3
<br /> Eye a,dowto under EL DISEASE-POLICY UrAT S
<br /> DESCRMON OF OPERATIONS below
<br /> B EMBLOYES DISHONBSTY CCP 0060574 as !19/2012 /1912013 LIMITS 100,QQ0
<br /> FORGERY/ALTERATION DEDUC ISLES 1,000
<br /> wacwiri0N QF OPERATIONS I LOCATIONS I VEt9CLFS(Attach ACORD 101.Addtlanal Remarks Schedule.B Mara 931=0 Is rsquked)
<br /> MONIES 6 SECMtITTES, POLICY # wS 000 3844-04 24425, EFF. 11/712012, Z". 11/7/2013, LIMIT $25,000,
<br /> DEDUCTIBLE $250
<br /> THE CODWrL of SAN JOAQ=N, ITS OFFICERS, AGENTS, DE71CLALS, F"LOYEES, AND VOLUWMERS ARE NAMED
<br /> ADDITIOLiiAI INStWn FOR TIM THOPIn4W FILL THE BOOT FOR BURNS BOOT DRIVE EVzNT FRO1b+I FSI ZMRY 23-24, 2013
<br /> AT THE FOLLOWING LOCATIONS: 1. THOItNTON RD / TURNER RD; 2. TSORNTO►N IM / PELTIER RD;
<br /> 13. THC}RNTa'N 1W / M12O'1' GRATE RID• FGHM 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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> COUNTY OF BAN L710AOVIN
<br /> I6TTN:THCMS Girl, DIRECTOR of FuEff C 'WORKS AUTWRIZEDREPRESENTATIVE
<br /> 1810 E FLk=LTON AVE
<br /> STOCXTON, CA 95205
<br /> ACORD 25(2010105) 04"Of
<br /> 7o PORATION. All rights reserved.
<br /> INso�s Ezoyoo5}.01 Tho ACORD name and lopo are registered maGO
<br />
|