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RIPOCOM-01 ALAN <br /> ,acoRL�T <br /> CERTIFICATE O F LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 2/28/2013 <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 /> ACT <br /> PRODUCER License#0707137 (209)578-0183 NAME: <br /> DiBuduo&DeFendis Insurance Agency,Inc.-MOD PHONE FAX <br /> License#0707137 A/c Ext): AIC No <br /> E-MAIL <br /> P.O.Box 580531 ADDRESS: <br /> Modesto,CA 95358-0071 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Nonprofits Insurance Alliance of California <br /> INSURED Ripon Community Athletic Foundation, Inc INSURER B: <br /> 610 Mohler Road INSURER C: <br /> Ripon,CA 95366- INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 /> ILTR TYPE OF INSURANCE INSR WVDSUBR POLICY NUMBER MM/LDD/YYYY EFF POLICY EXP <br /> LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> DAMAGE T RE ED <br /> A X COMMERCIAL GENERAL LIABILITY X 201223128NPO 5/20/2012 5/20/2013 PREMISES Ea occurrence $ 500,00 <br /> CLAIMS-MADE FX_1 OCCUR MED EXP(Any one person) $ 20,00 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 <br /> POLICY PE OT X LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> UMBRELLA LIABOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> HDED RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVEF__] N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> If as,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Directors&Officers 201223128DONPO 5/20/2012 5/20/2013 Annual Aggregate 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Re:Rina's Mother's Day Run half Marathon. Certificate holder is Additional Insured per company form CG2026 07/04. <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 /> San Joaquin County Public Works ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1810 E. Hazelton Avenue <br /> Stockton,CA 95205- AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />