|
May 17 '13 08:48a Woodbridge Fire District 12093694568 p.10
<br /> CERTIFICATE OF LIABILITY
<br /> IABILITY INSURA CE naTB(Mm1cD/Y1)
<br /> 2413
<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, EXTENT} OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCEIDOES NOT CONSTITUTE A CONTRACT BETINEEN 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(ies)must be endersed. If SUBROGATION IS WAIVED,SUbJect to
<br /> the terms and conditions of the policy,certain policies may require an endorserrlent. A statement on this certificate does not confer rights to the
<br /> certificate holder fn lieu of such endorsermnt(s).'
<br /> FRO1)UCER CO TACT Di.Anna Kartin
<br /> N E:
<br /> All—Cal Insurance Agency PHONE (916)784-9070 FAX (916)784-015E
<br /> 505 Vernon Street ADD E :dianna@ail-calinswrance.com
<br /> INSUREM)AFFORDING COVERAGE NAIC0
<br /> Ros®villa CA 95b7E3._ INSueEaa:Nonprofits' Ire .A1-lianLce of CA Li�,C
<br /> INSURED - I�rsuRl:a s;Eidelit And Deposit
<br /> Co an
<br /> Firefighters Burn Institute INSURER
<br /> c:
<br /> 3101 Stockton Blvd, INSURER D:
<br /> INSURER E:
<br /> Sacramento CA 95820 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:CL12Y21203083 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED AaDvE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,-TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO V%KCH THIS
<br /> CERTIFICATE fMY 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 /> L[R TYPE OF INSURANCE AQP B I POLICY EFF �a�� �M�
<br /> GENERAL LIABILITY POLICY NUMBER _
<br /> EACH OCCURRENCE E 1,DOD,000
<br /> X COAIMERCALGENERAL LLABUTY PREMISES xc�arerlCe t 500,OOO
<br /> A CLAILISNWDE OCCUR X 2012-I4425NP0 1/7/2012 li/7J2013 MEOEXP(Arriane and S 20,000
<br /> X IIHrROPER SEXUAL COMUCT PERSONAL 6 ADV INJURY $ 1,000,000
<br /> $250,000 / $250,000 GEFJERdLAGGREGATE S 2,000,004
<br /> GcN'LAGGREGATE LIR4ITAPPLIES PER: PROOLICT$-CO4APlOPAGG S 2,000,10100X POLICY PRO- LOC FULL LIQUOR MPI1TY S
<br /> 1,000,000
<br /> ALTCMo3Il-c LIABILITY G NED Sltr LE LIMIT
<br /> �ae,-Idenl
<br /> ANY AUTO BCDILY INJURY(Parpeman) y
<br /> ALL D41'NEO SCHEDULE) - - " '
<br /> AUTOS AUTOS I BODILY INJURY(Pernoadent) 3
<br /> NON 0VWgEF)
<br /> HIP.EG AUTOSAUTOS PROPERTY DAMAGE 5
<br /> }w ea edent
<br /> X UMB1tELLALIAB OCCUR EACH DCCURPENCE $ 4,000,()00
<br /> A EXCESS LIAR CLAI1wr>•MADE AGGP.EGATE 5 4,GOD,040
<br /> DEO X RETEriITIO�II$ 10,00 X 2012-14425-L1-ID 1/7/2012 11/7/2013 S
<br /> WORKERS COM PEN BA'n NN QVC STATU- OTH-
<br /> AND EMPLDYERS'LIABlITY
<br /> ANY PROPRIETORIPARTNER11EXECUTIVE Y/N E.L.EACH ACCIDENT g
<br /> CfFICER/MEUSER EXCLUDED? ID
<br /> N f A
<br /> (Mandatory an NMI
<br /> IE.L.DIS EASE-EA EMPLOYE S
<br /> yos descrltra urxlc�r .. .
<br /> E
<br /> Dr ESCRIPTION OF OPEFRA.TIONS beFow E.L DISEASE-POLICY LIA11T S
<br /> B @QPI.OYEE DISHONESTY CCP 0060574 09 /19/2013 /19/2014 LIMITS 100,000
<br /> 1:'ORGMYJALTERATION I DEDUCTIBLES 3.1000
<br /> DESCRIPTION OF OPERATION&I LOCATIONS I VEMICLES (Attach ACORD 1 Ct,A,adlticnel Remodcs Schedule,if mOM s oc Is Mquired)
<br /> MONIES S SECURITIES, POLICY If CAPS 000" 3544-08 14425, EFF. 11/7 2012, EXP. 11/7/2013, LIMIT $25,000,
<br /> DEDUCTIBLE $250
<br /> WOODBRIDGE FIRE PROTECTION.DISTRICT, ITS OFFICERS, AGENTSr OFFICIALS, EMPLOYEES, AND VOLUNTZERS ARE RAM=
<br /> ADDITIONAL INSURED FOR THE BOOT DRIVE BEM ON MAY '26, 2013 AT TBE ItiTSRSECTION OF MOKELDMWE ST AND LOMR
<br /> SACRAIMNTO RD IN WOODBRIDGE, CA. FORM CG 20 26 APPLIES.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> (209)369-- 568 SHOULD ANY OF THE aISOVE UF.SCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL SE'DELIVERED w
<br /> WOODBRIDGE FIRE PROTECTION DISTRICT ACCORDANCE WITH THE POLICY PROMfONS.
<br /> AT T.14: ADAM-HARRAGM
<br /> 4D 0 E kT112US TA ST - AUTHORIZED REPRESENTATIVE
<br /> WOODBRIDGE, CA 95258
<br /> ACOFtiD 23(2010105) 1 Bt�Ak
<br /> COR CORPORATION. All rights reserved.
<br /> IINS026(201005).01 The AGORD name and IoRo are registered f
<br />
|