Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2020_PS-2000001 thru PS-2000500_ - PS-2000157

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CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01 / 15/2020 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER All -Cal Insurance Agency 505 Vernon Street Roseville INSURED Firefighters Burn Institute 3101 Stockton Blvd, DiAnna Martin (916) 784-9070 INSURERS) AFFORDING COVERAGE CA 95678 INSURERA: Nonprofits' Insurance Alliance of California INSURER B: INSURER C: INSURER D : INSURER E; Sacramento CA 95820 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1912908919 REVISION NUMBER: (916) 784-0158 NAIc # 011845 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD WVD POLICYNUMBER EFF MMIDDY/YYYY) EXP MM/DDY/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR rx Improper Sexual Conduct Y 2020-14425NPO 01/01/2020 01/01/2021 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED PREMISES Ea occurrence 500,000 $ MED EXP (Any one person) $ 20,000 X PERSONAL &ADV INJURY $ 1,000,000 $500,0001500,000 GENERAL AGGREGATE $ 2,0001000 GEN'LAGGREGATE LIMITAPPLIES PER: X POLICY F]PRO F1 LOC JECT X OTHER: No Deductible PRODUCTS - COMP/OPAGG $ 200003000 Liquor Liability Coverag $ 1,000,000 AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOSONLY N COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE Y 2020-14425UMB 01/01/2020 01/01/2021 EACH OCCURRENCE $ 41000,000 AGGREGATE $ 4,0001000 $ DED I X RETENTION $ 101000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER STATUTE O7H- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Employee Dishonesty Forgery &Alteration 2020-14425PROP 01/01/2020 01/01/2021 Limit Limit Deductible $ 100,000 $ 100,000 $ 250 DESCRIPTION OF OPERATIONS f LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) San Joaquin County, its officers, agents, officials, employees and volunteers are named additional insured for "Fill the boot for burns" boot drive February 7th-9th3 2020 Form CG 20 26 applies CF_RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Joaquin County ACCORDANCE WITH THE POLICY PROVISIONS. 1810 E . Hazelton Ave. AUTHORIZED REPRESENTATIVE Stockton CA 95210 & ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD