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<br /> r� DATE
<br /> ERTIFICAT F LI4 ILITY 1NI M �/
<br /> THIS CER'T'IFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE= HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR tJGGATIVF_LY AMEND, EXTEND OR A1JER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETt'JlEL=N TIES ISSUING INSURER(5), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: if the certificate holder ie an ADDITIONAL 0li
<br /> INSURED,the Pcy(fes)must Ise endorsed. If SUBROGATIOI'1 ES`1JAIVEI?,subject to
<br /> the terms and conditions of the policy,certain(soiieles may regLIIre X11 endorsement. A staterns on chis cer(iiicate does not center rights :o the
<br /> certificate holder in Eieu of such endorsemant(s). conrACTDyn a Mas-lir
<br /> PRODUCER 14AME:
<br /> All-Cal 1:1SL4rcYlO( Sei1cS. PHONE (916)784-9070 F rMC.tJe:(916)784-----
<br /> E-MAlL •a3� ,�yg���.�,-00- +risu ESLCe--Om
<br /> 5(]5 V&:�o52 Str�cat: ADDRESS:
<br /> INSURER(M AFFORDING COVERAGE NAM 0
<br /> Roacyr77s CA 95675 INSURERAISO%2 rofits' �nS Alliance of CA TIAC
<br /> INSUREDINSURERB:Fidelity And. Deposit C any
<br /> Firefighters Burn Instil:-ate INSURERC:
<br /> 3101 Stockton Blvd. INSURER O:
<br /> INSURER E:
<br /> Sacramento CA. 95820 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:CL13102303605 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 TWIS
<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 /> TA POLICY EFF POLICY EXP LIMITS
<br /> TYPEOFINSURANCE ADD POLICYNUMSER MM/DDNYY MM/DD YYY 1,000,000
<br /> GENERAL LIABILITY EACH OCCURRENCE $
<br /> X COMMERCIAL GENERAL LIABILITY
<br /> PR_ SES Eaoaurence $ 500,000
<br /> CLAIMS MADE QOCCUR 1{ 2413-14925 11/7/2013' 11/7/2014 MED EXP(An one person) $ 20,000
<br /> PERSONAL&ADVINJURY $ 11000,000
<br /> X IMPROPER SEXUAL CONDUCT 2,000,000
<br /> GENERAL AGGREGATE $
<br /> $250,o4D / $250,000 2,000,000
<br /> PRODUCTS-COMP/OP AGG $
<br /> GEN'LAGGREGATE LIMIT APPLIES PER:
<br /> X POLICY PRO LOC FULI.LI000RLIABILITY $ 1,000,000
<br /> 171 COMBINED SINGLE LIMIT $
<br /> AUTOMOBILE LIABILITY Ea acddent
<br /> BODILY INJURY(Per person) $
<br /> A ANY AUTO 1/7/2013 1/7/2014 BODILY INJURY(Per accident) $
<br /> ALL OWNED SCHEDULED 2423-13925
<br /> AUTOS AUTOS PROPERTY DAMAGE $
<br /> NON-OWNED Per accident
<br /> HIRED AUTOS ALTOS $
<br /> X UMBRELLA UAB EACH OCCURRENCE $ 4,000,000
<br /> OCCUR 41000,000
<br /> A EXCESS LI AB CLAIMS-MADE AGGREGATE $
<br /> �[ 10,000 2013-14425-UMB 1/7/2013 11/7/2014 $
<br /> DED RETENTION$ WCSTATU- OTH-
<br /> WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITYEL EACH ACCIDENT $
<br /> ANY PROPRIETORIPARTNER/EXECUTIVE Y� NIA
<br /> OFFICER/MEMBER EXCLUDED? E.L DISEASE-EA EMPLOYE $
<br /> (Mandatory In NH)
<br /> It yes,descr'a under EL DISEASE.POLICY LIMIT $
<br /> DESCRIPTION OF OPERATIONS below
<br /> B EMPLOYEE DISHONESTY CCP 0060574 09 /19/2013 /19/2014 LIMITS 100,000
<br /> FORGERY/ALTERATION DEDUCTIBLES 1,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addttlonal Remarks Schedule,H more space is required)
<br /> MONIES & SECURITIES, POLICY # CWB 000 3844-10 14425, EF0. 11/7/2013, EXP. 11/7/2014, LIMIT $25,000,
<br /> DEDUCTIBLE $250
<br /> FARMINGTON FIRE DEPARTMENT, THE STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTP+TION' AND SAN aCAQUIN
<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 14-17, 2014. 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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PARMINGTON FIRE DEPA-RTDM14T
<br /> ATTN: CONN, BAILEY AUTHORIZED REPRESENTATIVE
<br /> P.O. SOX 7.3
<br /> FARMXgGTON, CA 95230
<br /> ACORD 25(2010/05) ©19 8- 010 A O PORATION. All rights reserved.
<br /> INS025(201406)-41 The ACORD name and logo are registered mark of CORD
<br />
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