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RIPOCOM-01 ALAN <br /> CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) <br /> 1133/20/2014 <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 Bndorsed. 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 flout of such endorsement(s). <br /> PRODUCER License#0707137 (209)578-0183 NAIME T <br /> DiBuduo&DeFendls Insurance Brokers,LLC-MOD PHONE — FAX <br /> License#0E02096 No ExtI, [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 INSURERB: <br /> 610 Mohler Road INSURER C: <br /> Ripon,CA 95366- INSURERD: _ <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 /> INSR I TYPE OF INSURANCE A POLICYEFF POLICY XP <br /> LTR POLICY NUMBER MMIDD/YYYY MM/DD LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0 <br /> A X COMMERCIAL GENERAL LIABILITY x 201323128NPO 5/20/2013 5/20/2014 PREMISES Me occurrence $ 500,00 <br /> CLAIMS-MADE Fx-�OCCUR MED EXP(Any one person) S 20,00 <br /> _ PERSONAL&ADV INJURY $ _ 1,000,00 <br /> GENERAL AGGREGATE E — 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000,00 <br /> POLICY PROJEC- X LOC —^ b <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ALL — <br /> AUTOS OWNED SCHEDAUTOS BODILY INJURY(Per accident) $ <br /> NON-OWNED PROPERTY DAMAGE E <br /> HIRED AUTOS gUTOg PER ACCIDENT <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE E <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE S <br /> DED F RETENTION b ( b <br /> WORKERS COMPENSATION WG STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YIN --A TORY UMITSER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> EL.EACHACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A I ._____ <br /> (Mandatory In NH) E.L DISEASE-EA EMPLOYE b <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below j E.L DISEASE-POLICY LIMIT E <br /> A IDIrectom 8 Officers 201323128DONPO 5/20/2013 5120/2014 Annual Aggregate 1,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more apace is required) <br /> Re:Rina's Mother's Day Run half Marathon 2014 May 9th42th. Certificate holder is Additional Insured per companytform CG2026 07/04. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> San Joaquin County Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 1810 E.Hazelton Avenue ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Stockton,CA 95205- AUTHORIZED REPRESENTATIVE <br /> O <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />