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Sep 25 14 01:43p Laura Pereira 209-745-1096 p.2 <br /> OURLADY-02 LWHITEAKER <br /> A� <br /> DATE D M <br /> CERTIFICATE OF LIABILITY INSURANCE si24122�u2as4 <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 P-RODUCER,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 /> CONTACT <br /> PRODUCER NAME: <br /> Rico Pfitzer Pires and Associates Insurance PHONE ;(600)399-7473 Nc:(209)854-2520 <br /> AIC No <br /> P.O.Box 129 L <br /> GuWne,CA 95322 ADDRESS: <br /> INSU AFFORDING COVERAGE IyAIC4 <br /> wsuRER a:Wutilus Insurance Company 17370 <br /> INSURED INSURER 13: <br /> Our Lady of Fatima Society of INSURER c: <br /> Thornton, Attn:Secretary INSURER D: <br /> P.O.Box 611 <br /> Thornton,CA 95688 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 FORTHE POLICY PERIOD <br /> INDICATED_ NOTVMHSTANDING 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 /> L TYPE OF INSURANCE` POLICYNUMDER V.LVDIfW11W <br /> A X OOMhERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 <br /> 0. <br /> C€AIMS-MADE OCCUR X NN496380 10/1812D14 IW2112014 PREMISES Eeoaour"Lj� s 100,00 <br /> MED EXP(Arty ore person) 5 5,00 <br /> PERSONAL&ADVIWURY S 1,DDD,00 <br /> 6EMLAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 <br /> X POLICY 1-1PRO- LOC PRODUCTS-COMPI.�AGG s Include <br /> f <br /> OTHER: MIT S <br /> AUTOMOBILELIABILITY Es aotlderd <br /> BODILY IMILIRY(Per persm) S <br /> ANY AUTO <br /> ALL OWNED SCHEDULED BODILY IWURY(Per&=WaM S <br /> AUTOS AUTOS NONN-OV NED (PRerseddent E _ <br /> HIREDAUTOSAUTOS s <br /> UAIBREL.LALIAa OCCUR EACH OCCURRENCE S <br /> EXCESS Ulko HCLAIMS-PAADE AGGREGATE S <br /> DFD RETENTION S S <br /> OTH- <br /> WORKERS COMPENSATION ST TUTE ER <br /> AND EMPLOYERS'LIABILITY <br /> AMY PROPRIETORIPARTNEWEXECUTIVE Y❑ NIA F�FACH ACCIDENT 3 <br /> (�,E�EMBE,,EXCLUDED? E.L.DISEASE-EA EMPLOYE S <br /> I'D <br /> 1 yea Sd,W&Neurd- EL.DISEASE-POLICY LIMIT i <br /> DESCRIPTION OF OPERATIONS below <br /> A Liquor Liability NN496390 10/18/2014 10/21/2014 Liquor Liability 1,000,00 <br /> DESCRIPTION OF OPERAMONS I LOCATIONS I VEHICLES(ACORD 101.Addrdonal Remarks SchaduSe,rmy 6e aNached U man■para is n pOmd) <br /> Certificate Holder is named as Additional insured with respect to General Liability In regard to the Bodo de Lek being held on 10-18-14. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> of San Joaquin&Its Board of Supervisors,Officers <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> County q pe ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Employees and Agents <br /> P.O.Box 1810 <br /> Stockton„CA 95201 Au1HOR¢i 0 REPRES 37TATNE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br /> Received Time Sep. 25, 2014 2 :49PM No. 8725 <br />