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'`'k�'® CERTIFICATE OF LIABILITY INSURANCE 1/21/201DATE(MM/DD/Y5 5 THIS CERTIFICATE IS ISSUED AS A 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 pollcy(ies)must 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 NAMe CT DiAnna Martin All-Cal Insurance Agency PHONE (916)784-9070 Fax A/C No:(916)784-0158 505 Vernon Street E-MAL ADDRESSdianna@all-calinsurance.com INSURERS AFFORDING COVERAGE NAIC# Roseville CA 95678 INSURER A:NOP rofits' Insurance Alliance 011845 INSURED INSURER B:North American Elite Insurance Firefighters Burn Institute INSURERC: 3101 Stockton Blvd. INSURERD: INSURER E: Sacramento CA 95820 INSURER F.- COVERAGES :COVERAGES CERTIFICATE NUM BER:CL1410104118 REVISION NUMBER: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADDL BR POLICY NUMBER MM/DDI YY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 500,000 A CLAIMS-MADE a OCCUR X 014-1442SUPO 11/7/2019 1/7/2015 MED EXP(Any one person) $ 20,000 X IMPROPER SEXUAL CONDUCT PERSONAL&ADV INJURY $ 1,000,000 $250,000/ $250,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO LOC FULL LIQUOR LIABILITY $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per parson) $ ALL AUTOS OWNED SCHEDULED AUTOSBODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLALIABOCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB HCLAAIMS-MADE AGGREGATE $ 4,000,000 DED I X I RETENTION$ 10,000 2014-14425UMB 11/7/2014 11/7/2015 $ WORKERS COMPENSATIONC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) If yyes describe under E.L.DISEASE-EA EMPLOYE $ DESGtRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B EMPLOYEE DISHONESTY cwB 000 3844--11 14425 11/7/2014 1/7/2015 LIMITS 100,000 FORGERY/ALTERATION DEDUCTIBLE 250 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) FARMINGTON FIRE DEPARTMENT, THE STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION, AND SAN JOAQUIN DEPARTMENT OF PUBLIC WORKS, THEIR OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED ADDITIONAL INSURED REGARDING THE FARMINGTON BOOT DRIVE AT HIGHWAY 4 AND ESCALON-BELLOTA ON FEBRUARY 13-16, 2015. FORM CG 20 26 APPLIES. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FARMINGTON FIRE DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: CONNI BAILEY P.O. BOX 73 AUTHORIZED REPRESENTATIVE FARMINGTON, CA 95230 ACORD 25(2010105) ©19882010 ACORIA CORPORATIO . AI I rights reserved. INS025(201005).01 The ACORD name and loqo are registered marks of ACORD