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DATE(MWDDNYYY) <br /> A�® CERTIFICATE OF LIABILITY INSURANCE <br /> 4/21/2015 <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(ies)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 /> PRODUCER CONTACT DiAnna Martin <br /> NAME: <br /> All-Cal Insurance Agency PHONEIAIC.No. (916)(916)784-9070 No).(916)784-0158 <br /> 505 Vernon Street E-MAIL ADDRESS:dianna@all-calinsurance.com <br /> INSURER(S)AFFORDING COVERAGE NAIC X <br /> Roseville CA 95678 INSURERA:Nonprofits' Insurance Alliance of 011845 <br /> INSURED INSURERB:North American Elite Insurance_ 29700A <br /> Firefighters Burn Institute INSURER C: <br /> 3101 Stockton Blvd. INSURER D: <br /> INSURER E: <br /> ISacramento <br /> - <br /> Sacramento CA 95820 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL1410104118 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 BEE14 REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBRI POLICY NUMBER MMIDCY EFF MMIDCY EXP LIMITS <br /> LTR <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED 500,000 <br /> A CLAIMS-MADE iOCCUR PREMISES(Ea occunence- $_,—_ <br /> ��J_$IM250,000 <br /> PROPER SEXUAL CONDUCT X 2014-14425NPO 11/7/2014 11/7/2015 MED EXP(Any one person) $ 26,000 <br /> / $ 250,000 PERSONAL SADV INJURY $ 1,000,000 <br /> GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> PRO- <br /> X I POLICY JECT LOC i PRODUCTS-COMP/OP AGG I$ 2,000,000 <br /> I OTHER: <br /> FULL LIQUOR LIABILITY Is 1,000,000 <br /> I ! COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY I ! ! Ea accident �$ <br /> ANY AUTO If ! BODILY INJURY(Per person) s <br /> ALL OWNED SCHEDULED I BODILY INJURY(Per accident) $ <br /> ! AUTOS AUTOS PROPERTY DAMAGE $ <br /> NON-OWNED <br /> FHIRED AUTOS I AUTOS i $ <br /> X UMBRELLALIABOCCUR EACH OCCURRENCE S 4,000,000 <br /> A EXCESS LIAB HCLAIMS-MADE I AGGREGATE S 4,000,000 <br /> DED I X I RETENTION$ 10,000 X 2014-14425UMB 11/7/2014 11/7/2015 $ <br /> WORKERS COMPENSATIONER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE I ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? C N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ <br /> B EMPLOYEE DISHONESTY CWB 000 3844-11 14425 11/7/2014 11/7/2015 LIMITS 100,000 <br /> FORGERY / ALTERATION DEDUCTIBLE 250 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached V more space is required) <br /> SAN JOAQUIN COUNTY PUBLIC WORKS, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES & VOLUNTEERS ARE NAMED <br /> ADDITIONAL INSURED FOR THE BOOT DRIVE TO BE HELD ON MAY 9, 2015 AT E. Hw 26 / N DUNCAN RD. FORM Cr. 20 <br /> 12 APPLIES. <br /> CERTIFICATE HOLDER CANCELLATION <br /> (209)468-3000 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> SAN TOAQUIN COUNTY PUBLIC WORKS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ATTN• THOMAS M. CAU ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1810 E HAZELTON AVE <br /> STOCKTON, CA 95201 AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br /> INS025(201401) <br />