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1 ® DATE(MMIDDIYYYY) <br /> AC40R D CERTIFICATE OF LIABILITY INSURANCE 4/30/2015 <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(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 /> CONT <br /> PRODUCER NAMEACT Wendy Clark <br /> Mid-Central Valley Insurance PHONE AIC (209)334-4242 FAX N .(209)369-0684 <br /> 301 S. Ham Lane, Suite F E-MAIL .wclark@mcvins.com <br /> P.O. BOX 490 INSURERS AFFORDING COVERAGE NAIL# <br /> Lodi CA 95241 INSURER A:Philadel hia Insurance Company <br /> INSURED INSURER B: <br /> Brad Coussons dba Chaparral Endurance Events INSURERC: <br /> 6371 Crestview Circle INSURER D: <br /> INSURER E: <br /> Stockton CA 95219 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL1362704238 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 /> INSA DL U POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMBS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE T(YRF-ENTED 100,000 <br /> �{ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ <br /> A CLAIMS-MADE OCCUR PHPK1041097 /1/2013 /1/2014 MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 3,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 <br /> X POLICY PRO LOC $ <br /> COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY Ea i en - <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS $ <br /> UMBRELLA UAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS $ <br /> JMMSIWORKERS COMPENSATION WC STATU- O IR <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? El <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) <br /> Linden Unified School District & San Joaquin County are named as an additional insured per form PI AM 002 <br /> 1208 <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 /> Linden Unified School District & <br /> San Joaquin County <br /> 1AUTHORI DREPRESENT <br /> 8527 E Highway 26 <br /> Linden, CA 95236 <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025(201005).01 The ACORD name and logo are registered marks of ACORD <br />