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i WESTERN SI CW I`Y 3 PL 8 <br /> DMUMMOR INC <br /> 11/2/OS CERTIFICATE OF INSURANCE 5 1050 Page 2of3 <br /> Evidendng Placerment of Insurance <br /> i <br /> 1 GONDITiONS Copt, <br /> } CG2002 Additional insuredclub Members <br /> 5152 Additional inswwUSpe4"Events <br /> i DeOL of Public Works <br /> ` 2)Linden UnNw School District` <br /> 41 Polity jndwt <br /> GS9" Cannmon Pblky Ded atiorns <br /> S902- - -- Sdtedale-of- orms <br /> 11.0017 Common POWV Condtions <br /> IL0270 CA ehanges-Canoeiladon and Nonrenewal <br /> SI 50 CGL Coverage PUM Dedaratlons <br /> 5001 Amendment of Premium Conditions <br /> $022 Deductible LatblW <br /> 5013CA 25%tGnlmum Estned Premium . <br /> Sl S7 Important Notice Policyholder <br /> _( Please note,policy will be subject to Inspection and/or audit. This may result In a change <br /> In premium.form or terms. <br /> 1 <br /> Ekdusiom CG2175 Certified Acts of Terrorism and Other Acts of Terrorism <br /> 5009 Total Uquor UnWilty <br /> = SM thnsclneduSed Activities or Events <br /> 5138 Assault dr Battery <br /> I 3033 Cross Sults <br /> t SO41 Partidpants;Persons In Activitlr Areas,such as but not limited <br /> i to chute,pl%trmct,corral or wren%Any Auto.WstercraR or <br /> Noble Equipment used in Racing.Speed or Demollthm Contest <br /> Animals;Amusement Ride or Device;Fireworks <br /> i CG0001 1"] Per form <br /> CCW62 WAr UabMcy - <br /> f ILA021 Nudetnr Energy LabNtty <br /> CC2160 Y29 Computer 6 Other Related Losses <br /> S05i Additional Exclusions m Conditions- Ernployee.Total PWludon. <br /> Asbestos,Silica Dust,Toxic Substances.ftnklve or Exemplary <br /> Danwtie. Employment Related ftwd ees,No coverage as <br /> required by Environmental Protectlan Agency(EPA)40 CFR <br /> Parts 280 and 261 for ground storage tanks nor any <br /> coverage under CERCLA or similar Stats or Federal <br /> Environmental Acus),Umitadon-Other insurance-No excess <br /> f insurance fo►alrcrak autos!or watercaft <br /> !li <br /> 2=1 Lava Ridge Coam 9uift 840 Rosev0s,C.A 86661 (910)677-SM Fax(816)677-+1484 <br /> Calirbrnis L 0 0688680 <br /> i <br />