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ATE <br /> �°� CERTIFICATE OF LIABILITY INSURANCE °1/162011' <br /> 11/16/2011 <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 /> PRODUCER NAME CT Kathy Bruno <br /> Mid-Central Valley Insurance PHONE (209)334-4242 FAAIcN.).(209)369-0684 <br /> 301 S. Ham Lane, Suite F <br /> E_ AIL <br /> USE <br /> P.O. BOX 490 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Lodi CA 95241 INSURER Western Security Surplus Ins <br /> -INSURED INSURER B: <br /> Linden-Peters Chamber of Commerce INSURERC: <br /> P. O. BOX 557 INSURER D: <br /> .INSURER E: <br /> Linden CA 95236. INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:2011-2012 Liability 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 /> INSR ADDL SUER POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER h1MIDLVYYYY MMlDOtYYYY <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMA000 <br /> X COMMERCIAL GENERAL LIABILITY PREM TO RENTED <br /> PREMISES Ea occurrence S <br /> A CLAIMS-MADE IX OCCUR 188826 11/1/2011 11/1/2012 MED EXP(Any one person) $ 5,000 <br /> PERSONAL BADV INJURY $ 1,000,000 <br /> GENERALAGGREGATE $ 2,000,.000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG S Include <br /> X POLICY PRO- LOC S <br /> COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY Ea accident <br /> ANY AUTO BODILY INJURY(Par person). $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> SNON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOSAUTOS (Per aecidenl <br /> S <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE S <br /> EXCESS LAB CLAIMS-MADE AGGREGATE S <br /> DED RENTION$ $ <br /> WORKERS COMPENSATIONETWC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YfN <br /> ANY PROPRIETORIPARTNERIEXECUTIVE N/A ANY EACH ACCIDENT S <br /> OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ <br /> (Mandatory In NH) <br /> If yes,describe under E.L DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Certificate Holder is listed as Additional Insured For Christmas Tree Lighting to be held on December 3, <br /> 2011 <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 /> San Joaquin County <br /> Department of Public Works AUTH [ZEDREPRESENTATIVE <br /> 1810 E. Hazleton <br /> Stockton, CA 95201 _ <br /> ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025(201005)01 The ACORD name and logo are registered marks of ACORD <br />