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ACORD'"CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJDDNVYY) <br />~3/24/2016 <br />THIS CERTIFICATE IS ISSUED AS A MAnER 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 I certain policies may require an endorsement A .statement on this certificate does not confer rights to the <br />certificate holder In Jieuof such endorsement(s). <br />PRODUCER ~2AA~~CTDiAnna Martin <br />~l-Cal Insurance Agency ~:3oExt»(916)784-9070 I r~No\:(916)'184-0158 <br />505 Vernon Street ~~t~~ss:dianna@all-calinsurance.com <br />INSURER{SI AFFORDING COVERAGE NAIC# <br />Roseville CA 9567B INSURER A :Noncrofits I Insurance Alliance of 011B45 <br />INSURED INSURER B :North American Elite Insurance 29700A <br />Firefighters Burn Institute INSURERC: <br />3101 stockton Blvd.INSURER 0: <br />INSURER E:( <br />Sacramento CA 95B20 INSURER F: <br />COVERAGES'CERTIFICATE NUMBER'CL161605112 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.NOTWTHSTANDING 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':LIMITSSHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS.'riC TYPEOFINSURANCE POl.ICYNUMBER &8M%UFF ~~~~'fv~vtl UMITS <br />X COMMERCIAL GENERAL L1A81LlTY =URRENCE $1.,000,000 <br />A I CLAIMS.M,ADE W OCCUR PI.,•500,000 <br />X IMPROPER SEXUAL CONDUCT X 2016-14425NPO 1/1/2016 1/1/2011 MED EXP (Anv one rersonl •20,000 <br />$250,000 I 250,000 PERSONAl &AOV INJURY .S 1,000,000:~EAGGREGATEU'AITAPPLIESPER,GENERAL AGGREGATE $2,000,000 <br />X POLICY D~~0 l.OC PRODUCTS -COMP/OP AGO $2,000,000 <br />OTHER:LIQUOR UABIUTY •1,000,000 <br />~TOM0811.E LIABIUTY I f~~N~~llSINGLELIMIT • <br />ANY AUTO BODILY INJURY (Per person)$-All OV'mED ~SCHEDULED-AUTOS I-AUTOS BODILY INJURY (Per acdde$)$ <br />NON-QWNED I rp~~~~I?AMI\GEHIREDAUTOSI-AUTOS S-S <br />2:..UMBRELLA LIAS ~~CCUR EACH OCCURRENCE •4 000 000 <br />A EXCESS LIAS ClAIMS-MADE AGGREGATE •4 000 000 <br />OED I X I RETENTION $10 000 X 2016-14G25OMB 1/1/2016 1/1/2011 •WORKERS COMPENSATION 1~~~n,••1 .1 gbH•AND EMPLOYERS'LIABILITY YINAt-.('(PROPRIETORIPARTNERlEXECUTIVE 0NIA E.L EACH ACCIDENT SOFACERlMEhlBEREXClUDED?(Mandatory In NHI E.L DISEASE -EA 8'IlPLDYEI=S <br />If~$,desorb under E.L DISEASE -PoLlCY LIMITDSCRIPTIONOFOPERATIONSbelow • <br />B EMPLOYEE DISHONESTY CWB000 3844-12 14425 1/1/2016 1/1/20l1 LIMITS 100,000 <br />FORGERY &ALTERATION DEDUCTlBLE 250 <br />DESCRIPTION OF OPERATIONS fLOCATIONS I VEHICLES (ACORD 101,Adl:lrtlonelRemarks Schedule,may !xl attached If mora Gpacels roqulrod) <br />SAN JOAQUIN COUNTY PUBLIC WORKS,ITS OFFICERS,AGENTS,OFFICIALS,EMPLOYEES &VOLUNTEERS ARE NAMED <br />ADDITIONAL INSURED FOR THE "FILL THE BOOT E'OR BURNS 11 BOOT DRIVE ON MAY 7,2016 AT E.HWY 26 /N DUNCAN <br />RD.FORM CG 20 12 APPLIES. <br />@1988.2014ACORD C <br />The ACORD name and logo are registered marks of ACORD <br />CERTIFICATE HOLDER <br />(209)468-3000 <br />SAN JOAQUIN COUNTY PUBLIC WORKS <br />ATTN:KRIS BALAJI <br />1810 E HAZELTON AVE <br />STOCKTON,CA 95201 <br />ACORD 25 (2014101) <br />INS025 (201401) <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br />ACCORDANCE V~THTHE POLICY PROVISIONS. <br />AUTHORIZED RE!'RESENTATIVE