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ACORD"CERTIFICATE OF L1ABIUTY INSURANCE r DATE {MMIODIYYVY) <br />~2/16/2016 <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 WAIVl:D,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 ~R~?t:CTDiAnna Martin <br />All-Cal Insurance Agency ~1igr~JoEx".(916)784-9070 !f...e~No':(916)784-0158 <br />505 Vernon Street ~~~gss:dianna@al1-calinsurance.com <br />INSURER/51 AFFORDING COVERAGE NAIC# <br />Roseville CA 95678 INSURERA:Nonnrofi ts f Insurance Alliance of 011845 <br />INSURED INSURERB:North AmericanElite Insurance 29700A <br />Firefighters Burn Instituba INSURERC: <br />3101 Stockton Blvd.INSURER0: <br />INSURERE: <br />Sacramento CA 95820 INSURERF: <br />REVISION NUMBER:CERTIFICAlE NUMBER:CL161605112COVERAGESTHISISTOCERTIFYTHATTHEPOLICIESOFINSURANCEUSTEDBELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED.NOlV\llTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT YVlTH RESPECT TO \fIJH!CH THIS <br />CERTIFICATE Iv'lAY 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 rMY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DOLSUER ~grJ%Yv~~1~1/'-6%Y~~LIMITSLTRTYPEOFINSURANCEPOl.lCY NUMSER <br />X COMrt'lERCfAL GgNERAL LIABIliTY EACH OCCURRENCE ,1,000,000 <br />A ICLAIMS.I'\.'\t\DE:W OCCUR ~~~~J9~~~~"mJ\$500,000 <br />.x IMPROPER SEXUAL COlIDUCT X 2016-14425NPO 1/1/2016 1/1/2017 MED EXP (Arry one person)$20,000 <br />$250,000 /250,000 PERSONAL &AOV INJURY $.1,000,000 <br />~'LAGGREGATE LIMITAPPLIESPER GENERAL AGGREGATE •2,000,000 <br />X POLlCY Dj:8+0 lOC PRODUCTS.COMPlOPAGG ,2,000,000 <br />OTHER:lIQUOR UABILITY ,1,000,000 <br />AUTOMOBILE LIABILITY I fi:~~~~d~~I1SINGLE LIMIT •- <br />ANY AUTO BODILY INJURY (Per person)•f-ALL OWNED ~SCHEDULED <br />f-AUTOS f-AUTOS <br />BODILY INJURY (Per-accident)$ <br />NON.QWNED I rp~~~J;;nt?AMAGE •f-HIRED AUTOS f-AUTOS , <br />e2'-UMBRELLA L1AB ~~CCUR <br />EACH OCCURRENCE •4-000,000 <br />A EXCESS LIAS CLAIMS-MADE AGGREGATE $4 000 000 <br />OED I X I RETENTION $10 000 2016-14425tW.B 1/1/2016 1/1)2017 , <br />WOfl,KERS COMPENSATION I ;\%UTE I I~,\"-AND EMPLOYERS'LIABII.ITY YINANYPROPRIETOR/PARTNER/EXECUTIVE 0 NIA E.l..EACH ACCIDENT , <br />OFFICER/MEMBER EXCLUDED?(Mandatory ill NH)E.L DISEASE"EA EMPLOYE $ <br />g~;'a~fpTr8N010PERAT10NS lIelow E.L DISEASE -POLICY LIMIT $ <br />B EMPLOYEE DISHONESTY CWB 000 3844-12 14425 1/1/2016 1/1/2017 LIMITS 1.00,000 <br />FORGERY &ALTERATION DEDUCTIBLE 250 <br />DESCRIPTION OF OPERATIONS 1LOCATIONS {VEHlCI.ES (ACORD 101,Add1t!onal Remarks Schedule,may"be attachGd lfmoro spacc lsrotjulrc.d) <br />THE COUNTY OJ?SAN JOAQUINl ITS OFFICERS,AGENTS,OFFICIALS,EMPLOYEES,AND VOLUNTEERS ARE NAMED <br />ADDITIONAL INSURED FOR THE IIFILL THE BOOT E'ORBURNS 11 BOOT DRIVE ON MARCH 19 &20,2016 AT THE FOLLOwrnG <br />LOCATIONS.1.THORNTON RD/'l'URNERRD.2.THORNTON RD/PELTIE~RD.3.THORNTON RD/WALNUT GROVE RD.FORM eG <br />20 12 APPLIES <br />CERTIFICATE HOLDER CANCELLATION <br />•All rights reserved. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLlC[ES BE CANCELlED BEFORE <br />THE EXPIRATION DATE THEREOF,NOTICE WlLL BE DEUVERED IN <br />ACCORDANCE WITH THE POI.ICY PROVISIONS. <br />AUTHORIZED REPRESENT ATNE <br />OF PUBLIC WORKS <br />de.,r-:~z:t <br />@1988.2014ACORDCORPORATIO <br />The ACORD name and logo are registered marks of ACORD <br />COUNT,\:"OF SAN JOAQUIN <br />ATTN:KRIS BALAJI,DIRECTOR <br />181.0 E.HAZELTON AVE. <br />STOCKTON,CA 95205 <br />ACORD 25 (2014101) <br />INS025 (201<101)