Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2018_PS-1800000 thru PS-1800500_ - PS-1800114

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CERTIFICATE OF LIABILITY INSURANCE V DAM(MMIDDNYYYI 01/11/2018 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME- Mike Espana All -Cal Insurance Agency PHONE EExt- (916) 7849070 AAC,No: (916)784-0158 505 Vernon Street E-MAIL ADDRESS: MikeQalFplinsurance.com INSURER(SI AFFORDING COVERAGE NAICN Roseville CA 95578 INSURERA: Nonprofits' Insurance Alliance of California 011845 INSURED INSURER B : Firefighters Burn Institute INSURER c: 3101 Stockton Blvd. INSURER D INSURERS: Sacramento CA 95820 INSURER F: COVERAGES CERTIFICATE NUMBER: OL181406876 REVISION NUMBER: l"HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPO LTR TYPE OFINSURANCE INSD WVD POLICYNUM.aER GY EFF Mfmaorrrvrl POLICY EXP pmnmOfrYYv7 LIMITS X COMMERCIAL GENERAL11A61LITY EACH OCCURRENCE 5 1000,000 CLAIMS-MADE['ZI OCCUR 9 DAMAGE 10 REN I ED PREMISES (Ea occurrence S 500,OOD MEDEXP(Anyoneperson) S 20,000 {I PERSONAL B ADV INJURY S 1,000,000 A Y 2018-14425NPO 01/01/2018 01/01/2019 'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S 2,000,000 GEN POLICY ❑ JST 0 LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER Improper Sexual Conduct s 250,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 Eaacddenll BODILY INJURY(Parperson) 5 ANYAUTO k OWNED SCHEOULEO AUTOS ONLY AUTOS BODILY INJURY(Peracdden0 S HIRED NON OWNED AUTOS ONLY AUTOSONLY PROPERWDAMAGE 5 Peremtlent) 1 5 �1 UMBRELLA LIAR OCCUR EACH OCCURRENCE S 4.000,000 A IX EXCESS LIAB CLAIMS -MADE 2018-14425UMB 01/01/2018 01/01/2019 AGGREGATE. S 4.000,000 DED I X{ RETENTION S 10,000 S WORKERS COMPENSATION ANDSMPLOYERVLtABILITY Yin PER OTH- STATUTE EF EL EACHACCIDFNT 5 ANY PROPRIETORIPARTNEWEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA E.L OISEASE. EA EMPLOYEE 5 (Maodataryin NH) IfeH, descuUeunder EL. DISEASE -POLICY L+MIT 5 DESCRIPTION OF OPERATIONS below A Employee Dishonesty Forgery & Alteration 2018-14425PROP 01/01/2018 01/0112019 Limits 100,000 Deductible 250.00 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES 1AGORD 101, Additional Remarks Schedule, may be anached if more space is required) Framinglon Fire Department, The State of California Department of Transportation and San Joaquin Department of Public Works, their officers, agents, officials, employees and volunteers are named additional insured for the "Fill The Boot For Burns" Boot drive. February 10-11, 2018. Form CG 20 26 applies Farmington Fire Department P.O. BOX 73 Farmingtoo CA 95230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©19882015 ACORD ACORD 25 (2016103) The ADDED name and logo are registered marks of ACORD reserved.