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GULFS -1 ,4c�►Ra° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12129/2017 THIS CERTIFICATE IS ISSUED AS A 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 A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, ilie policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS 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 endorsemont s . PRODUCER 530-622-9300 Capital Sierra Ins. Svc. LLC- 694 Pleasant Valley Road #7 Diamond Springs, CA 96619 Kathleen Verplancken Nor CT Kathleen Verplancken PHUNB 530-622-9300 F x 530-622-9303 ( c' N°' EX1 i lc. INSUREINSUPERISI AFFORDING COVERAGE NAIC A INSURERA:Financial Indemnity Company 19852 INSURED Gulf Shore Construction Svc INSURER B: Mercer Insurance Company Inc.dba G S Exploration PO Box 1601 INSURERC: Sta#e Compensation ensation ins. Fund 35078 INSURERD: Shingle Springs, CA 96682 INSURF.FiE: ODUC S-COMPIOPAGG INSURER F : A COVERAGES CERTIFICATE NUMBER! REVISION NUMFIFR: THIS 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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, INSRAM TYPE OP INSURANCE ADPL SUB wvrl POLICY NUMBER POLICY EVyFF MM POLICY 8XP LIMIFS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE DAMA_RREM VETO RENTED MED UPM o PERSON -a & ADYINJUR AGGREGATE LIMIT APPLIES PER: POLICY ❑ JEGpT LOC Gfl ERA AO GATE ODUC S-COMPIOPAGG A AUTOMOBILE LIABILITY ANYAUTO OWNED X AUTO$ULED AUTOS ONLY QQNN opy�NEo X AUT09 ONLY X hU705 ONLY Y y CCFIMV3621238-06 02/1012017 02/1012018 COMBINED SINGLE LIMIT 1,000,000 _ _S POGILY INJURY Per arson $ B DILY INJURY e acclderd � ,-...__ Pa�auR�az>< AMACE B X UMBRELLA LIAB EXCESS LIAS X OCCUR CLAIMS -MADE 27306981 0211012017 0211012016 EACH OCCURRENCE 3 1,000,000 _AGGREGATE 1,000,000 DED RETENTION $ C WORKERS COMPENSATION ANDERRMPppLOYERS'LIAFBIyyLITYIN AQN�FICEOH r�fMEMB�E�RPE)CCLUDED7 ECIJTNE IMandaterytnNrl' f�I If es deGeAbeunder DESCRIPTION OFOPrRATIONS hale,, N I A Y 9066678-17 08103/2017 08102/2018 X PER TH- 0 ACCIDENT 1,000,000 E.L. DISEASE - CEMPLOYEE 1,000,000 E L DI EASE. POLICY LIMIT 1,000,000 bgSCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 104, Addlllonal Romarka Sohedula, may be ottaohod If more spaoo la roquUed) ERM Is named as additional Insured as respects to commercial automobile Insurance policy. Waivers of subrogation for commercial automobile and worker's compensation applies, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ERM c/o Avetta P. 0. Box 51387 Irvine, CA 92619 ACORD 26 (2016103) �"� g 1988-2016 ACORi1''CORPCFATION. All rights reserved. The ACORD name and logo are registered marks of ACORD