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690019 41V �1 �-L�-I� AC� OW DATE(MMIDDIYYYY) l`../ViR CERTIFICATE OF LIABILITY INSURANCE F3/21/2018 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, the policy(ies) must 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 endorsement(s). PRODUCER CONTACT Shala Pearson NAME: _ TLB Insurance Services PHONE Ext)*, (916)691-5555 1FAc,No): (888)329-8842 CA License #OB82095 AIL ADDRESS:shala-pearson@leavitt.com 3000 Oak Road, Suite 210 INSURER(S)AFFORDING COVERAGE _ NAIC# Walnut Creek CA 94597 INSURERA:Admiral Insrua_nce Company a24856 INSURED INSURERB:Travelers Casualty Co.__of America 19046 Walton Engineering, Inc. INSURE_RC:State Compensation Insurance Fund 35076 P.O. Box 1025 INSURERD:Travelers Casualty_Co. of America 19046 INSURER E: West Sacramento CA 95691 INSURER F: COVERAGES CERTIFICATE NUMBER:18/19 All Policies REVISION NUMBER: 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. INSR ADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCEINSD WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 10RFN"ED A I CIAIMS VADI I X I OCCUR PREMISES(Ea occurrence) $ 50,000 X Incl._Pollution Liab. FEIECC1358705 3/6/2018 3/6/2019 _MED_E=X_P(Any one person) $ 5,000 X Incl. Professional Liab. PERSONAL&ADV INJURY $ 1,000,000 GI N': AGGRE:GAFF LIMA APPLIES PER: GENERAL AGGRE:GAl'E $ 2,000,000 POLICY lXIfP2O.. f floc PRODUCTS-COMP/OPAGG $_ 2,000,000 JLCF — 01 l 1I.R: $ AUTOMOBILE LIABILITY COMBINED SINGLE::LIMIT $ 11000,000 (I:a accidentj._-——_ XANY AUTO BODILY INJURY(Per person) $ B All OWNI.D SOI[DULED - - - � - AUFOS AUTOS 8106K992397 3/6/2018 3/6/2019 BODILY INJURY(Por $ NON OWNED PROPERLY DAMAGE $ X HIi2ED AUTOS X ADIOS mor accident___ _ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A X EXCESS LIAB CIAIMS-MADE; AGGRFGAFE: $ 10,000,000 OED I I REEHAHON$ FEIEXS1358805 3/6/2018 3/6/2019 $ WORKERS COMPENSATION X PER O7H AND EMPLOYERS'LIABILITY _ SFATU�E; _E;ft_ YIN ANY PIZOPRIE:"I"OH/PAF21'NIiR/F:Xf:CU1-iVi: I NIA E.L.EACHACCI')E.NT _$ - --1,000,000 OEFICI R/MEliMBER E;XCLUDEID9 9113339-2017 10/1/2017 10/1/2018 L.DISEASE.IA IiMPLOYL1: $ 1,000,000 C (Mandatoryin NH) ILS _ - _ _ _ If yyes,doschbe under E.L.DISEASE I.POLICY LIMIT $ 1,000,000 ) SCRII TION OE OPISIJAI IONS below D Inland Marine 3/6/2018 3/6/2019 Limit $ 300,000 Rented, Leased or Borrowed Deductible $ 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) JUL 18 ENVIRONMENTAL F,;-W TH M7—"" ;TitnENT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TO Whom it May Concern i THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE Sha la Pearson/S11PEAR ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 %;r