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..o �a AC A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVYY) 3/14/2016 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(les) 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 TLB Insurance Services, Inc. CONTACT Heidi ruble NAME: PHONE (925)395-2600 FAX N,.(925)261-0710 AUDR6 haidi-gablelleavitt.com CA License #0882095 3000 Oak Road, Suite 210 INSURER AFFORDING COVERAGE NAIL# INSURER A Admiral IIIisruance Company a24856 Walnut Creek CA 94597 INSURED INSURER B:Inte On National Insurance Company 29742 INSURERc:State Co enation Innrance 35076 Walton Engineering, Inc. ERDartford Casuals Insurance Company 29424 INSURH P.O. Box 1025 RE: INSURBRE. INSURER F: bleat Sacraalento CA 95691 COVERAGES CERTIFICATE NUMBER:16-17 PEG w/ 15-16 WC 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 T T EOFINSUMNM ADM WOR POLICY NUMBER POLICYFY MMM/ POLICY UP UI61rs S COMMERCIAL GENERAL UABILRY EACH OCCURRENCE $ 1,000,000 CLNMSWADE ® OCCUR MAGEA PREMI ET E MED $ 50,000 S MED UP (Any we Person) $ 5,000 Incl. Pollution L1ab. PRIRCC1358703 3/6/2016 3/6/2017 Z I Incl. Professional Liab. PERSONAL& ADV INJURY $ 11000,000 GENL AGGREGATE DMR APPLIES PER: GENERAL AGGREGATE $ 2,000,000 S POLICY [:1 JECaT F-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 EMPL BENEFITS UAB $ OTHER: AUfDMD&LE LABILITY COMBINED SINGLE LI $ 1,000,000 Ea accident BODILY INJURY (Par person) $ E S ANY AUTO ALLOVMED SCHEDULED AUTOS AUTOS 12003162 3/6/1016 3/6/2017 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ N&INED HIRED AUTOS X AUTOS UninsurechrVonetcomdrled It 500,000 X UMBRELLA UABOCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 A X EXCESS UAB CWMSJ DED RETENTION $ 1111IS1313511111103 3/6/2016 3/6/2017 WORKERS COMPENSATION AND EMPLOYERS' UABILIT' YIN S PERT ER ANY PROPRIETOWPARTNEWEXECUOVE E.L EACH ACCIDENT $ 11000,000 C OPFICEWMEMBER EXCLUDED' (Mandatory In NH) N/A 911333915 10/1/2015 10/1/2016 E.L DISEASE - EA EMPLOYE $ 11000,000 Ayes, Oescit antler DESCRIPTION OF OPERATIONS bales, E.L. DISEASE -POLICY UNIT 11000.000 D Inland !Sarin 57UONzC1966 3/6/2016 3/6/2017 Limo $ 300,000 Rested, Leased or Borrowed Deductible $ 2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aBaohed H mm pap is rpuln0) To Whom It May Concern SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cote/JUBAUT 01968-2014 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 mnIam,