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JONECOV-02 DADACAYA A�ORO` CERTIFICATE OF LIABILITY INSURANCE DA 6/28/20112 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 License#OE67768 NAME; Celeste Garcia IDA Insurance Services-ORG PHONE 949 297-5962 AIC,No� (949 297-5960 130 Vantis,Suite 250 AJ_No Ell:( ) ) Aliso Viejo,CA 92656 ADDRESS:celeste.garcia@ioausa.com INSURER(S)AFFORDING COVERAGE NAICS INSURERA:OneBeaconInsurance Company 21970 INSURED INSURER B:Golden Eagle Ins Corp 10636 Jones Covey Group,Inc. INSURER C:Granite State Ins Co 23609 9595 Lucas Ranch Rd Ste 100 INSURER D: Rancho Cucamonga,CA 91730 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CON13TION 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADUL SUBR POLICY EFF POLICY EXP I S TYPE OF INSURANCE LIMITS LTR INSR WVD POLICY NUMBER MMIDD/YYYY MMIDD/YWY GENERAL LIABILITY EACH OCCURRENCE $ 5,080,000 A X COMMERCIAL GENERAL LIABILITY X 930001440001 7/1/2012 71112013 PREMISES aoccunence $ 50,000 CLAIMS-MADE 1K OCCUR MED EXP(Any one Person) $ 5,000 PERSONAL B ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,080,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 5,000,000 POLICY X jEC7 LOC $ AUTOMOBILE LIABILITY (EaCO accident MBINN LE LIMIT $ 1,008,888 B X ANY AUTO BAS853096 7/112012 7/1/2013 BODILY INJURY(Per Demon) $ ALLOWNED F7 SCHEWLED BODILY INJURY(Per accident) $ AAUTUTOS No OVMED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accidam) 8 UMBRELLA LUIB X OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESS LUIB CLAIMS-MADE 930001460001 7/1/2012 711/2013 AGGREGATE $ 2,000,000 DED X RETENTION$ $ WORKERS COMPENSATION X VJC b'TATU- OTH- AND EMPLOYERS'LIABILITY TORY LI ITS C ANY PROPRIEfOR/PARTNEREXECUTIVE YIN C009970790 2/1/2012 2/1/2013 E.L EACH ACCIDENT $ER 1,000,000 OFHCER/MEMBERElCLUDED? NIA (Mandatory In NH) EL DISEASE-EA EMPLOYIEE1 EMPLOY $ 1,000,000 It yes describe under EL DISEASE-POLICY LIMIT 1$ 1,800,888 DESCRIPTION OF OPERATIONS below A Professional Liab 930001440001 7/1/2012 7/1/2013 Limit: 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION 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 Costco Wholesale Gas Station Service /•.- /1__ 0.1 G' '/ 999 Lake Drive Issa ualtWA 98027 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD