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...... 1 JONECOV-02 DADACAYA A4CC RIX CERTIFICATE OF LIABILITY INSURANCE DATDIYYYI) 61/2 2812 812 012 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 WANED,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 130 Vantis,Suite 250 No EM:(949)297-5962 AIC.No: (949)297-5960 Aliso Viejo,CA 92656 D lL.ss celeste.garcia@ioausa.com INSURER(S)AFFORDING COVERAGE NAIC0 INSURERA:OneBeacon Insurance Company 21970 INSURED INSURERS:Golden Eagle Ins Corp 10836 Jones Covey Group,Inc. INSURERC:Granite State Ins Co 23808 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 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY EFF POLICY� INSR WVD POLICY NUMBER MWDDIYYYY MMOOr(YYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A X COMMERCIALGENERALUABIUTY X 930001440001 7/1/2012 7/1/2013 PREMISES Ea occurrence $ 50,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL a ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 5,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY P1,111NE0.DSINGLE LIMIT $ 1,000,000 B X ANY AUTO BA8863096 7/1/2012 7/112013 BODILY INJURY(Per person) $ ALL OWNED SCHEDAUTOSULED BODILY INJURY(Paramitlen[) $ AUTOS NON.OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS (Per accident $ UMBRELLA LMB X OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESSLMB CLAIMS-MADE 930001460001 7/1/2012 7/112013 AGGREGATE $ 2,000,000 DED X I RETENTION 8 $ WORKERS COMPENSATION X YVC I ORY UMIU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS CER C ANY PROPRIETOR/PARTNER/EXECUTIVEY� NIA 0009970790 2/112012 21112013 E.L.EACH ACCIDENT $ 1,000,000 /M OFRCEREMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYE $ 1,000,000 It yes desabe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 A Professional Liab930001440001 7/112012 7/1/2013 Limit: 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addttlonal Remadus Schedule,Ir 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 � r� //� L' 999 Lake Drive t I -1`1( c— Issa uah WA 98027 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD