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<br />OP ID: JS
<br />14��� CERTIFICATE�� Y INSURANCE
<br />DATE(MMJDDIYYYY)
<br />1 10/04/11
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does nek confer right to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER 916-784-1008
<br />CONTACT
<br />Placer Insurance Agency
<br />916-784-8116
<br />PHONE
<br />License #OC66701
<br />(Arc. No,:t1...__._.._._____P.
<br />0. Box 619052
<br />E-MAIL --
<br />ADDRESS:
<br />Roseville, CA 95661-9052
<br />Jeff P. Dreyer
<br />PRODUCER
<br />CUSTOMER ID #: FILLC 1 w_
<br />�. 300,00
<br />INSURERLBZAFFOROING CO +=RAC -^c NAIC #
<br />INSURED Filiner Construction, Inc. -
<br />_
<br />INSURER A: Zurich American Insurance Co 1;16535
<br />4470 Yankee Hill Rd., Ste 200 6 f1
<br />INSURERB: Travelers Property O Casualt C ;25674
<br />Rocklin, CA 95677
<br />--•- -_Y _
<br />INSURERC.National Union Fire Iris of Pry 19_445
<br />INSURER D: Travelers IndemnityCOrn)aa _ � _ ;25658
<br />NSURERE: Westchester Surplus Lines Ins,
<br />hI
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />CERTIFICATE HOLDER; CANCELLATION
<br />NAME --1
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T -)E INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
<br />BY THE POLICIES DESCPiFED HEREIN IS SUBJECT TO ALL THE
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS.
<br />INSR — jAdtSU.iS i" ' ------ --
<br />LTR i TYPE OF INSURANCE POLICY NUMBER
<br />— POLICY EFF -'- POLICY EXP --.-.—
<br />I MM/DDIYYYY Ii� .VDWYYYY f. LIMITS
<br />i GENERAL LIABILITY
<br />! — EACH OCCURRENCE �S
<br />1,000,00
<br />B
<br />X II COMMERCIAL GENERAL LIABILITY !C08239X433TlL11
<br />_
<br />- 05101?11 06/01/12 j -PREM SESLa cue reel • s -_
<br />�. 300,00
<br />CLAIMS MADE LX OCCUR
<br />. MED EX_P_(Any one persan) : 5
<br />..PERSONAL
<br />_ 10,00
<br />& ADV lNJURY S
<br />1,000,00
<br />GENERAL AGGREGATE is
<br />2,000,00
<br />1 GEN'L AGGREGATE LIMIT APDL ES PERPRO9UCTS
<br />--�
<br />-COMP/OP AGG S
<br />2,000,00
<br />POLICY ! X PRO- LOC
<br />---------.__—
<br />AUTOMOBILE LIABILITY
<br />! COMBINED SINGLE LINNT
<br />1,000 000
<br />D
<br />X ANY AUTO 810823Gn433TCT11
<br />05/01/11 ! 05101/12 Eaa cdert)
<br />BODILY INJURY (Per person)
<br />ALL OWNED AUTOS
<br />`—i
<br />I BODILY INJURY (Per accident) $
<br />SCHEDULED AUTOS
<br />- - ---- ------
<br />PROPERTY DAMAGE
<br />HIRED AUTOS
<br />i
<br />(Per acudent;
<br />_
<br />X NON•OWNEOAUTOS
<br />UMBRELLA LIAB X I OCCUR
<br />j EACH OCCURRENCE S
<br />4,000 00
<br />C
<br />X EXCESS LIAB CLAIMS -MADE ,
<br />--_ _..__'BE067954501
<br />,AGGREGATE ! ;.
<br />05101/11 05/01/12
<br />4,000,00
<br />—
<br />_ _ DEDUCTIBLE
<br />X ^ RET, ENT10N S
<br />5
<br />WORKERS COMPENSATION
<br />i : WC STATU- i 0TH
<br />X
<br />AND EMPLOYERS' LIABILITY Y / N
<br />.'TORY LIMIT -
<br />B
<br />ANY PROPRIETORIPARTNER/EX-ECUTIV'c [-- I jUi38239X433TIL11
<br />05/01/11 I 05/01/12 E EACH ACCIDENT S
<br />1,000,00
<br />OFFICER/MEMBER EXCLUDED" 1 l N; A I
<br />I (Mandatory in NH)
<br />..---- .—.—
<br />i E DISEASE - EA EMPLOYE S
<br />1,000,00
<br />If yes, deseribe under
<br />DESCRIPTION OF OPERATIONS below
<br />.' EL DISEASE • POLICY LIMIT S
<br />1,000,00
<br />A
<br />(Builders Risk !EC04367340
<br />j 10/01/11 10/01/12 ;Limit:
<br />5,000,00
<br />E
<br />;Pollution Liab 62380433005
<br />10/01111 i 10101112 (Limit:
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />CERTIFICATE HOLDER; CANCELLATION
<br />NAME --1
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Narmed Insured
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />�JQ'�C-G�✓ CQ- �G�
<br />©1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
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