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® CERTIFICATE p ® fie. ®p�® DATE(MM/DD/YYYY) A�® ®.ITER 1 IFICATE ®F LIABILITY INSURANCE 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(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 Heidi Gable NAME: TLB Insurance Services, Inc. PHONE (925)395-2600 pICNo:(925)287-0710 CA License #OB82095 ADORIesS:heidi—gable@leavitt.com 3000 Oak Road, Suite 210 INSURERS AFFORDING COVERAGE NAIC# Walnut Creek CA 94597 INSURERAAdmiral Insruance Company a24856 INSURED INSURER B:Inte on National Insurance Company 29742 Walton Engineering, Inc. INSURERC:State Compensation Insurance Fund 35076 P.O. Box 1025 INSURER D:Hartford Casualty Insurance Company 29424 INSURER E West Sacramento CA 95691 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 PRG 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. LICY EXP INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDY/Y EFF MMIDD/YYYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE � OCCUR PREMISES(Ea occurrence) $ 50,000 X Incl. Pollution Liab. FEIECC1358703 3/6/2016 3/6/2017 MED EXP(Any one person) $ 5,000 X Incl. Professional Liab. PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F1 PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X PRO- OTHER: EMPL BENEFITS LAB $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BIx X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 12003162 3/6/2016 3/6/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON--OWNEDPaccident) PROPERTYDAMAGE $ HIRED AUTOS AUTOS Uninsured motorist combined $ 500,000 UMBRELLA LAB OCCUR EACH OCCURRENCE $ 10,000,000 A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ FEIEXS1358803 3/6/2016 3/6/2017 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? C (Mandatory in NH) 911333915 10/1/2016 10/1/2017 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 1,000,000 D Inland Marine 57UUMZC1966 3/6/2016 3/6/2017 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) RECEIVED [SEC 2016 CERTIFICATE HOLDER CANCELLATION T L SHOULD ANY OF THE ABOVE DESCRIBE I C TLED BEFORE To Whom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Dennis Cote/JUBAUT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025/9014011