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AC V CERTIFICATE OF LIABILITY INSURANCE r
<br /> TE (MMDD/YYYY)
<br /> �/ 3 / 3 / 2020
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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( les) 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 not confer rights to the
<br /> certificate holder in lieu of such endorsement(s) .
<br /> PRODUCER CONTACT NAME: Shala Pearson
<br /> Leavitt United Insurance Services , Inc , PHONE o t • ( 925 ) 395 - 2600 FAX ( 925 ) 287 - 0710
<br /> A/C, No
<br /> CA License # OJ02939 ADDRESS: shala - pearson@leavitt . com
<br /> 2358 Maritime Dr , Ste 100
<br /> INSURERS AFFORDING COVERAGE NAIC #
<br /> Elk Grove CA 95758 INSURER A : Admiral Insurance Company 24856
<br /> INSURED '
<br /> INSURER B : Travelers Property CasualtyCompany , 36161
<br /> Walton Engineering , Inc . INSURER C : State Compensation Insurance Fund 35076
<br /> P . O . Box 1025
<br /> INSURER D :
<br /> INSURER E :
<br /> West Sacramento CA 95691 INSURER F :
<br /> COVERAGES CERTIFICATE NUMBER: 20 - 21 Master REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS ,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ,
<br /> INSR ADDL SU BR LTR TYPE OF INSURANCE CY EFF POLICY EXP
<br /> VVVn POLICY NUMBER MM DI D/YYYY MM/DD/YYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY
<br /> EACH OCCURRENCE $ 11000 , 000
<br /> A CLAIMS-MADE a OCCUR DAMAGE TO RENTED
<br /> PREMISES Ea occurrence $ 50 , 000
<br /> X Pollution Liability P8I8CC1358706 3 / 6 / 2020 3 / 6 / 2021 MED EXP (Any one person) $ 5 , 000 '..
<br /> X Professional Liability PERSONAL & ADV INJURY $ 1 , 000 , 000
<br /> GENIAGGREGATE LIMITAPPLIES PER:
<br /> POLICY a E
<br /> GENERAL AGGREGATE $ 21000 , 000
<br /> JCOT- LOO
<br /> PRODUCTS - COMP/OPAGG $ 21000 , 000 '.
<br /> OTHER: $ '..
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident y 1 , 000 , 000
<br /> _
<br /> B ALL OWNED SCHEDULED X ANY AUTO 8108L785302 BODILY INJURY (Per person) $
<br /> AUTOS AUTOS 3 / 6/ 2020 3 / 6 / 2021 BODILY INJURY (Per accident) $
<br /> X HIREDAUTOS X AUTOS NON-OWNED PROPERTY DAMAGE
<br /> AUTOS Per accident $
<br /> Uninsured motorist combined single $ 1 , 000 , 000
<br /> UMBRELLA LIAB OCCUR
<br /> EACH OCCURRENCE $ 10 , 000 , 000
<br /> A X EXCESS LIAB HCLAIMS-MADE AGGREGATE
<br /> $ 10 , 000 , 000
<br /> DED I X I RETENTION $ 0 FEIEXS1359806 3 / 6 / 2020 3 / 6/ 2021 $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS' LIABILITY Y / N X STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
<br /> C (MandatoryOFFICERIMin H) EXCLUDED? yy N / A $ -_ 1 , 000 , 000
<br /> (Mandatory b un 9113339 10 / 1 / 2019 10 / 1 / 2020
<br /> E.L. DISEASE - Fla EMPLOYEE $ _ 1 , 000 , 000
<br /> If yes, describe under '.
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ i , 000 , 000
<br /> B Inland Marine QT6608X816207 3 / 6 /2020 3 / 6 /2021 Limn $ 300 , 000
<br /> Leased , Borrowed , Rented Deductible $ 2 , 500
<br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached if more space�fs required)
<br /> Where required by written contract , Certificate Holder is Additional Insured with respects to the General
<br /> Liability per attached policy endorsement form CG203707041 and with respects to the Auto , Additional
<br /> Insured with Waiver of Subrogation and Primary and Noncontributory clauses apply when required by written
<br /> contract per attached endorsement forms CAT3530215 and CAT4740216 . General Liability insurance is Primary
<br /> and Noncontributory where required by written contract per attached endorsement form ECC5480712 . A
<br /> separate Designated Construction Project General Aggregate Limit applies to each designated construction
<br /> project of the Named Insured when agreed to and required under written contract per attached endorsement
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> To Whom it May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> AUTHORIZED REPRESENTATIVE
<br /> Shala Pearson/ SHFRED - _
<br /> © 1988-2014 ACORD CORPORATION . All rights reserved .
<br /> ACORD 25 (2014/01 ) The ACORD name and logo are registered marks of ACORD
<br /> INS025 (201401)
<br />
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