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ACCP CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)
<br /> 3 / 3 /2020
<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 not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACTShala Pearson
<br /> NAME:
<br /> Leavitt United Insurance Services , Inc . PHCN u E , ( 925 ) 395 -2600 FAX No : ( 925 ) 287-0710
<br /> CA License # OJ02939 E-MAIL shala -pearson@leavitt . com
<br /> ADDRESS:
<br /> 2358 Maritime Dr , Ste 100 INSURERS AFFORDING COVERAGE NAIC #
<br /> Elk Grove CA 95758 INSURERA : Admiral Insurance Company 24856
<br /> INSURED INSURER B : Travelers Property Casualty Company , 36161
<br /> Walton Engineering , Inc , LINSURER
<br /> URERC : State Compensation Insurance Fund 35076
<br /> P . O . BOX 1025 URER D :
<br /> E :
<br /> West Sacramento CA 95691 URERF :
<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 SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS '..
<br /> X COMMERCIAL GENERAL LIABILITY 11000 , 000
<br /> EACH OCCURRENCE $
<br /> A CLAIMS-MADE ❑X PREMISESS
<br /> OCCUR DAMAGE REMISES
<br /> 50 , 000
<br /> PREMIEa occurrence $
<br /> X Pollution Liability FEIECC1358706 3 / 6/2020 3/ 6/2021 MED EXP (Any one person) $ 5 , 000 '..
<br /> X Professional Liability PERSONAL & ADV INJURY $ 11000 , 000 '...
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 21000 , 000 ',..
<br /> POLICY a PESLOC 21000 , 000 '..
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 , 000 , 000
<br /> Ea accident
<br /> B X ANYAUTO BODILY INJURY (Per person) $
<br /> ALL OWNED SCHEDULED 8108L785302 3 / 6/2020 3 / 6/2021 BODILY INJURY (Per accident) $
<br /> AUTOS AUTOS
<br /> X X NON-OWNED PROPERTY DAMAGE $
<br /> HIREDAUTOS AUTOS Per accident
<br /> Uninsured motorist combined single $ 11000 , 000
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10 000 000
<br /> A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10 , 000 , 000
<br /> DED X RETENTION $ 0 FEIEXS1358806 3/ 6 /2020 3 / 6 /2021 F $
<br /> WORKERS COMPENSATION X, PER OTW
<br /> STATUTE ER
<br /> AND EMPLOYERS' LIABILITY Y / N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 11000,o00
<br /> C (Mandatory toMEn NH MBER EXCLUDED? NIA 9113339 10/ 1 /2019 10 /1 /2020
<br /> ( rY � ) E.L. DISEASE - EA EMPLOYEE $ 1 , 000 000
<br /> If yes, describe under
<br /> DESCRIPTION OF OPERATIONS below E,L, DISEASE - POLICY LIMIT $ 1 000 , 000
<br /> B Inland Marine QT660SK816207 3/6 /2020 3/6 /2021 Limit $ 300 , 000
<br /> Leased , Borrowed , Rented Deductible $2 , 500
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached if more space is required)
<br /> Where required by written contract , Certificate Holder is Additional Insured with respects to the General
<br /> Liability per attached policy endorsement form CG20370704 ; 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 / SHFREDf- -
<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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