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BALCPET-01 KBORN <br /> CERTIFICATE OF LIABILITY INSURANCE DA 1 /5/2021) <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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder In lieu of such endorsement(s) . <br /> PRODUCER License # 0757776 CONTACT <br /> NA <br /> HUB International Insurance Services Inc. PHONE 925 609-6500 FAX <br /> 2300 Clayton Rd IA/C, No, Ext) { �_ No):(925) 609-6550 <br /> •MAIL _. .--.--- --._.._. .. _ _ ____ , .. <br /> Concord, CA 94520 <br /> INSURERS AFFORDING COVERAGE NAIC N <br /> INSURERA : State Compensation Insurance Fund of California ( 35076 <br /> INSURED INSURER B : <br /> Balch Petroleum Contractors & Builders INSURERC : <br /> P.O. Box 361230 INSURER D : <br /> Milpitas, CA 95035 INSURER E : <br /> INSURER F ; <br /> COVERAGES CERTIFICATE NUMBER: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE 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 /> INS TYPE OF INSURANCE ADDL $UBRINSD WV pOLICY NUMBER POLICY EFF POLICY EXPt TA LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE F-1 OCCUR DAMAGE TO RENTED <br /> _EBEMLSESlEa�su>s�tt*.s $ _,. <br /> MED EXP (Anv one Corson $ <br /> PERSONAL & AOVINJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: ( GENERAL AGGREGATE S <br /> POLICY ❑ j T LOC I PRODUCTS - COMPJOPAGG S <br /> OTHER: S <br /> AUTOMOBILE LIABILITY SINGLE LIMIT <br /> C a acdde <br /> ANY AUTO BODILY INJURY,(Perpersgq) __$ <br /> OWNED SCHEDULED f <br /> I <br /> AUTOS ONL <br /> AUTOS <br /> D � BODILYINJURY (Peraemdent) $ <br /> AUTOS ONLY : AUTOS ONLY IPROa�de AMAGE $ <br /> y <br /> UMBRELLA LIAR I OCCUR f EACH OCCURRENCE $ <br /> II <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE <br /> -,� DED .. L �tiRETENTION $ _._ . . 5 <br /> A AND LIABILITY iEE <br /> EMPLOYERCOMPENSATION <br /> STUTE� R <br /> 9039224-2021 1 /1/2021 1 /112022 11000,000 <br /> ANY PRpOPPRIIETgO�RRIPARTNER/EXECUTIVE Y r N N / A 1 E.L. EACH ACCIDENT $ <br /> andetoryiM EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 1 '000,000 <br /> B yes <br /> es; beunder 1 ,000,000 <br /> DESGtRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached it more space Is requlred) <br /> FOR INFORMATION PURPOSES ONLY <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> *FOR INFORMATION PURPOSES ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25 (2016/03) © 19884015 ACORD CORPORATION. All rights reserved . <br /> The ACORD name and logo are registered marks of ACORD <br />