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AC40 ® F7ATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/22/2021 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(les) must have ADDITIONAL INSURED provisions or 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 NAME: ACW GROUP, LLC dba. AKAMINE CHRISTMAN WALL INSURANCE PHONE C No, o Ext):760-485-3710 N,; 760-262-3673 79-220 CORPORATE CENTER DR., SUITE 102-F E-MAIL ADDRESS: acro osns w u ADDRESS: � 9 P•com LA QUINTA, CA 92253 INSURERS AFFORDING COVERAGE NAIC# INSURERA: U.S. SPECIALTY INSURANCE COMPANY INSURED INSURER B: State Compensation Insurance Fund WEST COAST EXPLORATION, INC INSURERC: INSURER D: P.O. BOX 133 INSURER E ESCALON CA 95320 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY X U19AC81810-06 04/26/21 04/26/22 EACH OCCURRENCE $ 1,000,000 F_V_1 CLAIMS-MADE OCCUR DA AGE ToRENE�D PREM SES Ea occur encs $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, x POLICY ElPRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PRO PER'$ Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE 9282808-2020 09/01/21 09/01/22 X PER O H- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDE[ ❑ (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below T 7 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) San Joaquin Environmental Health Department, has been Additional Insured per the attached endorsement for work performed on behalf of the named insured as required by way of written contract. Note: Additional Insured status is subject to all policy terms, conditions and exclusions. r CDTICIr`ATC unl nGD RANCFI I OTION San Joaquin Environmental Health SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1868 E Hazelton Ave, ACCORDANCE WITH THE POLICY PROVISIONS. Stockton, CA 95205 AUTHORIZED REPRESENTATIVE V 191St$-LU19 AC:UKU L;UMVUH:A I IUN. An rlgntS reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD