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CERTIFICATE OF WORKERS' COMPENSATION COVERAGE <br />ACORD DATE,MM/DDIYY) <br />1 <br />,~. 2uo6 <br />zn <br /> THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br />PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br /> THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />llriver Alliant Insurance Services, Inc. COVERAGE AFFORDED BV THE POLICIES BELOW. <br />The Transamerica Pyramid <br />600 Monlgmnery Street, 9dI Floor INSURERS AFFORDING COVERAGE <br />San Francisco, CA 9411 I <br />Phone. (415)403-1400 Fax: (415)402-0773 <br />- <br /> Com ensnuon GrouT <br />INSURER A- NonProfi ts~ United Workers <br />INSURED <br />NsuRER B. Insurance Co oration of Hannover <br />Celitornia Hispanic Commission on Alcohol R Drug Abuse, hlc. INSURER c- <br />2101 Capitol Avenue INSURER D. <br />Sacramento- CA 95816 <br /> INSURER P. <br />COVERAGES Tnis CeniLCete ~s not imanaea m specify an endorsements. coverages, terms conditions and excwsons of the policies shown. <br />EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />THE POLICIES OF INSURANCE LISTED BELOW NAVE BE <br />THER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR MAV <br />ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR O <br />INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />PERTAIN, THE <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />POLICIES <br />T <br />. <br />LIMI <br />S <br />INSR TYPE OFINSURANCE POLICY NUMBER POLICY POLICY <br />EFFECTIVE EXPIRATION <br />LTR <br />DATE MMIOOIYV DATE (MMIODIYV <br /> EACH OCCURRENCE £ <br /> GENERAL LIABILITY <br /> FIRE DAMMGE (Any one tire) $ <br /> COMMERCIAL GENERAL LIABILITY <br /> MED EXPENSE I~aYOne Oerscni $ <br /> CLAIMS MADE OCCUR <br /> PERSONAL & ADV INJURY $ <br /> <br /> GENERAL AGGREGATE $ <br /> <br /> PRODUCTS-COMPIOP AGG S <br /> GE N'L AGGREGATE LIMIT APPLIES PER. <br /> <br /> PRO- <br /> POLICY JECT LOC <br /> <br />AL'TUNOBILE: LNBILITV <br />COMBINED SINGLE LIMIT <br />$ <br /> (Ea accident) <br />$ <br /> ANY AVTO <br /> BODILY INJORV $ <br /> ALL OWNED AUTOS (Per person) $ <br /> SCHEDULED AUTOS <br /> BODILY INJURY $ <br /> HfREO AUTOS <br />~~0.~ ' ) <br />(Per accident) <br />$ <br /> NON-OWNED AUTOS i~ <br />S>S <br /> ~~pp <br />Y PROPERTY DAMAGE 5 <br /> - V ~ <br />~ IPer accioenV <br /> , <br />/. $ <br /> Ji <br /> GARAGE LIABILITY r AUTO ONLY-EA ACCIDEM F <br /> \ {~ N <br />O EA <br /> ANY AUTO ~ <br />t 'L C'~ NLV <br /> `, ~ AUTO O AGG $ <br /> ~~ -. <br /> EXCESS LIABILITY n EACH OCCURRENC 5 <br /> Jf REGATE % <br /> OCCUR CLAIMS MADE ( AGG <br /> \ $ <br /> \ <br /> 5 <br /> DEDUCTIBLE <br /> <br /> RETENTION <br /> WORKERS'COMPENSATION AND WC STATU~ J( OTH- <br />TORY LIMITS ER <br /> EMPLOYERS LIABILITY NPU-WCGOO ?006 2/V2006 1!1!2007 E L. EACH AcaDENT $ 100,000 <br />A E L. DISEASE-EA EMPLOYEE g 500,000 <br /> EL DISEASE-POLICY LIMIT g566A00 <br /> OTHER <br />B Excess' Worker .Compensation H35~740260I 211!2006 1/1!2007 5_5. p00,00f1 x 5500.000 <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIE%CLUSIONS ADDED BY ENDORSEMENTIBPECIALIPROVISIONS <br />Evidence of Cova'age of Workers' Compensation <br />CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> SHOVED ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE <br />NPU-CHC'ADA-OV4 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BVT GAfLURE TO 00 GO SHALL IMPOSE NO <br />City of Sarno Ann <br />UBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER- ITS AGENTS OR <br />Wr OTRtOfCe III VUSInICnI Adminl$lratl On <br />S61[2 ~2Q~ <br />Ane BODIeVeid <br />t <br />I DO6 ) <br />S REPRESENTATIVES. <br />, <br />an <br />a <br />= <br />Santa Ana, CA 92701 AUTHORIZED REPRES ATIVE <br />~~ <br /> n e!-l1RIl rl1RPl1R AT1(l AI tURR <br />ACORD 25-5 (7197) <br />TO. CSG DOGMASTERS CenlGcaie of Liabilirt Insurance ACORD'_5-S.I <br />