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OP ID: PC "�k"`� CERTIFICATE OF LIABILITY INSURANCE DAT11108DIYYYY) EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 11/08/11 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(ies) must 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 626 -405 -8031 Chapman 626 -405 -0585 License #0522024 P. O. Box 5455 Pasadena, CA 91117 -0455 CONTACT NAME: PHONE FNC No: EMAIL ADDRESS: PRODUCER BACKT -1 T M R to, INSURER (S) AFFORDING COVERAGE NAIL e I a � INSURED Back to Natives Restoration INSURERA: New York Marine and General PO Box 6539 Irvine, CA 92612 -6539 INSURER B: S INSURER C: S INSURER D: COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR INSURER E INSURERF: MED UP (Any one person) S COVERAGES CERTIFICATE NUMBER- REVICIOM MI AMBER: 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractors State License POLICY NUMBER MMIDO� POLICY UP LIMITS P.O.Box 26000 GENERAL LIABILITY I a � EACH OCCURRENCE S PREMISES Ee occurrence S COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR MED UP (Any one person) S PERSONAL SADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO E POLICY PRO- LOC C. E AUTOMOBILE LIABILITY ANY AUTO ` i " ,yn/,I COMBINED SINGLE LIMIT (Ea arrAdenQ E BODILY INJURY (Per parson) S ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS `i.to hii h t "'I BODILY INJURY (Per a¢ident) S PROPERTY DAMAGE (PeraWdent) S S NON - OWNEDAUTOS S UMBRELLA LIM OCCUR EACH OCCURRENCE S AGGREGATE E EXCESS LIAR CLAIMS -MADE DEDUCTIBLE $ S RETENTION S A WORKERS COMP NSATION AND EMPLOYERS. LIABILITY ANY PROPRIETORIPARTNEILEXECUTIVE YIN EXCLUDED? F7 NIA WC201100000404 10/26/11 10/26/12 X TMC STATIU- N E.L. EACH ACCIDENT',' —` $ N 1,000,00 E.L. DISEASE -EA EMPLOYE S � 1,000,00 (Mandatory In NH) 9gs.dtoryln and D SCRI ON under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S co 1,000,00 U DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Adeltbnal Remarks Schedule, H mom spa" Is required ) Re: Application Fee # 20100119693 a IV CERTIFICATE HOLDER CANCELLATION " CONTRAB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractors State License ACCORDANCE WITH THE POLICY PROVISIONS. Board AUTHORU:ED REPRESENTATIVE P.O.Box 26000 . Sacramento, CA 95826 I a � ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD