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THIS CFRTIFIOATF IC ISSI IFO AS A MATTFR OF INFORMATION ONI V Awn CnNFFRS NO RIr wTR IIPfIN THE CFRTIFICATF HOI OFR TNIC OP ID: PC ACp/2p° `� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDN —'? ) 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 626405 -0585 License #0522024 P. O. Box 5455 Pasadena, CA 91117.0455 CONTACT PHONE FAX olio ac No E -r ADDRESS: PRODUCER BACKT -1 T MER, INSURER(S) AFFORDING COVERAGE NAIC# INSURED Back to Natives Restoration INSURER A: New York Marine and General EACH OCCURRENCE PO Box 6539 Irvine, CA 92612 -6539 INSURER B: S INSURER C COMMERCIAL GENERAL LIABILITY INSURER D: INSURER E: MED EXP (Any one person) INSURER F: CLAIMS -MADE El OCCUR 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 POUCYNUMBER POLICY EFF MMIp POLICY EXP MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurrence S COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) S CLAIMS -MADE El OCCUR PERSONAL B ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOPAGG S POLICY PRO- LOC JECT S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acgdent) S ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per acgdent) IS SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) S $ NON -OWNEDAUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LAS I CLAIMS -MADE DEDUCTIBLE S E RETENTION S A PL COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER /EXECUnVE OFFICERIMEMBER EXCLUDED? NIA WC201100000404 10126111 10126/12 ( A OTH - TORY E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE S 1,000,00 (MSndetory In NH) Ilyea,desr+lbe OFF DESCRIPTION OF OPERATIONS belay E.L. DISEASE- POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addleonal Remarks ScAedule, R more space Is required) Re: Application Fee # 20100119693. CERTIFICATE HOLDER CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED nREPRESENTATIVE © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD