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�� BACKTON -01 PATRA4 CERTIFICATE OF LIABILITY INSURANCE °ATE `M YYY' 1 10/5/2012 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 - - NAME: T NAME: Chapman PHONE FAX a Division of Arthur J. Gallagher S Co. (A /c, No, E.p: 1 (626) 405 -8031. (A /c, No): 1 (626) 405 -0585 Insurance Brokers of California, Inc. E MAIL- _ _ I - PO Box 54$$ ADDRESS __ _ Pasadena, CA 91117-0455 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A Nonprofits' Insurance Alliance of California 011845 INSURED INSURER B: New York Marine and General Insurance Company f 16608 Back to Native Restoration INSURER C 1 PO BOX 6539 INSURER D: III Irvine, CA 92612 -6539 - - -- _- - INSURER E: ' 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, ' LTR TYPE OF INSURANCE POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EXCLUSIONS AND CONDITIONS OF SUCH IIIr CLAIMS -MADE f X OCCUR �SUBR - _ � POLICY EFF POLICY E %P PREMISES {OEa occu ence) $ 500.000 GENERAL LIABILITY POLICY NUMBER (MM /DDmril {MM /DD/YYYY) I MED EXP An one erso LIMITS 20 I n S 000 INSR ADD A X I COMMERCIAL GENERAL LIABILITY NsR 201221765N PO j 10/1/2012 � 10/1/2013 EACH OCCURRENCE I � 1,000'ODO PERSONAL 8 ADV INJURY 5 1,000,000 GE POLICY PRO ' III` GENERAL AGGREGATE t $ 2,000,000 AGGREGATE APPLI E SPER I PRODUCTS- COMP /OP AGG S 2,000,OOO �'L ECT LOC L_ -. -- - $ - - - i AUTOMOBILE LIABILITY ' _ I -- - COMBINED SINGLE LIMIT 1 1 1,000,000 Ea acclaenl $ A ANY —ro 201221765N PO 1011/2012 10/1/2013 BODILY INJURY(Perperson) $ ALL OWNED SCHEDULED AUTOS AUTOS 1 BODILY INJURY (Per acc d—) 5 X HIRED AUTOS X NON -OWNED _ _.. AUTOS _ _ PROPERTY DAMAGE ! $ UMBREL LA LIAR % - J - - _ - EACH OCCURRENCE $ I� COLAIMS MADE EXCESS L.AB DED a RETENTION b 1 _. AGGREGATE $ ,_.._ $ 1 WORKERS COMPENSATION WC STATU OTH ANY EMPLOYERS' LIABILITY YIN __ TORY LIMITS I ER WC201100000404 N/A B AESCRIPn 1D/26/2011 10/26/2012 �rH,ae<xcLU EXCLUDED? 1 f EL DI EASE CEA EM $ � ON OF OPERATIONS euoµVE - ` E.L DIS EASE LIMIT $ 1'000,00 A ABUSE 201 2 21 76 5NPO _ 10 10/1/2012 10/1/2013 �Occurence /Aggregate 1,000,000 III DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Aft— 1 ( ACORD 'IOt, Atltlltional Remarks Scb¢tlul¢, if more space is r¢qulr¢tl) ,Evidence of Coverage. gnR TFo PIS � A4YgpV£D CORGK Attorney CERTIFICATE HOLDER CANCELLATION P Ssistar`t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC LLED BEFORE Evidence of Coverage ICI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1 AUTHORIZED REPRESENTATIVE © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD