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?? BACKTON-01 PATRA4 <br />CERTIFICATE OF LIABILITY INSURANCE °ATE`MYYY' <br />1 1 0/5//2012012 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER - ? - CONTACT <br />NAME: <br />Chapman PHONE FAX <br />a Division of Arthur J. Gallagher S Co. (A/c, No, E.1): 1 (626) 405-803.1 (A/c, No): 1 (626) 405-0585 <br />Insurance Brokers of California, Inc. EMAIL- I - <br />PO Box 54$$ ADDRESS <br />Pasadena, CA 91117-0455 INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER A Nonprofits' Insurance Alliance of California 011845 <br />INSURED INSURER B New York Marine and General Insurance Company f 16608 <br />Back to Native Restoration INSURER C 1 <br />PO BOX 6539 INSURER D : <br />III Irvine, CA 92612-6539 <br />INSURER E : ' <br />EXCLUSIONS AND LIABILITY CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFO RDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS <br />' <br /> , <br />r <br /> <br />INSR TYPE OF INSURANCE <br />POLICY NUMBER <br />NsR <br />II <br />POLICY EFF POLICY E%P <br /> <br />LIMITS <br />I <br />(MM/DDmril {MM/DD/YYYY) I <br />I <br />I <br />EAC <br />H <br />RRE <br />OCCU <br />NCE <br />s 1,000,000 <br />ODO <br />? <br /> <br />201221765N PO <br />A X I COMMERCIAL GENERAL LIABILITY <br />R <br />j 1 1 <br />0/1/2012 <br />0/1/2013 P <br />e <br />MSES <br />E <br />OE <br />$ 500 <br />000 <br />f aoccu <br />nce) <br />R <br />. <br />{ <br />CLAIMS-MADE <br />X OCCU ME <br />D <br />EXP A <br />n <br />one <br />erson <br /> PERSONAL 8 ADV INJURY 5 1,000,000 <br />` <br /> II <br />GENERAL AGGREGATE t $ 2,000,000 <br /> <br />'L AGGREGATE <br />SPER <br />APPLI E <br />GE I <br />I PRODUCTS-COMP/OP AGG S 2,000,OOO <br />? <br />ECT <br />POLICY PRO ' <br />LOC L_-. <br />-- - _ $ <br />i <br />-- - <br />- - - <br />AUTOMOBILE LIABILITY <br />' COMBINED SINGLE LIMIT 1 <br />I <br />1 <br />1 <br />000 <br />0001 <br /> , <br />, <br />Ea acclaenl <br />$ <br />A ANY -ro 201221765N PO 1011/2012 10/1/2013 BODILY INJURY(Perperson) $ <br />ALL OWNED <br />SCHEDULED <br /> <br />AUTOS AUTOS 1 BODILY INJURY (Per acc d-) 5 <br />X HIRED AUTOS X NON-OWNED <br />AUTOS PROPERTY DAMAGE ! $ <br /> <br />? <br />UMB REL -L. <br />EXCESS ABLIAR <br />% - <br />O - - _ - EACH OCCURRENCE $ <br />I <br />C <br />LAIMSMADE <br />DED a RETENTION b 1 <br />AGGREGATE $ <br />$ 1 <br />WORKERS COMPENSATION WC STATU OTH <br />AN EMPLOYERS' LIABILITY <br />YIN TORY LIMITS I ER <br /> <br />B A <br /> <br /> <br />-I WC201100000404 <br />NY <br />VE <br />u <br />OFF1 <br />xcLU EXCLUDED? <br />N/A <br /> <br /> <br /> <br />0/2612011 <br />10/26/2012 <br />E.L EACH <br />CC <br />IDENT <br />f <br />' <br />, <br />oµ <br />1 <br />M-d- <br />N <br />H <br />n <br />ry I EL DI EASE <br />1,000,0001 <br />EM <br />? <br />$ <br />Ibe <br />r <br />,ae< <br />S <br />ON OF OPERATIONS e <br />ESCRIP <br />- E.L DIS EASE <br />1 <br />POLICY <br />LIMIT <br />$ <br />000 <br />00 <br />` <br />A 1ABUSE <br />201 2 21 76 5NPO _ <br />10/1/2012 10/1/2013 ?Occurence/Aggregate <br />1,000,000 <br />II <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Aft- 1 <br />ACORD 'IOt, Atltlltional Remarks Scb¢tlul¢, if more space is r¢qulr¢tl) <br />nR <br />I <br />Evidence of Coverage. g <br />Fo 1 y i <br /> T <br />g'S <br />? <br /> pV£D <br /> A4Yg <br /> C ?`yGK <br /> Attorney <br />L\SF* E' <br />t` <br /> G\ <br />J <br />`t <br /> sistar <br />CERTIFICATE HOLDER S <br />CANCELLATION P <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC LLED BEFORE <br />Evidence of Coverage IC <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> I <br />ACCORDANCE WITH THE POLICY PROVISIONS. 1 <br /> AUTHORIZED REPRESENTATIVE <br /> <br /> © 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD