BACK TO NATIVES RESTORATION (BTN) (2) -2011

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BACKTON -01 PATRA4 AcoR °° CERTIFICATE OF LIABILITY INSURANCE DAT 1015/2015/20IYYYY,- 12 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 Chapman a Division of Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. PO Box 5455 CONTACT NAME: PHONE FAX AIC No, E.t):1 (626) 405 -8031 Arc, Yo l: 1 (626) 405 -0585 nDDRIESS: — GENERAL LIABILITY Pasadena, CA 91117 -0455 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Nonprofits' Insurance Alliance of California 011845 EACH OCCURRENCE INSURED INSURER B: New York Marine and General Insurance Company 16608 INSURER C Back to Native Restoration INSURER D: _ 10/1/2013 PO Box 6539 Irvine, CA 92612 -6539 INSURER E: CLAIMS -MADE a OCCUR INSURER F: 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 IN WVD POLICY NUMBER POLICY EFF MMIDDIYYW POLICY EXP MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 20122176SNPO 10/1/2012 10/1/2013 PREMISES Ea Occurrence $ CLAIMS -MADE a OCCUR MED EXP (Any one person) $ 20,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: F - -� - PRODUCTS - COMP /OP AGG -- --t-$_ $ — 2,000,000 L ..__ -1 - -� PRO- POLICY JECT LOC — J -- --= _ _ i I AUTOMOBILE LIABILITY ( COMBINED SINGLE LIMIT Ea accident $ 1,000,OOOi A _ — � ANY AUTO 201221765NPO 10/1/2012 10/1/2013 BODILYINJURY (Perperson) -- $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident - _ $ $ i �____A X ALL OWNED II 1 SCHEDULED AUTOS r—� NON OWNED HIREDAUTOS X AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ S _ WORKERS COMPENSATION WC STATU- OTH- T DRY LIMIT R B AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNERIEXECUTIVE YIN F-7 OFFICER /MEMBER EXCLUDED? N/A WC201100000404 10/26/2011 10/26/2012 E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory ry in NH) E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below _ A ,ABUSE 201221765NPO 1011/2012 101112013 Occurence /Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) i Evidence of Coverage. �a 10 �r D K Oix rrey CA); TE HOLDER Evidence of Coverage CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEtLLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD