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CERTIFICATE OF WORKERS' COMPENSATION COVERAGE Do, 020, 2012 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br />Nonprofits' United Workers' Compensnuon Group AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />431 1 Street, Suite 200 THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />Sacramento, CA 95814 Phone: (916) 868-6231 COVERAGE AFFORDED BY THE POLICIES BELOW <br />Fax(916)890-5251 <br />Arthur J. Gallagher Risk Management Services <br />One Market Plaza, Spear Street'Power, Suite 200 INSURERS AFFORDING COVERAGE <br />San Francisco, CA 94105 <br />INSURED INSURER A: Nonprofits' United Workers' Compensation Group <br />Association for Retarded Citizens Mid-Cities INSURER B: Safety Natl Cas Corp [NAIL d 151051 <br /> <br />14208 Towne Ave. -- <br />Los Angeles, CA 90061 INSURER C: <br /> INSURER D: <br /> INSURER E: <br />COVERAGES This Certificate is not intended to specify all endorsement s, coverages, terms, conditions and exclusions of the policies shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />OR CONDITION OF ANY CONTRACTOR OTHER DOCU <br />TERM <br />ANY REQUIREMENT MENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />, <br />, <br />COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS <br />SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF COVERAGE <br />POLICYNUMBER POLICY <br />EFFECTIVE DATE POLICY <br />EXPIRATIONDATE <br />LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ <br /> CLAIMS MADE OCCUR MED EXPENSE (Any one person) $ <br /> <br /> GEN ERAL AGGREGATE LIMIT APPLIES PER; PERSONAL B AOV INJURY $ <br /> POLICY PROJECT LOC GENERAL AGGREGATE $ <br /> <br /> PRODUCTS-COMPIOP AGO $ <br /> L <br />TY COMBINED SINGLE LIMIT $ <br /> AUT OMOBILE LIABI <br />I h.ecke <br />t <br />E <br /> ANY AUTO ac <br />n <br />( $ <br /> <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS (Par person) $ <br /> <br /> HIREDAUTOS BODILY INJURY <br />dd $ <br /> NON-OWNED AUTOS i <br />Fwae $ <br /> <br /> PROPERTY DAMAGE <br />d $ <br /> (Perac <br />i $ <br /> WC STAT <br />LIMITS X <br />OTHER <br /> WORKERS' COMPENSATION <br />U <br />1/1/14 :.L. EACH ACCIDENT $ 500,000 <br />A AND <br />EMPLOYERS LIABILITY E.L. DISEASE-Ea EMPLOYEE $500,000 <br /> t E.L. DISEASE-VFRAGE LIMIT $500,000 <br /> <br />13 COVER <br />GBCCSS Workers' Compensation <br />1/1/14 <br />$100,000,000 X $500,000 WC <br /> $2,000,000 x $500,000 EL <br />DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIALIPROVISIONS <br />Bvicienec of Workers' Compensation Coverage: Waiver of SU6rogation provided by Endorsement No. NPUWCG-ARCMIDC-035 <br />CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER : CANCELLATION <br />APP OV?,D <br />D <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE <br /> BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED <br />i <br />Ana <br />City <br />? IN ACCORDANCL WITH THE POLICY PROVISIONS. <br />O f <br />le C <br />Clerk of the City Council ?...>? <br />- <br />eedY <br />i <br />, <br />tt <br />20 Civic Center Plaza Laura St <br />PO Box 1988 Assistant City, Attorney <br />CA9„702-1983 <br />SanhrAna ,? - <br />, <br />Based on ACORD 25 (2009109)