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C(^)REY CERTIFICATE OF LIABILITY INSURANCE DATE {M UDwwYn
<br />05/3112012
<br />HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />ERTIF'CATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />EPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
<br />PORTANT: It the certificate holder is an ADDITIONAL INSURED, the pollcy(Ies) must be endorsed. It SUBROGATION IS WAIVED, subject to
<br />a terms and condlllons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />rtillcate holder In lieu of such endorsemerl(s).
<br />LACER Mane: (826) 30C9000 Fast (620)570-0908
<br />W CENTURY INS SERVICES, INC.
<br />_
<br />COyE^CT NEW CENTURY INS SERVICES, INC,
<br />PWNE (626) 300.9000 IFZA (626) 670.0908
<br />N. 2ND ST.
<br />HAMBRA CA 91801
<br />E.MAu Info®uancl.com
<br />P�WOER
<br />r ME 1 15724
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC0
<br />Agency UO: 0607085
<br />wo
<br />T, INC.
<br />I BONNIE CIRCLE, SUITE 101A & 102
<br />IRONA, CA 92880
<br />INSURERA , GOLDEN EAGLE INSURANCE CORP
<br />INsuREns . NATIONAL UNION FIRE INS COMPANY
<br />IN,,REgc ZURICH INSURANCE COMPANY
<br />INSURER 0:
<br />IN6VAERE
<br />INSUFIERF
<br />IVERAGES CERTIFICATE NUMBER: R7914 REVISION NUMBER:
<br />HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />4DICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />:ERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />r TYPE OF INSURANCE
<br />�
<br />SLBN
<br />POLICY NUMBER
<br />POLICYaPP
<br />MUCYW
<br />LIMITS
<br />DaNeRN. LIABILITY
<br />CBP8283936
<br />05131112
<br />06131M3
<br />EACH OCCURRENCE
<br />$ 1,000,p00
<br />X COMMERCIAL GENERAL LIABILITY
<br />DNAAOETO RENTED �,
<br />ra1E41Ee� n„ce
<br />s 500,66o
<br />OIAIMSMAOE I X IOCOUR
<br />MED. EXP(My one peraoc
<br />s 10,000
<br />PERSONAL a AOV INJURY
<br />IS 1,000,000
<br />GENERAL AGGREGATE_
<br />S 2,000,000
<br />GENT AGGREGATE LI MIT APPLIES PER:
<br />j PRODUCTS - COMPIOPAGG
<br />_
<br />§ 2,0001000
<br />POLICY EO LOC
<br />AUrosoBlLe LUAarry
<br />— BA2442759
<br />02122/12
<br />02/22/13
<br />COMBINED SINGLE LIMIT
<br />(Ea acclddOr)
<br />§ --
<br />§ 1,000,000
<br />X ANY AUTO
<br />BODILY INJURY (Per peracn)
<br />S
<br />ALLOWNEDAUTOS
<br />jij
<br />BODILY INJURY(P., accidenp
<br />S
<br />SCHEDULEDAUTOS
<br />PROPERTY DAMAGE
<br />HIREDAUTOS
<br />(Par awdenl)
<br />IS
<br />NON OWNED AUTOS
<br />S
<br />AR
<br />XL�ppR
<br />8
<br />1 17411
<br />11/04/12
<br />EACH OCCURRENCE
<br />4,000,0007
<br />AGGREGATE
<br />4,000,000
<br />ExcEsO LIAa CLAIMS -MADE
<br />OLE
<br />_
<br />RETEEOUCTIB, If
<br />WORNEaa COMPENSATI)d
<br />4007748
<br />02106/12
<br />02/06/13
<br />X UTH
<br />i BY IIMR
<br />§
<br />AND EMPLOYERS• LIAe,LNY YIN
<br />ANY PROPRRTOWFIVYNEMExECUnVC r
<br />E.L. EACH ACCIDENT
<br />S 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />S 1,000,000
<br />0"ICEMEMBER EXOLUodor _ t
<br />(Mand.tW IN 0)
<br />N(A
<br />E.L. DISEASE -POLICY LIMIT
<br />§ 1,000,000
<br />IY4bMrAnu r
<br />OESCRIPTIONOFOPERATICNSM
<br />1
<br />OCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACOAD 101, AddlNOntl Remarks Schedule, If marespace la required)
<br />a insurer will not Cancel the insured's coverage without 30 days prior written notice to the State. The State of California, its officers,
<br />ants, employees, and servants are included as additional Insured, but only Insofar as the operations under this Contract are
<br />Tcerned.
<br />iRTIFICATE HOLDER CANCELLATIONS
<br />Department of Rehabilitation
<br />Business Enterprises Program (BEP)
<br />Vending Machine Unit (VMU)
<br />721 Capitol Mall, 5th Floor
<br />Sacramento, CA 95814
<br />(V6))r 558.5345 Fax (916) 658.8347
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUh WQED REPREBENrAT,VE
<br />The ACORD name and logo
<br />
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