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co CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />I CONT
<br />PRODUCER Owen -Dunn Insurance Services NAMEACT
<br />1455 Response Road, Suite 260 PHONE FAx
<br />Sacramento, CA 95815 'Ai!C E..!t. (91619,93-2700 fvc, No). (916,) 993 2s8:
<br />A-2016-241 E MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />0522677Insurance
<br />11
<br />INSURER ComppanyyLTD 11000
<br />INSURED
<br />INSURED
<br />Associates, LLC
<br />INSURER B TfUm 1
<br />InSUf-. ance Com an 27120
<br />David DeROOs
<br />INSURER C Land mark Am f
<br />mark -American Insurance Company 33138
<br />2250 E. Bidwell St. #100
<br />INSURERD.
<br />Folsom CA 95630
<br />�.
<br />COVERAGES CERTIFICATE NUMBER; 34333104
<br />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
<br />PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY
<br />CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
<br />THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY
<br />THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />�ADDL SUER
<br />1LTR
<br />... ............................ .
<br />EFF EXP
<br />—__
<br />TYPE OF INSURANCE POLICY NUMBER
<br />„ (MM/DDPOLICY
<br />LIMITS
<br />I (MM/DD YYYY)YYYY)
<br />/
<br />A ✓ I COMMERCIAL GENERAL LIABILITY 57SBAAZ1255
<br />7/15/2016 7/15/2017 EACH OCCURRENCE S
<br />2,000,000
<br />i.
<br />CLAIMS -MADE OCCUR
<br />✓
<br />DAMAGE To RENTED
<br />PREMISES (Ea arcurrenceJt 5
<br />1,000,00C
<br />✓ Deductible - $0 ... '
<br />MED EXP (Any one person) 5 .....
<br />10,000
<br />........ .....
<br />V
<br />PERSONAL & ADV INJURY S
<br />2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $
<br />........
<br />4,000,000
<br />PRO.
<br />POLICY ✓ ...
<br />JECT l -0C
<br />COMP/OP S
<br />. ......
<br />4,000 000
<br />... .. _,_
<br />OTHER:
<br />I 4 S
<br />Employee
<br />50,000
<br />A
<br />AUTOMOBILE LIABILITY
<br />57SBAAZ1255
<br />7/15/2016 7/15/2017
<br />LIMIT
<br />5
<br />I
<br />jEa acct deDttSINGLE
<br />,,,,,,,,,,,,,,
<br />2„,,000 000
<br />ANY AUTO
<br />BODILY INJURY (Per person) S
<br />OWNED SCHEDULED
<br />. AUTOS ONLY ........ AUTOS
<br />-.-- ......... ...,,_, -
<br />BODILY INJURY (Per accident) S
<br />HIRED NON -OWNED i
<br />�✓...._ AUTOS ONLY �. a` AUTOS ONLY f
<br />PROPERTY DAMAGE
<br />jPar accident r S
<br />....._
<br />J
<br />is
<br />A
<br />I e/ UMBRELLA LIAB _✓ OCCUR
<br />157SBAAZ1255
<br />7/15/2016 7/15/2017
<br />EACH occURRENCE
<br />S
<br />4,,000 00,0
<br />EXCESS LIAB CLAIMS -MADE
<br />AGGRE LATE
<br />S
<br />4,000,000
<br />✓
<br />DED J RETENTION S 10,000 1
<br />$
<br />B
<br />WOR KERS COMPENSATION
<br />57WECEU6620
<br />10/1/2016 10/1/2017
<br />PER OTH
<br />ER
<br />AND EMPLOYERS' LIABILITY.
<br />ANYPROPRIETOR(PARTNER(EXECUTIVE Y/N
<br />STATUTE
<br />1,,,000,000
<br />ER EXCLUDED? NIA
<br />E.L. EACH ACCIDENT
<br />$
<br />(Mandatory in
<br />`(Mandatory m NHJ
<br />E„L DISEASE - EA EMPLOYEE'S
<br />00�..
<br />If yes. describe under
<br />....1,2000
<br />DESCRIPTION OF OPERATIONS below
<br />E L. DISEASE - POLICY LIMIT
<br />o-$
<br />1,000,000
<br />C Professional Liability LHR831359
<br />2/14/2017 2/14/2018 Aggregate: 2,000,000
<br />Each Claim: 2,000,000
<br />Deductible: $10,000 each claim
<br />....... ..__ ...
<br />Retro Date: 1/6/1999
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: UASI Training Services County of Alameda, its Board of Supervisors, the individual members thereof, and all County Officers, agents, employees
<br />and
<br />representatives are included as additiional insureds as per endorsement attached.
<br />CERTIFICATE HOLDER CANCELLATION
<br />Count Of Alameda Sheriff's Office SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Office Of Emergency Service & Homeland ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Security
<br />4985 Broder Blvd
<br />Dublin CA 94568 AUTHORIZED REPRESENTATIVE
<br />__-- Kerryn Bieg ®e
<br />O 1988-2015 ACORD CORPORATION.
<br />rhts reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />'I r,i J I i v. m I I yllie1 d' ”, P , . r 'i, . — I. I Qy" , , .w e ” 2'. , I .. A r " 16 2 Q A ": (A I' '"4 a,.
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