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-� oP ID• Pc <br />ACC ►R p DATE (MM /DDM� 17 <br />�- CERTIFICATE OF LIABILITY INSURANCE 11/08/11 <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 626 -405 -8031 CONTACT <br />NAME: <br />Chapman 626- 405 -0585 PHONE FAX <br />License #0522024 Ar A/C No <br />E- <br />P. O. Box 5455 ADDRESS: <br />PRODUCER gACKT -1 <br />Pasadena, CA 91117 -0455 CUSTOMER ID #: <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Back to Natives Restoration INSURER A: New York Marine and General <br />PO Box 6539 INSURER B <br />Irvine, CA 92612 -6539 <br />INSURER C <br />INSURER D <br />INSURER E: <br />_ <br />INSURER F <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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR POLICY EFF POLICY EXP <br />LTR TYPE OF INSURANCE POLICY NUMBER MM/D MM /DD LIMITS <br />GENERAL LIABILITY EACH OCCURRENCE $ <br />COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ <br />CLAIMS -MADE = OCCUR MED EXP (Any one person) $ <br />PERSONAL 8 ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ <br />POLICY PF RO- <br />T LOG <br />Irr{uN I C Rvl_I..ICR l.ArvI.CL.LA 1 IVIV <br />EVIDENC <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Evidence Of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1958 -2009 ACORD CORPORATION. All rights reserv <br />ed. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />$ <br />$ <br />AUTOMOBILE L <br />LIABILITY C <br />10/26/11 1 <br />10/26/12 E <br />COMBINED SINGLE LIMIT $ <br />$ <br />BO a <br />$ <br />BODILY INJURY (Per accident) $ <br />$ <br />(Pena .identOAMAGE $ <br />$ <br />$ <br />EACH OCCURRENCE $ <br />$ <br />UMBRELLA LIAB O <br />OCCUR E <br />AGGREGATE $ <br />$ <br />DEDUCTIBLE $ <br />$ <br />X WC STATU- OTH- <br />$ <br />A A <br />WORKERS COMPENSATION X <br />N/A <br />WC201100000404 1 <br />E.L. EACH ACCIDENT $ <br />$ 1,000,00 <br />E.L. DISEASE - EA EMPLOYE $ <br />$ 1,000,00 <br />E.L. DISEASE - POLICY LIMIT $ <br />$ 1,000,00 <br />DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (Attach ACORD I*1. Additional R,ma Schedule, N more space is required) <br />Re: Application Fee # 20100119693. <br />ed. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />