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1 DATE (MLVMYYYY) CER`31 t KATE OF LIABILITY INSURANCE 0513112012 HIS CaRTIFIC ATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIF'CATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER 'THE COVERAGE AFFORDED BY THE POLICIES ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. PORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to e terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the rtificate holder in lieu of such endorsement(s). XUCER Phone: (626) 30C-9000 Fax: {626) 5710-0906 CCMEACr NEW CENTURY INS S F_RVICES, INC. NA. W CENTURY INS SERVICES, INC. PHONE (626) 300-9000 FAX (626) 570-0908 A/C No E.11 IfAiC N. 2ND ST. E-MAIL infoi@usnci.com HAMBRACA 91801 ns PRODUCER 15724 CUSTQMER ID. Agency Lic#: OB07085 INSURER(S) AFFORDING COVERAGE NAICS FIFO INSURERA , GOLDEN EAGLE INSURANCE CORP T, INC. I BONNIE CIRCLE, SUITE 101A & 102 INSURERa : NATIONAL UNION FIRE INS COMPANY INSURERI ZURICH INSURANCE COMPANY IRONA, CA 92880 INSURER D: INSURER E INSURER F IVERAGES CERTIFICATE NUMBER: 97974 REVISION NUMBER: HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD JDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS :ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AWL SUBR' POLICY EFF POLICY EXP I TYPE OF INSURANCE I INR WVD POLICY NUMBER M I MMr y LIMITS GENERAL LIABILITY CBP8283936 05131112 05/31113 EACH OCCURRENCE ' $ 11000,000 X COMMERCIALGENERALLIABILITY I IDAMAGE70RENTED 500,000 i~ MI$E;L(faoccurencel S CLAIMS-MADE I n OCCUR MED. EXP (Any one person) $ 10,000 I PERSONAL & ADV INJURY $ 1,00D,000 I GENERAL AGGREGATE $ 2,000,000 L 1 GENL AGGREGATE LIMIT APPLIES PER: j PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY EO LOC I $ AuroeoBaE LutBarrY BA2442759 02122/12 02/22/13 COMBINED SINGLE LIMIT $ 1,000,000 j (Ea accident) X ANY AUTO I BODILY INJURY (Per person) $ ALL OW NEC AUTOS E BODILY INJURY (Per accident) $ SCHEDULED AUTOS [ PROPERTY DAMAGE HIRED AUTOS I (Per accident) $ NON-OWNED AUTOS i I $ $ X UMBRELLA LIAR X OCCUR ElIU014184859 11104/11 11104112 s EACH OCCURRENCE $ 4,000,000 Excess LIAB~ CLAIMS-MADE AGGREGATE f $ _ 4,000,000 DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION 4007748 02/06112 02/06113 X w RY uM r OTH $ AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNEgEXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUPEJO? ~ NIA (Mandatory in mm) - i I E. L. DISEASE-EA EMPLOYEE $ 1,000,000 ESCRIPTIOa under If y" , O ( E.L-DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATK7NS below ! Is 3CRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) a insurer will not cancel the insured's coverage without 30 days prior written notice to the State. The State of California, its officers, ants, employees, and servants are included as additional insured, but only insofar as the operations under this Contract are -icerned. :RTIFICATE HOLDER CANCELLATION Department of Rehabilitation ( SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Business Enterprises Program (BEP) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Vending Machine Unit (VMU) 721 Capitol Mall, 5th Floor . AUTHORIZED REPRESENTATIVE Sacramento, CA 95814 (116) 558-5345 Fax (916) 558-8347 ttentlon: I -ORD 2 (2009/09) 05- J0988-2009 A R CORPORATION. A31 rights reserved. The ACORD name and logo ar-26A44 of ACORD