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CER`31 t KATE OF LIABILITY INSURANCE
<br />DATE (MLVMYYYY)
<br />05/3112012
<br />HIS CaRTIFIC ATE 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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />e terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />rtificate holder In lieu of such endorsemert(s).
<br />XICER Phone: (626) 30C -9000 Fax: {626) 5710-0906
<br />W CENTURY INS SERVICES, INC.
<br />N. 2ND ST.
<br />HAMBRA CA 91801
<br />CCMEACr NEW CENTURY INS S F_RVICES, INC.
<br />PHONE (626) 300 -9000 FAX (626) 570 -0908
<br />A/C No E:I
<br />no 51 infoi@usnci.com
<br />PRODUCER 15724
<br />CUSTQMER ID.
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICS
<br />Agency Lic#: OB07085
<br />RED
<br />T, INC.
<br />I BONNIE CIRCLE, SUITE 101 A & 102
<br />IRONA, CA 92880
<br />INSURERA , GOLDEN EAGLE INSURANCE CORP
<br />PERSONAL & ADV INJURY
<br />INSURERS : NATIONAL UNION FIRE INS COMPANY
<br />INSURER ZURICH INSURANCE COMPANY
<br />BA2442759
<br />j
<br />I
<br />02/22/12 02/22/13
<br />L
<br />INSURER o:
<br />$ 2,000,000
<br />INSURER E
<br />; PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />INSURER F
<br />$ --
<br />$ 1,000 000
<br />X ANY AUTO
<br />IVERAGES CERTIFICATE NUMBER: 97974 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 />JDICATED. 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 />X17-11LISIONS L%N Q (-QNQTT IONS OES[ InH PnLtC- I P- I IfidITA SHOWN MAY HAVE 13PFN RPDUrFQ BY PAID rLAIMS
<br />I TYPE OF INSURANCE
<br />AWL
<br />I IN SR
<br />SUBR'
<br />POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />M I MMr y
<br />LIMITS
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />I CLAIMS -MADE n OCCUR
<br />I
<br />CBP8283936
<br />05131112 05/31/13
<br />IDAMAGE70RENTED
<br />i�
<br />EACH �'
<br />$ 11000,000
<br />MI,�,,,�(fauccurenCel
<br />� $ 500,000
<br />MED. EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,00D,000
<br />BA2442759
<br />j
<br />I
<br />02/22/12 02/22/13
<br />L
<br />I GENERAL AGGREGATE
<br />$ 2,000,000
<br />1 GENL AGGREGATE LIMIT APPLIES PER:
<br />POLICY � EO FLOC
<br />AuroeoeaE LIABILITY
<br />; PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />COMBINED SINGLE UNIT
<br />(Ea accident)
<br />$ --
<br />$ 1,000 000
<br />X ANY AUTO
<br />j
<br />BODILY INJURY (Per person)
<br />$
<br />ALLOW NEC AUTOS
<br />I
<br />E
<br />BODILY INJURY (Per accident)
<br />$
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />[
<br />I
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />$
<br />NON -OWNED AUTOS
<br />i
<br />I
<br />$
<br />X
<br />UMBRELLA uaB X OCCUR
<br />ElIU014184859
<br />11/04/11
<br />11/04/12
<br />s EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />Is _ 4,000,000
<br />EXCESS LIAB� CLAIMS -MADE
<br />DEDUCTIBLE
<br />RETENTION $
<br />1$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOWPARTNERlEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED'? _�
<br />(Mandatory In MN)
<br />NIA
<br />4007748
<br />02/06/12
<br />I
<br />02/06113
<br />I
<br />X w RY uM r OTH
<br />$
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />I DISEASE -EA EMPLOYEE
<br />E.L.
<br />$ 1,000,000
<br />�E.L— DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />try " ,daaon0e under
<br />OESCRIPTION OF OPERATIONS WIDW
<br />(
<br />!
<br />Z"RIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />D 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 />icerned.
<br />:RTIFICATE HOLDER CANCELLATION
<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 />(116) 558 -5345 Fax (916) 558 -8347
<br />ttentlon:
<br />The ACORD name and logo are
<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 />AUTHORIZED REPRESENTATIVE
<br />I •-
<br />
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