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PROD / CUSTOMER ID:
<br />OTHER:
<br />EROTH-STATUTEPER
<br />LOC
<br />LOC
<br />LOC
<br />OTC LOC $
<br />$
<br />AUTO ONLY (Ea accident)
<br />$AGGREGATE
<br />ONLYHIRED AUTOS
<br />AUTOS ONLY
<br />IN GARAGE
<br />AUTOS USED
<br />JECT
<br />COLLISION
<br />EXCESS
<br />PERILSSPECIFIED
<br />PRIMARY
<br />COMP /
<br />DIRECT BASIS
<br />LEGAL LIABILITY
<br />GARAGE KEEPERS LIABILITY
<br />$
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-LOC
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />$
<br />$
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />REMARKS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$
<br />OTHER THAN
<br />AUTO ONLY
<br />$EA ACCIDENT
<br />GARAGE LIABILITY
<br />OWNED
<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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION #:CERTIFICATE #:COVERAGES
<br />The ACORD name and logo are registered marks of ACORD
<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 />CERTIFICATE OF GARAGE INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 30 (2016/03)
<br />© 2010-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />NON-OWNED
<br />BUSINESS
<br />ANY AUTO
<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 />06/07/2024
<br />Hoffstot Insurance
<br />PO Box 219
<br />Creswell OR 97426
<br />Ryan Hoffstot
<br />(541) 895-4515 (541) 741-0175
<br />Ryan@ryanhoffstotagency.com
<br />NextGen Alpha Upfitting, LLC
<br />8400 Carbide Ct, Unit A & B
<br />Sacramento CA 95828
<br />MESA UNDERWRITERS SPECIALTY INS CO 36838
<br />MID CENTURY INSURANCE COMPANY 21687
<br />WESTCHESTER SURPLU LINES INS CO
<br />A Y Y MP0046001006004 04/11/2024 04/11/2025
<br />1,000,000
<br />A Y Y MP0046001006004 04/11/2024 04/11/2025
<br />1 1,000,000
<br />1
<br />A
<br />Y Y MP0046001006004 04/11/2024 04/11/2025
<br />1,000,000
<br />300,000
<br />5,000
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />A Y MP0046001006004 04/11/2024 04/11/2025
<br />1,000,000
<br />1,000,000
<br />B Y A09519925 02/23/2024 02/23/2025 1,000,000
<br />1,000,000
<br />1,000,000
<br />A
<br />GKL
<br />Y Y MP0046001006004 04/11/2024 04/11/2025 PER
<br />OCCURRENCE
<br />$1,000,000
<br />PER VEHICLE $ 150,000
<br />Locations: 8400 Carbide Ct Unit A & B, Sacramento, CA 95828
<br />8401 Rovana Circle, Sacramento, CA 95828
<br />30 days written notice will be sent to the certificate holder
<br />City of Pleasanton
<br />200 Old Bernal Ave
<br />Pleasanton OR 94566
<br />DocuSign Envelope ID: BDC37D32-43C7-40C0-BC1C-CD44C0380975
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