Laserfiche WebLink
09-10-25 Page 1 of 1 <br />NIA-FORMS SCHEDULE <br />ACCOUNT NUMBER: 0003720 POLICY NO: 01-CP-0003720-01-22 END: 016 <br /> <br />NAMED INSURED AND MAILING ADDRESS PRODUCER AND MAILING ADDRESS 1662 <br />Tri-Valley Haven for Women <br />3663 Pacific Ave <br />Livermore, CA 94550 <br />Jeffrey Stephens Insurance Services, LLC <br />9 Laurel Ave <br />San Anselmo, CA 94960 <br />POLICY PERIOD: FROM 04/01/2025 TO 04/01/2026 AT 12:01 AM STANDARD TIME AT YOUR MAILING ADDRESS <br />SHOWN ABOVE. <br />NOTE: THIS LIST OF FORMS IS NOT PART OF THE ACTUAL POLICY, BUT IS FOR YOUR INFORMATION ONLY. <br />PLEASE REFER TO THE POLICY(S) FOR ACTUAL LIMITS, COVERAGES AND EXCLUSIONS. <br /> <br /> <br />INTERLINE FORMS APPLICABLE COVERAGE PARTS <br />IL0021 09-08 <br />Nuclear Energy Liability <br />Exclusion Endorsement <br />(Broad Form) <br />General Liability Modified <br />IL0270 07-20 <br />California Changes - <br />Cancellation And <br />Nonrenewal <br />General Liability Modified <br />ILP063 01-16 <br />California Notice Of <br />Designated Additional <br />Person To Receive Notice Of <br />Cancellation Or Nonrenewal <br />BP Modified <br />ILN119 10-15 California Auto Body Repair <br />Consumer Bill Of Rights Commercial Auto Modified <br />COMMERCIAL GENERAL LIABILITY FORMS <br />CG2026 12-19 Additional Insured - Designated Person Or Organization-24 Added <br />SOCIAL SERVICE PROFESSIONAL LIABILITY FORMS <br />NIA-180 SSP 01 21 Communicable Disease - Exclusion Modified <br />BUSINESS OWNERS FORMS <br />BP1201 08-10 Businessowners Policy Changes Modified <br />FORMS SCHEDULE <br />Docusign Envelope ID: BAF64511-C271-4FC1-BBE9-5AF1BC605D95