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DECLARATION <br />POLICY NO: 01-CP-0003720-01-22 END: 016 <br />INSURED: TRI-VALLEY HAVEN FOR WOMEN <br />EFFECTIVE DATE: 04/01/2025 <br />PRODUCER: JEFFREY STEPHENS INSURANCE <br />SERVICES, LLC <br />NOTICE: This risk pooling contract is issued by a pooling arrangement authorized by California Corporations Code <br />Section 5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of California and <br />is not subject to regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay <br />claims in the event the risk pool becomes insolvent. <br />THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE <br />COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS, IF ANY, ARE ISSUED TO FORM A <br />PART THEREOF, AND COMPLETE THE ABOVE NUMBERED POLICY. <br />Docusign Envelope ID: BAF64511-C271-4FC1-BBE9-5AF1BC605D95