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09/10/2025 BY <br />(AUTHORIZED REPRESENTATIVE) <br /> “NOTICE: This risk pooling contract is issued by a pooling arrangement authorized by California Corporations <br />Code Section 5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of <br />California and is not subject to regulation by the Insurance Commissioner. Insurance guaranty funds are not <br />available to pay claims in the event the risk pool becomes insolvent.” <br />NIA-DEC CA <br />BUSINESS AUTO LIABILITY COVERAGE DECLARATION <br />MEMBER ID: 0003720 POLICY NO: 01-CP-0003720-01-22 END: 016 <br />ITEM ONE <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 />3663 Pacific 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 />ENDORSEMENT EFFECTIVE: 04/01/2025 <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL TERMS OF THIS POLICY, WE AGREE <br />WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br />TRANSACTION REASON The following additional insured(s) is/are hereby added to read City of Pleasanton, its <br />officers, officials, employees, or volunteers <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