Laserfiche WebLink
THIS CERTIFICATE M ISSLIED ASA MATT ER a FIN FORM AT] ON ONLY AND CONFERS NO RIGHTS VP ONTHECEIT_ _ HEICAI'E HOLDER 1'I IIS CERTIFICATEDOES NOT ATE AcC) V RIG <br />DATE(MM/DD/ 11/22l2019 <br />CERTIFICATE OF LIABILITY INSURANCE Y) <br />'AMEND, EXTEND OR ALTER THC COVERAGE AFFORDCD BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTEA CONTRACT BLTWEENFTHEI ISSUING IHSURER(S}. <br />AUTHORIZED REPRESENTATIVE OR PRODUCER AN )THE CERTIFICATE HOLDER. i <br />SURED. the <br />IMPORTANT: HIT, <br />epolicy,cecertificate in ujj as rADmTIDIIALI rdwsern.m. AlFw Goneal anhi ADDITIONAL Igllnng or beendorsed. [IS <br />UBROGATIONISWAIVCO,sr:biecttethetermgand <br />rnntlltfons of the Poli y,aer[aln palldes may reRViramendorsement Ast remvnin thiv ce tiRaa[e do sI t unfar rlryhfs nr the cart Rcate holder in live ofi ch ondmsemmst(s) <br />PRODUCER <br />CONTACT - <br />NAME: <br />Why Lamrn(9755341-1) <br />PHONE <br />2915 Red hull Ave Ste 1`201 ' (A/c No EXT) 866-416-8939 (A/C, ND) 866-Hi6-8939 <br />i [.MAIL _._,. <br />I Costs Mesa CA 92626-3428 [ADDRESS: kl2mfn@farmeisagent.com <br />INSURER(S) AFFORDING CDVERAGE NFlICYf <br />INSURED INSURERA 1­11Truck InSLIrance Exchange __ , 21709 <br />DINH, JAMES INSURERS Faramrs lnslifance Exchange ! 21652 � <br />STUDIOFOLIA INSURERC Mid Century Insulance Company - 21607 i <br />12723 PARK S'II INSURERD: - - -- <br />CERRITOS iwsuarer..--�` <br />CA 90703 <br />INSUItLRF: I <br />COVERAGES CERTIFICATE NUMBER: - - R <br />ItEV15lON PLUMBER: <br />rl'R51.SLMERr11Y f11Ar TOII it IOLION Or INSURNYC(ANCCCT R 11F,R HA/LETWITT RESPECT <br />f1EIO VIR HD NAME ABOVE FOR f HEMAY <br />POLICY LDOR INDICATEDNOTWjEsu"NCEAHOANY <br />REOUIRFML5I, TERM OR CGPIUIID ION OF ANYCOPIEI U R S, EXCLUSIONS <br />ONDI RESPECTTOP/11OLICI IS CERTSSHObMAYRE ISSE BEEN <br />MAY PER DB1N.THE INSURANCE ApfORUEf3 BYTHE <br />_ LUSItlNS AND CONDIT101L 01"SUCIIVOtICIF �. LIMITS SHOWN b1AYINVE BF;EPI REDIICEfJ BY PAID r'IAIMS j <br />1 1DOTL <br />ILyn <br />LTR v SllI3R POLICY MUMeCR T PQLICYEVF POLICY LXP -- <br />!1 TYPE OFINSURANCE <br />I I lu .)ALL THE IRMS f%C mu I(MM/DO/VYVV) (MM/DO/YYYY) LIMITS ' <br />COMMERCIALfEDIFAALLMRILITV t ----- 7 --�- CT]--� <br />I i I I I I CAf.H OCCURRENCE 8 1000,ODU <br />0.AINISMAI]E X OCCUR I DAMAGETO RCHILD Ij , <br />-'---' ---- PREMISr.S(fa Occurrence) 75;000i <br />NiCUEXP In Yon Par on) Iq t <br />_ Y _ Y 605513299 - 02./0112020 02/01/2021 "FPSONAL&AD INJORY s iD0U 000F' <br />CtN L ACrnRF.GAI E LIMII APPLIES PEfL <br />Plo GENERALAGGRCGArE _-1S <br />i 000 0OU, <br />__ — ; POIIU VrtUl Efl !OC. I I I PRODUCT COM1IPr OR AGG j <br />_11 <br />OILIER:. -_ - <br />ALnOMOaiLf: LIABILITY i rONiBINE11SINGLE LIMIT <br />�- -ArvY AIIfD iEaaccfdentl -., b 1000,00(7 <br />f BODILY INJURY We, I1aI, T) I$ <br />A OWNIIDAUIOS I5CHEDIILF.D I -"- I <br />UNLY AUTO.) BODILY INJURY par eccfden'1113 <br />I 1 G055132.99 02/0112020 02/01/2021 I <br />IIIRLOAHSOS ' X NOD QwNLJ <br />ONLY ALRDSOPBY PROPERLY PDAMAGE <br />PROPERTY <br />UMRRCLLALIAIi '. OCCUR ! <br />EXG,ESS LIMI CLYINIS h1ADE I E'A(51 OCCIINNENCt A <br />, > <br />._ _ ___.__ AGGREGATE q <br />DEC Rm CI RIGPI$ <br />WORNERSCO PE <br />RS'LIAILIT _ -- I PER <br />APIs EMPLOYER5'UARIIIT\' OII IF.R ; <br />S1AIU'f. <br />ANYPROPFHETOR <br />CXSCUHVFOFF1cFP MFNIRi Y/x EA. UCHACCIDCNT <br />EXECu1 NF UI'fICER;MG41Rr-R -- N/A 15 I <br />I EXCLUDED? (Mandate" In NhU El DISEASE F.AfMPwvEE p -- --� <br />ffyeslucrhamtder DTCRIPTIUNOF --_--- ""-""-'-- -1 <br />OPEIEAlIONS below I EA DISFASE P(IIICYLINIP d <br />'. DESCRIPTION Op ORERATIONS/LOCATIONS/VEIIICLF,S (ACORO ItlI Atldltim al Remark Schadule, nlny be afta<hetlUmnre space is required) - - --- I <br />I12723 PARK ST. CERRITOS. CA 90703. '1 HE CITY OF SANTA A AN(�,{'G$r = EMPLOYEES AGENTS AND VOLUNTEERS HAVE BEEN ADDED AS IAN ADDITIONAL INSURED VIA A PRIMAR C f7�'llkNfl 9EMENT. 30 DAY NOTICE OF CANCELLATION. <br />EiIY RISC MANAGEMENT pNI510N <br />CERTIPICAIE I IOLDER <br />—_ <br />_.. CI — OF nuANTA ANA— —_ _.-. <br />20 CIVIC CENTER PLA7A C <br />_..-. _..._. ....._SANTA.ANA—.. <br />CA V27GL_____. <br />OF THE ABOVE DESCRIBED POLI Cl <br />AUTHORIZED REPR ,Tf <br />3E CANCEIALED BEFORE THE EXPIRATION <br />ORDAP(OC WI TH THE POLICY PROVISIONS <br />ACORD 25 (2016/03) ©196-2015 ACORD CORPORATION. All Rights Reserved <br />31 1769 ILLS The ACORD name and 1090 are registered marks of ACOHO <br />