Laserfiche WebLink
~,z ooq - ~~~~ <br />Commercial Certificate of Insurance <br />Agency 1 ~ I A I <br />FARMERS <br />Roy Pa actos nsurance gency, nc. <br />Name .26081 Merit Circle, Suite 101 Issue Date (MM/DD/YY) 01/08/10 <br />& Laguna Hills, CA 92653 <br />Address This certificate is issued as a matter of information only and confers no rights <br /> upon the certificate holder. This certificate does not amend, ex[eod or alter [he <br /> coverage afforded by [he policies shown below. <br />St. 97 Dist. 55 Agent 397 <br /> Companies Providing Coverage: <br />Insured Company A Tmck Insurance Exchange <br />. i Water, Ina Leta <br />mpany B Farmers Insurance Exchange <br />Name I8 Goodyear, Suite 100 i ty <br />& lrvine, CA 92618 company CMid-Century Insurance Company <br />Address Letter <br /> Company <br /> Letter <br />Coverages <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding <br />any requirement, term or condition of any contract or other document with respect to which this certifipte may be issued or may pertain, [he insurance <br />afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by <br />paid claims. <br />Co. T e of Insurance Polic Number <br />YP Y Policy Effective <br />Date Imwonwn Policy Expiration <br />Date (rtmm~m9 policy Limits <br />Ltr <br /> General Liability General Aggregate $ <br /> Products-Camp/OPS <br /> Commercial General ' Aggregate $ <br /> Liability Personal & <br /> - Occurrence Version Advertising Injury $ <br /> Contractual -Incidental Each Occurrence $ <br /> Ouly Fire Damage <br /> (Any one fire) $ <br /> Owners & Contractors' Prat. Medical Expense <br /> (Any one person) $ <br /> Automobile Liability iombined Single <br /> All Owned Commercial $ <br /> Autos Bodily Iri]ury <br /> (Pet person) $ <br /> Scheduled Autos <br /> <br />Hired Autos <br />~ Bodily Injury <br />(Per accident) <br />$ <br />'., Non-Owned Autos <br />Property Damage <br />$ <br /> Garage Liability ~ <br />Garage Aggregate <br />$ <br /> Umbrella Liability Limit $ <br />A ~ Workers' Compensation A0109 58 34 Ol/01/10 Ol/O1/11 Statutory <br />Each Accident <br />$ 1,000,000 <br /> and Disease -Each Employee $ <br /> Employers'Liabllity Disease-Polk Limi <br />Description of OperationsNehicles/Restrictions/Special items: A <br />Water Distribution Engineering & Maintenance ~~ <br />J <br />~ <br /> y Stitt heedy <br />aur <br />-'-~" L <br /> e <br />Certificate Holder Cancellation <br />City of Santa Ana Should any of the above described policies be cancelled before the expiration date <br /> thereof, the issuing company will endeavor to mail 30 days written notice [o the <br />Name Bldg Inspection Dept certificate holder named [o the left, but failure to mail such notice shall impose no <br />& 20 Civic Center PLZ obligation or liability of any kind upon the company, its agents or representatives. <br />Address Santa Ana, CA 92701-4058 <br /> <br />i Roy Palacios <br />Authorized Representative <br />56-za92 4-9a Copy Distribution: Service Center Copy and Agent's Copy <br />H-Ol <br />