Laserfiche WebLink
COMPANY NAME: <br />MID-CENTURY INSURANCE COMPANY, LOS ANGELES, CALIFORNIA <br />A STOCK INSURANCE COMPANY, HEREIN CALLED THE COMPANY <br />PART I tERTIFICATE OF INSURANCE <br />INSURED'S NANIE & ADDRESS: <br />SHARON A H LA BONTE <br />17962 WESTON PL <br />TUSTIN CA 92780 <br />ISSUING OFFICE: <br />P. O. BOX 4820 <br />POCATELLO, ID 83205 <br />/ RSA <br />POLICY NO: 97 17615-29-63 <br />POLICY EDITION: 02 <br />EFFECTIVE DATE: 08-08-2007 <br />EXPIRATION DATE: CONTINUOt i5 UNTIL CANCELLED <br />EXPIRATION TIME: 12:01 A.M. Standard Time <br />AGENT: Tyler Harms <br />AGENTNO: 97 44 31L AGENTPHONE: (714) 744 0733 <br />)ESCRIPTION OF VEHICLE <br />Yeor Ma ie Mudd VeNde Iden ilica ion Nurri6er <br />2002 BMW 5302 WBADT63462CK25841 <br />r - rDi __rc ., r ,K, -,-. T TC o MQ r W nrni T AD c ISFF RFVFRSF SIDE FOR COVERAGE DESIGNATIONS) <br />Bodily Injury ' P.D. <br />0dMotaikt <br />Addili" <br />_Equi_ '' <br />ge .c <br />No Eardt <br />— <br />(owa <br />Deductible <br />Lo inion <br />Dedw!We_ <br />r � <br />Non -Aura <br />250 5001100 <br />* ; <br />250 5001 COV <br />1000 <br />5,000 <br />1000 <br />1000 <br />NOT COV <br />--0 — <br />* ; <br />NC 1 NC <br />Each 1 Each <br />Per on aurr n <br />Each 1 Each <br />P c e <br />liah. Medical <br />i <br />COV <br />This certificate is subject to all of the terms, conditions and limitations set forth in the policy(ies) and endorsements <br />attached to it. It is furnished as a matter of infornzation only and does not change, modify or extend the policy in any <br />way. It supersedes all previously issued certificates. <br />PART li <br />ADDITIONAL INSURED ENDORSEMENT E 1 136 <br />3rd Edition <br />We provide the coverages indicated by "COV," or the limit of the Company's liability, on the above <br />Certificate of Insurance. We provide this coverage in respect to the vehicle described above, to the person or <br />organization named below as an additional insured. <br />This coverage applies only: <br />(1) while the named insured is the owner, or has care, custody, or control of the above described <br />vehicle, and <br />(2) when liability arises out of the acts and omissions of the named insured. <br />This coverage does not apply: <br />(1) where liability arises out of negligence of the additional insured, its agents, or employees, unless the <br />agent or employee is the named insured, or <br />(3) to any defect of material, design or workmanship in any equipment of which the additional insured is <br />the owner, lessor, manufacturer, mortgagee, or beneficiary. <br />If any court shall interpret this endorsement to provide coverage other Char, what is stated in the Certificate <br />of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage <br />liability specified by any motor vehicle financial responsibility law of the state, province, or territory where <br />the narned insured resides, as applicable to the vehicle described above. <br />If there is no such law, our limit of liability shall be $5,000 on account of bodily injury sustained by one <br />person in any one occurrence and subject to this provision respecting each person, $10,000 on account of <br />bodily injury sustained by two or more persons in any one occurrence. Our total liability for all damages <br />because of all property damage sustained by one or more persons or organizations as Che result of any one <br />occurrence shall not exceed $5,000. <br />The insurance afforded by the policy described above is subject to all terms of die policy and any <br />endorsements attached to it. This endorsement does not increase the limits of the policy. <br />Upon cancellation or termination of this policy or policies from any cause we will mail 15 days <br />notice in writing to the other interest shown below. <br />CITY OF SANTA ANA <br />20 CVIC CNTRPZM36 <br />CA 92 <br />SANTA ANA CA 92702 y <br />AUTHORIZED SIGN URE <br />91-1136 3RD EDITION 1-05 <br />E1136331 <br />