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<br />11/07/2005 17:15 <br /> <br />5512902770 <br /> <br />IMPERIAL <br /> <br />PAGE 02/02 <br /> <br /> <br />PROOUCEF\ <br />SYSCO GENERAl. INSUIlANC~ SVC. <br />4450 PARK ALISAL <br />P.O. BOX 8188 <br />CALABASAs. CA 91372 <br />INSURED <br />JOS~ TORRES AND JOSE TORRES JR. <br />29124 HIGHPLAJNES CT. <br />CASTAIC CA 91384 <br /> <br />11 6/06 <br />1M1!!: C.R.TlFICATE 1s.1SSU~l) 1.5 A M.Q,TIli~ OF INFORiiArr\ON ONLY.AND CO~RS NO <br />~IGHTS UPON ~ CEFrrtrlCATE HOWER. -rnIS CMTIFICATE OOES NOT AMEN!;) <br />EXT!l:Hb CRALTl:R THli COIIEFlAGEAFFORDE"lJ BY nit POLICIES IlIe-OW, . <br />INSUREiRS AFFORDING COVERAGEi <br />INSUR.ER A; PENN - STA~ INSURANCE CO. <br /> <br />INSURER B: Pro res si ve Insurance <br />INSURER C, <br />INSURER D: <br />INSURER E, <br /> <br /> <br />THIS ~ TO CERTIF"Y' tHAT i1-fE POI.lClE$ OF INSURANCe IJSTEO BELOW MAVE ee~N ISSUED TO THE 'MSi.J~F.:D NAMEO MOv!;;; FOR THE POLICY "'!Jl:IOO INOICAiJ;;:C. - <br />Nm\'vrn-rStANOINtJ ANY flEOUI~EMI'!N1". TI:RM rlPt CONomoN OF fW'f CON'TRACT OR OTHER COCUMENT WITH RESPECt TO W1"nCH tMrs ClORTlFlCAT!! !.lAy !!IE: ISSU,!O OR <br />MAY PERtAIN. THE IH!;:URANCli AFFORDED BY TH'" FtOtlClES DESCRtsEO Hlll'Q:lN IS SUSJS;T TO ALL THE TERMS. !i!XClUSIONS M-m CONDrnOrllS OF SUCH POI.IC1E8. <br />AI3GFI&:rJATI; LIMITS SHCYv'N MAY' lolAVI'! !teEN REWC:~o B'YPAIO ClAIMS. <br /> <br />EXCESS LIABILITY <br />tJ OCCUI'l 0 CL..r\IM.!O M^OF. <br /> <br />~_I DSOUCTlliIl..~ <br />RETI!NTION S :;.ntem <br />WORKERS COMPEN~ATI(")N AND Ass,'sta t C,'ty Arney <br />EMPLOYERS' UAblL.1'rf <br />_I City 0 Santa An ,CA <br /> <br />J OTHER _ <br /> <br />DESCRIPTION OF OP!:RAT10NSfl.OC^TIONSNEHICLEsJ~(;L,USIONS ADDED BV ENbORSE.MENl'/SI'>EClAl PROVISIONS <br />CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED WITH THE RESPECTS TO THEIR INTEREST IN THE OPERATIONS OF THE <br />NAMED INSURED. <br />.10 DAY NOTIC~ OF' CANCS.U..AttON Due FOR NON PAYMENT OF PREMIUM. <br /> <br />INS <br />LrR <br /> <br />pOLICY NUMB~R <br /> <br />POLICY P ICY <br />EFFECTIVE EXPIRATION <br />~ DATJ;; <br /> <br />5/1/0615/1/07 <br /> <br />TIPE OF INSURANCE <br /> <br />Gr::NERAL llAelUTY <br /> <br />X r;OMMl;f1CI^L GENEIW. LlAell1TY <br />J ~r.AIMS M'AOEl!J ar:C~IR. <br /> <br />CPS5005928 <br /> <br />A '$~c <br /> <br />GEN'l AGtlRI!GATE LIMIT APPlIIIS I"e:R: <br />X I'"cucyD PRO- I I LOC <br />. _ JEer <br />AUTOMO!3IL~ liABILITY <br /> <br />~ ^NY ,ura <br />ALL OWN!"!Ll AUTOS <br />~ SCHEDUlEb AUTOS <br />B ~ ""nl'leo AUTOS <br />-, NO"!-OWNIii:D AUTOS <br />p-- <br /> <br />GARAGE L1A,91LlTY <br />~l ANy AUTO <br /> <br />I <br />---1- <br /> <br />084896860 3/21/06 3/21/07 <br /> <br />APPROV...l) AS TO FORM <br /> <br />I <br />I. <br /> <br />LIMITS <br /> <br />EACH OCCURRENce <br />FIRE;: OAMA.G~ (Arry an" OrA) <br />MEO. EXPENse {Any ono ~(!,rsonJ $ <br />PERSONAL & ADV INJURY $ <br />GEN~RA~AGGRe~ATE $ <br />~Ii:ODUCTS.cOMP'OP AGO. $ <br /> <br />$ <br /> <br />1,aoo.Ooo <br />100.000 <br />5,000 <br />1,000,000 <br />2.000.000 <br />2.000.000 <br /> <br />COMI;IINED SINGL~ <br />LIMIT (Ea ~ceidenl) <br /> <br />60DIL., Y INJURY <br />(Per person) <br /> <br />aODIL Y INJURY <br />(PeraecidlO'lnt) <br /> <br />$1,000.000 <br />$ <br /> <br />$ <br /> <br />$ <br /> <br />, <br />I <br />~ <br />I <br />=:J <br />1 <br />. <br />, <br /> <br />-t <br /> <br />$ <br />$ <br />$ <br />$ <br /> <br />1 <br />~ <br /> <br />VVt;5TATU. <br />f TOR""LlMrr~ <br />G,l ~ H ACCIDENT <br />E l.. OISEAS~-EI\ ~MPLOYEE; <br />E L, DISEASE:;. POLICY UMIT <br /> <br />OTH_ <br />eR <br /> <br />1$ <br /> <br />1 <br />I <br />I <br />-, <br />i <br />I <br /> <br />CtiRTIFICATE HOlDEA: l X: "-OQITIONAL rN!lUREO; INSUAe:A llm!:~~....:;, CA.NCElLATION <br />SHOULO ANY OF THl': A.eOVE OaSCRIM:O POLICIES BE OANC~LlED <br />City of d:1d(l ta Ana~.eolice D.8p't _ 8...FORE\'HIi~PIMiION I;)ATET~E~eOF, THe rSSUINGINSUI<!ii;R <br />p 1 () 1 W!LL e:NOEAVOR TO. MAIL 30 IJA"t'S WRITTEN NOTrCIi. TO T1-IE: <br />I - 0 . Box 9 C~RTrFICAie HOl,Oi:RNAf,'lt;t;I TOll-lE LErr. BUt F^llUREro 00 so SHALL IMPOSE NO <br />San ta A.na, CA 9270 2 OB~IG'-'TION OR llABrut'YOF ANY KINO UPON tHE!: INSURER,ITS-AGENTS 01t <br />F\Ell'RI!SI!i;NTIITIVES. <br />AUTHORIZeo REP!":~I! <br /> <br /> <br />A(,;UKU 2~~(7'9{' <br />