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4,2 aC y - Z'6_9 Commercial Certificate of Insurance FARMERS' Agency , Roy Palacios Insurance Agency, Inc. Name , 26081 Merit Circle, Suite 101 Issue Date (MM/DD/YY) Ol/08/]0 & ' Laguna Hills, CA 92653 Address This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies shown below. St. 97 Dist. 55 Agent 397 Companies Providing Coverage: Insured Company A Truck Insurance Exchange , i Water, Inc. Letter B Farmers Insurance Exchange Name 18 Goodyear, Suite 100 evcompany er & • Irvine, CA 92618 Company C Mid -Century Insurance Company Address Later Company p Later Coverages 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 any requirement. term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance of such Limits shown may have been reduced by afforded by the policies described herein is subject to all the terms, exclusions and conditions policies. paid claims. CO Type of Insurance Policy Number Policy Effective Policy Expiration policy Limits Date (MM/r)o/YY) Date (MM/Dn/Y'Y) Ltr. General Aggregate $ General Liability products-Comp/OPS Commercial General Aggregate $ Liability Personal & - Occurrence Version Advertising Injury $ Each Occurrence $ Contractual - Incidental Fire Damage Only (Any one lire) $ Owners & Contractors Prot. Medical Expense (Any one person) $ Combined Single Automobile Liability Limit $ All Owned Commercial Bodily In1'ury Autos (Per person) $ Scheduled Autos Bodily Injury Hired Autos (Per accident) $ '.Von -Owned Autos Property Damage s Garage Liability Garage Aggregate $ Umbrella Liability Limit $ A Workers' Compensation A0109 58 34 01/01/10 01/01/I1 Statutory Each Accident $ 1,000,000 and Disease Each Employee $ Employers' Liability Disease - Poll L l Description of Operations/Vehicles/Restrictions/Special items: A Water Distribution Engineering & Maintenance Laura Strtt heeay ev Certificate Holder Cancellation Should any of the above described policies be cancelled before the expiration date City of Santa Ana thereof, the issuing company will endeavor to mail 30 days written notice to the Name Bldg Inspection Dept certificate holder named to the left, but failure to mail such notice shall impose no & 20 Civic Center PLZ obligation or liability of any kind upon the company, its agents or representatives. Address • Santa Ana, CA 92701-4058 Roy Palacios Authorized Representative r d A f (' H-ol 59-2492 4-94 Copy DlSlriuuuuu. oetvrr.e s,cuicr wpy m.� � •51 - --r.l