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AC Rt7►_.......
<br />DATE(MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 01/06/2017
<br />......................::...::............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................::.::....................I................................ .. ........... _ _
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY
<br />AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
<br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT' If the certificate holder is anADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and
<br />conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />-..... ..... ..............._. , .,,w ., ,,...�...,, ..
<br />. -- -..------ ...., ._.. ..... .......... ............. ....-...... ......... ......... .........
<br />PRODUCER CONTACT
<br />NAME: BLAKE E. CORNISH
<br />Blake Comish(2925320) A-2016-240 PHONE FAX
<br />8816 S Sepulveda Blvd Ste 108 (A/C, NO, EXT): 310-215-3638 (A/C, No): 310-496-0627
<br />E-MAIL
<br />Los Angeles CA 90045-4852 ADDRESS: bcomish@farmersagent.com
<br />..... ._._.... . .. _.......... ..... .... _
<br />INSU RER(S) AFFORDING COVERAGE NAIC *
<br />INSURED INSURERA: Truck Insurance Exchange 21709
<br />INSURERB: Farmers Insurance Exchange 21652
<br />CONSTANT & ASSOCIATES
<br />INSURER C: Mid Century nce InsuraCompany 21...
<br />3655 TORRANCE BLVD STE 430 687
<br />Insurance �
<br />INSURER D:
<br />INSURER E:
<br />TORRANCE CA 90503 �.. �---. �. .... .�...... �
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
<br />REQUIREMENT, TERM OR CONDITION OFANYCONTRACT OROTHER DOCUMENT WITH RESPECTTO WHiCHTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTH E
<br />POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR TVPEOFINSURANCE ADDTL SUBR POLICY NUMBER POLICYEFF POLICYEXP LIMITS
<br />LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY)
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE f
<br />0
<br />2,000.00..
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE
<br />DAMAGES(ED
<br />f
<br />aE�T
<br />(RO Occurrence)
<br />...
<br />75,000
<br />MED EXP (Any one person) f
<br />5,000
<br />C Y N 04655924
<br />06/04/2016 06J04/2017 PERSONAL& ADV INJURY f
<br />0
<br />2,000,00
<br />i GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />4,,000,000
<br />POLICY [—] PROJECT D LOC
<br />PRODUCTS-COMP/OPAGG f
<br />2,000,00
<br />OTHER:
<br />( f
<br />AUTOMOBILE LIABILITYCOMBINED
<br />SINGLE LIMIT f
<br />''..
<br />1,000,000
<br />(Ea accident)
<br />..,...-
<br />$ -�
<br />ANYAUTO
<br />BODILY INJURY (Per person)
<br />-.-..._
<br />.m.....
<br />C '. AUTOS X SCHEDULED
<br />BODILY IN URY(Peraccident
<br />J ) $
<br />ONLY AUTOOWNED
<br />604655924
<br />06/04/2016 � 06/04/2017
<br />�—
<br />HIREDAUTOS X NON -OWNED
<br />PROPERTY DAMAGE f
<br />ONLY AUTOS ONLY
<br />(Per accident)
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE f
<br />EXCESS LIAB CLAIMS -MADE
<br />AGGREGATE f
<br />DED C V RETENTION 11
<br />$
<br />WORKERS COMPENSATION
<br />PER OTHER $
<br />AND EMPLOYERS' LIABILITY
<br />STATUTE
<br />ANY PROPRIETOR/PARTNER/ Y/N
<br />E.L. EACH ACCIDENT f
<br />1,000,000
<br />N/A
<br />EXECUTIVE OFFICER/MEMBER 9150620-2016
<br />...-..— -------- --------.
<br />01/11/2017 01/11/2018
<br />—_,...._..
<br />D EXCLUDED? (Mandatory in NH) Y
<br />E.L. DISEASE -EA EMPLOYEE
<br />1,000000
<br />If yes, describe under DESCRIPTION OF
<br />E.L. DISEASE -POLICY LIMIT is
<br />1,000,000
<br />OPERATIONS below
<br />Aggregate Limit: A
<br />$3,000,000
<br />E ERROR AND OMISSIONS Y C RTP0006942
<br />01/10/2017 01/10/2018 Per Claim:
<br />$2,000,00
<br />0
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more spaceis required)
<br />LOCATION: 3655 TORRANCE BLVD STE 430, TORRANCE, CA 90503
<br />Certificate holder, its officers, agents, and employee are named as additional insured in regards to general liability per attached BP 04 47 01 97.
<br />10 days notice of cancellation for nonpayment.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />.......
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />ATTN: Purchasing Department
<br />DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PL2
<br />AUTHORIZED REP_... i;MT(VE ,,_57"..................... ^^, "'._r......-.......-.-.�.._ .._..
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<br />ACORD 25 (2016/03) 91988-2015ACORD CORPORATION. All Reserved
<br />31-1769 11.15 TheACORD nameand logoare registered marksofAC
<br />ORD
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