DULUX PAINTING, INC.-2016 - Laserfiche WebLink

Home Browse Search

AC "N" il*. --= CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 10126/2016 _ THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT NAME: Golsa Dolatabadi(295033N) PHONE 1451 W 7th St Ste A PAX (A/C, NO, EXT): 310.371-3575 (A/C, NO): 855-320-8748 _ E-MAIL ADDRESS; gdolatabadi(Afarmersagent.com San Pedro CA 90732-3524 INSU RER(S) AFFORDING COVERAGE NAtC# INSURED J— INSURERA: Truck insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 PERSONAL &Any INJURY JOHN MANTIKAS INSURERC: Mid Century Insurance Company GENERALAGGREGATE Dulux Painting 26 ROCKINGHORSE RD RCH PALOS VRD CA 90275 INSURER D: _2_1687_ — — -- INSURERS: - INSURERF: AUTOMOBILE LIABILITY ANYAUTO OWNEDAUTOSSCHEDULED ONLY X AUTOS XHIREDAUTOS X NON -OWNED ONLY AUTOS ONLY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMEN'f, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPEOFINSURANCE ADDTL INSD SURR WVD POLICYNUMBER POLICYEFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERALLIABILITY CLAIMS -MADE OCCUR u _ EACH OCCURR ENCE $ DAMAGE TO RENTED PREMISES (Ea Occurrence) $ MED EXP (Any one person) $ PERSONAL &Any INJURY $ GENT AGGREGATE LIMITAPPLIES PER: E PROJECT D LOC LOTHR: GENERALAGGREGATE $ PRODUCTS-COMP/OP AGO $ _$ B AUTOMOBILE LIABILITY ANYAUTO OWNEDAUTOSSCHEDULED ONLY X AUTOS XHIREDAUTOS X NON -OWNED ONLY AUTOS ONLY N 605889049 01/19/2016 01/19/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1�66Q,669 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLAUAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ _ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPR IETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEM BER EXCLUDED? (Mandatory In NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below N/A PER STATUTE OTHER$ E. L. EACH ACCI DENT _ $ E.L. DISEASE - EA EMPLOYEE E. L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may beattached If more space is required) 2008 FORD F250 SUPER; VIN: 1FTSW21R08EB70681 Policy shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. CERTIFICATE HOLDER CANCELLATION ITP-6F�SANT A DATE THEREOF OF NOTICE WILL DESCRIBED POLICIES BE CANCELLED BEFORETHEEXPOVIS0" DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. F_210CIRVIC CENTER PLA7�4 M -11 AU THORIZEDREPRESENTATIVE Goias Uolatabadi 10/25/2016 SANTA_ANA__._ rA a�7-0-1 ACORD 25 (2016/03) 31-1769 11-15 ©1988-2015 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD