PROOF OF INSURANCE (2023) CLOSEDAC " "
DATE (MM/DD/ )
LIABILITY INSURANCE 10/18/2022
ONLY AND CONFERS NORIGH BI�
AMEND,
IS ISSUED AS A MATTER OF INFORMATIONI ���� O ,_,.,...-...�.��....��.�.�.._.
RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY
I END 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:Ifthecertlficat .....___ .-.-,�.
conditions ofthe policy, certain policies mayrequirean endorsement. Als statement on this certificate does INSURED
confer provisionsrights t t e certificate holder lieu olffsuch WANED, ent(stto the terms and
mmminxµ I
endorsement(s).
apRODUCER--__—__,.m......... ,..m�...._ _�,,��,.......� �..� �.6 .. CnDNTAT.�.,�,_ � .....,,,a .. w _�.......... ... _ m ...,._..... �..m
NAME. Michael Evans
Michael ErkGIS Insurance A(1ea1C' I PHONE FAX
11706 Ariesia Blvd (A/c No EXT) 562-924-8228 (AJC, NO): 562-924-3961
Artesia, CA90701 E-MAIL
...
(562) 24.8228 Ess. mevans@farmersagent.com
INSURER(S)AFFORDING COVERAGE m� m�W NAIC#
. .....
IINSUREDITITITmmm---- _ ... ......... .�..m. _ INSURERA: Truck Insurance Exch ntge ............ �..-. 21709
_
INSURERB: Farmers Insurance 216 Exchange 216
FIREFIGHTER SAFETY CENTER9 52
14565VAL,LEYVIE'J'�'AVE SIFE'UP INSURERD: Mid Cen&uAyInsurance Company
Y 8° 7
SANTA FE SPRINGS, CA 90670
INSURER E:
(562) 921-8686 ...... .. __ i
INSURERF: ..__ _......
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
�....._...............................w .._.... .....�_... ,.
T HIS ISIO CERTIFY TFIAT THE POLICIES OF INSURANCE LI I ED BELOW HAVE BEEN ISSUED TO TI IE INSJRED NAME ABOVE FOR THE POi ICY PERIOD CNDICAlED NOIWIT41`i1A DING ANY ..
REQUIREMENT, TERM. ORC014DITIONOFANY CONTRACTi ROB HER DOC.,UMENfWITH RESPECTTCYWJ OHTIflSCFRFIFICA1EMAYBE ISSIJEDORMAY PERTAIN I 4 IE INSURANCE AFFORDED BY1 HE
POLICIES DESCRIBED FIE:RE::IN IS SUBJECT "TO ALL F1IE TERMS, EXCLUSIONS AND CONDITIONS," OF SUCIi POLICIES, LIMITS SHOWN MAY I IAVE BEEN REDUCED BY PAID CLAIMS
LTR _�,.... IDDTL WVD POLICY NUMBER ' (MM/DD EFF POLICY EXP INSR r COMMERCIALGENURANCE ADDTL SUER POLI /YYYY) (MM/DD/YYYY) LIMITS
TYPE OF INS
GENERAL LIABI A
LITY ��---�� EACH OCCURRENCE � 1
i� � _ I � z,aoo,00a
1 DAMAGE CLAIMS MADE x OCCURI lg
PREMISES (FaOccurrence) 250,00&
9 _...m ..._........- — ... ..�_ �.�..........._ yy� { 4 IVIE@7 E7tP tArry erne Parsorr7 . �5 ,. . 10,00_0I
A I Y Y 606622936
. p � I .. 04/01/2022 04/01/2023 .P.,ERSONA..LA&.G...GA. RDEVGINATJUE R...Y ...� 3
42,000,000"
000.000tEGATETAM>LIFS,aFR GENERAL
POLICY PROJECT LOfPRODUCTS (CMP)OPAG �y ..
2 ooa oaa
AUTOMOBILE LIABILITY — .,.,., ^^^^, ...,._.._.., —.11-- min m111 COMF" ...,INGL.LLIIVI4T..2000.Oa01
(Ea acciden t,
ANY AUTO BODILY INJURY (Per pemonl a
OWNED AU1OS SCHEDULED
/`, � I BDfYIIYINJURY (Ireraccidevr r.
ONLY aN 606622936 04.101/2022 04/01/2023 ..�...mm �
+�,+� HIREDAUTOS (� N.ucC ON OWNED I I` PROPERTY r3laMAGF I„
i 0NI_Y y AUTOS0NLY I (Peraccident) '
..w,,,......... _...,......, . �- _..._...__.................
...
'x UMBRELLA LIAB�.X O cUR { 4 { s & ACH ,.XX....... .µ - ^.. ITIT.mm.
( AGGRr...GATFRRENC.P. S 1,000.000
EXCESS LIAB IluSMAI"YF 4�06626292 04/01/2022 E 04/01/2023 B WORKERS COMPENSATION CIA,
IkGIP 1, r Rd�TINIIC>IW°u ? I I$
AND EMPLOYERABILSTAIUT'
ITY ,.,.�
r �, OTHER �qti
AINYPROPRIETOR/PART'NER' Y/N I ELEACH ACCIDENT $ 1,000,000
EXrcurlvEOFF1CFrdfI4lEIViBFR ����°� N/A � ;A09239644 � 04/01/2022 04/01/2023 !
�E L DISEASE E EA EMPLOYEE � 1 000 00(1,
C EXCLUDED' (Mandatory in NH).._:
ICyes dc•,c:ribe under DESCRIPTI ON OF
ELDISEASE- POLICY LIMIT $ 1
OPERAFIONS below
a00.000
1
^ _ m spa , .- � d..�.!.........
DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES Remarks Schedule, maybe attached ifif more space is required)
OCATION 1 14565 VALLEY VIEW AVE STEW(ACORD SANTA FEAdditional SPGS, CA 90670
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE
THEIiEOr,NDTIC80V LD ,v
.. mm � ES ED POLICIES BE CANCELLED BEFORE THE EXPIRATION
MIT m � EIIVEREOINACCORDANCE WITH THE POLICY PROVISIONS.
A'LYa'H't.�17A'XEO'RP E.P6kE'S„e#M .£ .. .,.. ., .. ,.,,.•.
_.......... _._ . ................_._..._�..._ ...�...... ...��. ..........m._, __, y� ��1988-2015ACORDCORPORATION..�..�
ACORD 25 (2016/03) II Rights Reserved
31-1.769 11 -'15 The ACORD name and logo are registered marks of ACORD