PROOF OF INSURANCE (2024) CLOSED"--� 0
DAYE'(MM DO/YYYY)
CERTIFICATE O�F LIABILITY INSURANCE I I � 17'/2023
tHISCCRTIFICATE IS 6SUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RlafTS, UPON'THE CEP71FICATE HOL DER, PAS CERTIFICATE DOES NO7 AFFIRMArtVVIV ORNEWIVELY
AM040, EXTENDORAILrER THE COVERAGE AFFORDED BY THE POLICIES BE.OW THISCERNFICAIEW IN'SURANCE DOES NOT CONST) rUTr A CONTRACT BE tWEEN THE ISSUMIG INSURER(S,,
AUTHORIZEDREPRIESENTATIVEOR PRODUCER AND THr, CEnTl"CA7E HOLDrR
. .... . . . . . . . ............. .
IMPORTANT: If the cenificate holder is an ADDITIONAL INSURED, the policy(ies) 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. A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
PRODUCER CONTACT
NAME: Michael Evans
Michael f varis linsuirainco, & f inanciall Servic es PHON , E FAX
11: 706 A11EI'S2 11flvd (A/C, NO, LXT): 562 924-8228 (A/C, No): 562-924-3961
ArkesO, CA 907011 E-MAIL
(562) 924 8228 ADDRESS: mevans@farrriersagent, corn
INSURER(S) AFFORDING COVERAGE NAIC#
P'VaWl"D INSURERA: Truck Insurance Exchange 21709
. ...........
INSURFRB: Farmers Insurance Exchange 21652
FIREFIGHTER SAF'ETY CENTER
INSURER C: Mid Century Insurance Cornpany 21687
14565 VALI. EY VIEW AVE STE W
INSLIRER D!
SAN FA FE SPRINGS, CA 90670
(562) 921-8686 INSURER E:
INSURERF,
COVERAGES CERTIFICATE NUMBER REVISION NUMBER:
,q, A )p I '1- 11 1101) D N )PA1111 ',JANDIW%I
'w,]'II, I -1,-o op ccli',lI. Hu% J 11R1,Clr P rJ] 'U" MIUNI 1,111, Pf ,: D,l M,l I I I ,„-1 ;"11; k-"I , ""I '"Ifl- 1 GY.I VIA, Ill S'' ,11'1 7111 Nk,,4l1'1:: l 'Rl)" I B111
Pr 'A 11 d IN h""INI I �1,Pk ',�,"A IM! I 1 1,01 C11 11,1111� AA,, I A�4" HFINN 11 Dtj' I l�� 1',1F) C d11,11
I'll, . .... . ....... - I'll I I I - - --- — I—.-. — I
INSR ADDTL SUBR POLICY EH;: POLICY EXP
YTR TYPE OF INSURANCE tNSD WVD POLICY NUMBER (11AIM/DD/YYYY) (M11A/D1D/YYYY) LIMITS
. . ... . . ...........
A
X COIWMEIIZ.0A�.GENERAL. I.IIABI�.iry
0,)dMS-11AADE X occup
I- �f„JA GAI t 1 %11; APP, 11 , l Ill
X
')WNFD AWOS
A
Rt I) AJ;10',
X
X ;,iJ N 011d'd
a
UMBRELLA LIAB
EXCESS LIAB I 9. 111Al I
1� R1 -1 N I ON
WORKERS COMPENSATION
A114D TYAPI! 0YERS'LIABli iry
ANYPROPRIII rOIR'PAR 1W R
r-x:oc : -,w oi :ic"T NTi r7 IN /A
r-4ci uoI ), (Mandatovy m NH
Ofyd—,,,I� lol
i DESCRIPTION OF OPERATIONS/1-OCATIONS/VEHICLES (ACORD 10 1, Additional Remarks Schedule, maybe attached ifmore space is required)
LOCATION 1) 14565 VALLEY VIEW AVE STE W, SANTA FE SPGS, CA 90670
CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED
i
CERTIFICATE HOLDER
CANCELLATION
CITY OF EL SEGUNDO FIRE DEPARTMENT SHOULD ANY,Cif"THE A V ESCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION
314 MAIN STREET DATE tHrOF,NQTI LL BE LSE, I RED IN ACCORDANCE WITH THE POLICY PRO I V I ISIONS ,
EL SEGUNDO, CA 90245 Aul 'ZEDREPTA' e—
ACORD 25 (2016/03) C 1988-2015 ACORD CORPORATION. All Rights Reserved
The ACORD name and logo are registered marks ofACORD