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TRUCK INSURANCE EXQANGE II RIM CERTIFICATE AS TO EVIDENCE qPINSURANCE THIS IS NOT AN INSURANCE POLICY. THIS IS ONLY A VERIFICATION OF INSURANCE. IT DOES NOT IN ANY WAY AMEND, EXTEND OR ALTER THE COVERAGE PROVIDED BY THE POLICIES LISTED BELOW. Named Insured •RICH LEHMAN EXCAVATING Address .P.O. BOX 1239 � .RED BLUFF, CALIFORNIA 96080 95 26 348 Policy N Gen Liab. 5583 82 82 Agent Policy M - Aulo Liab. Policy M CARGO This is to certify that policies for the above named insured are in force as follows: Policy M Work Comp This Interim Certificate As To Evidence of Insurance shall expire sixty days from M., July 25 , 19 88, unless cancelled prior to such date by written notice to the named insured. ❑ / Please issue a Permanent Certifirnte OWNED AUTO- MOBILES, IF COVERED .Incluaes vooas or rroaucts warranty, written Lease of Premises, Easement Agreement, Municipal Ordinance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by specific endorsement providing additional Contractual Coverage. Descrhed Descript�nn below � wowed YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY I IDENTIFICATION NUMBER POLICY NUMBER Umbrella Liability LAST 3 DIGITS SHOWN $ 000 retained limit $ each occurrence $ aggregate If this Interim Certificate As To Evidence Of Insurance is to be cancelled prior to the expiration date, we shall provide 10 days advance notice in writing to whom this certificate is issued. Certificate issued to: Name And SAN JOAQUIN LOCAL HEALTH Address P.O. BOX 2009 STOCKTON, CALIFORNIA 95201 G/ Countersignedz"", # # Not Applicable in Texas. Autho4ted Representative # # # In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations. 5"514 4-87 11261 W1200 C11200 PRINTED IN U.S.A. n M COVERAGE COMBINED LIMITS OF LIABILITY COVERED COVERED AUTO LIABILITY ❑ F1 Owned Bodily Injury $ ,000 each person ❑ Hired $ 000 each occurrence ❑ Non -Owned Property $ O ❑ Employer's Non -Ownership Damage 000 each occurrence Contingent Liability Single Limit Liability for Coverages checked X above $ 11000 000 each occurrence GENERAL LIABILITY $ M&C - OLT Bodily Injury 000 each person # # ❑ Owners & Contractors $ 000 each occurrence ❑ Contractual # $000 °nnual nggregate • ♦ • ElProducts Elevators and/or Property Damage $ products ,000 each occurrence Completed Operations $ annual aggregate 1000 products... Single Limit Liability for Coverages checked X above 1 000 $ � ,000 each occurrence $ '000 annual aggregate products • ❑ ® CARGO $ ,000 each vehicle $ 000 each occurrence El Ei WORKERS' COMPENSATION Statutory .Incluaes vooas or rroaucts warranty, written Lease of Premises, Easement Agreement, Municipal Ordinance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by specific endorsement providing additional Contractual Coverage. Descrhed Descript�nn below � wowed YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY I IDENTIFICATION NUMBER POLICY NUMBER Umbrella Liability LAST 3 DIGITS SHOWN $ 000 retained limit $ each occurrence $ aggregate If this Interim Certificate As To Evidence Of Insurance is to be cancelled prior to the expiration date, we shall provide 10 days advance notice in writing to whom this certificate is issued. Certificate issued to: Name And SAN JOAQUIN LOCAL HEALTH Address P.O. BOX 2009 STOCKTON, CALIFORNIA 95201 G/ Countersignedz"", # # Not Applicable in Texas. Autho4ted Representative # # # In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations. 5"514 4-87 11261 W1200 C11200 PRINTED IN U.S.A. n M