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MUCK INSURANCE EXC NGE ,.,..,. . INWm gERTIFICATE AS TO EVIDENCE SU.4!ANCE 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. D c r. Named Insured ,RICH LEHNIAN EXCAVATING R952E Address . P.O. BOX 1239 Policy# -Gen. Liab. .RED BLUFF, CALIFORNIA 96080 AUG �$ 348 15583 82 82 Agent Policy # - Auto Liab. ENVIROMENTAL HEALTH! Policy #- CARGO This is to certify that policies for the above named insured are in F T/61I iCE$ Policy # -Work Comp. OWNED AUTO- MOBILES, IF COVERED This Interim Certificate As To Evidence of Insurance shall expire sixty days from M., July 25 , 19-B-8-, unless cancelled prior to such date by written notice to the named insured. F t Please issue ri Permnnent Cartifirnte * Includes Goods or Products warranty, written Lease of Premises, tasement Agreement, Municipal Urdtnance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by specific endorsement providing additional Contractual Coverage. Described Descnpnon ❑ below 9:1 wowed YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY I IDENTIFICATION NUMBER LAST 3 DIGITS SHOWN Umbrella Liability $ 000 retained limit POLICY NUMBER $ 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 • STOCKPON, CALIFORNIA 95201 Countersigned * * Not Applicable in Texas. Auth i,ed Representative * * * In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations. 56-0514 4-87 11261 W1200 01200 PRINTED IN USA, Q M COVERAGE COMBINED LIMITS OF LIABILITY COVERED NOT COVERED LIABILITY ❑] Owned Bodily Injury $ 000 each person ❑] Hired $ 000 each occurrence ❑ Non -Owned Employer's Non -Ownership Property Damage $ 000 each occurrence O ❑ Contingent Liability Single Limit Liability for Coverages checked X above $ 1.1000 000 each occurrence GENERAL LIABILITY M&C - OLT Bodily Injury $ 000 each person Owners & Contractors $ ,000 each occurrence ElContractual * $oOQ products � � * annual aggregate Elevators Property Damage $ each occurrence yn ❑ Products and/or $ ,000 annual aggregate X-1 Completed Operations ,OOO 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 ❑ WORKERS' COMPENSATION Statutory * Includes Goods or Products warranty, written Lease of Premises, tasement Agreement, Municipal Urdtnance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by specific endorsement providing additional Contractual Coverage. Described Descnpnon ❑ below 9:1 wowed YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY I IDENTIFICATION NUMBER LAST 3 DIGITS SHOWN Umbrella Liability $ 000 retained limit POLICY NUMBER $ 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 • STOCKPON, CALIFORNIA 95201 Countersigned * * Not Applicable in Texas. Auth i,ed Representative * * * In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations. 56-0514 4-87 11261 W1200 01200 PRINTED IN USA, Q M