|
Apr 22 04 03.31p The Doughertu Companu
<br />PRODUCtK
<br />The Dougherty Company, InC
<br />P.O. Sox 7277
<br />]Gong leach CA 90807
<br />p.2
<br />OF LIABILITY `NSU 04/2CSR DG DATE Domr)
<br />3wEA-� 4/zzI04
<br />THIS CERTIFICATE IS ISSUED ASA MATTER 4F INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON 1 HE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
<br />INSURERS AFFORDING COVERAGE
<br />Phone:562-424-1621 Fax:562-490-0432
<br />INSURkb INSUHI-H A Liberty Surplus Ins. Corp.
<br />INSURLH it, Hartford Insurance Company
<br />S.J. Weaver Contracting, Inc- INSURER C: National Union Fire Ins. Co.
<br />2655'T1 Walnutl Hill CA Avenue$06 INSURrRD State Compensation Ina. Fund
<br />SigI INSURLR I.,
<br />COVERAGES
<br />I Hi. PCX.ICIES U} IN SURANCL 0STrD BELOW HAVr DCCN ISBUf D TO THE INCURED NAWD MOVE FOR I Hr POLICY Pi: RIOD INDICATI 1) NOTWITHSI ANDING
<br />ANY KLUVIRCMCNT, II -RM OR CONDII tON Or ANY GONTRACI OR ODIER DOCUMI'NT WITH KL31PrCT TO WHICH T IDIS CCR I It-ICATG MAY HE ISSIIrD OR
<br />MAY PI'RTNN, T HI; INSURANCE AFFORDED BY I HI POLICIES 01 SCRIBED HLR1 IN IS SUBJL:(:T TO ALL THL 11 RMS, EXCLUSIONS AND CONmrIONS Or• ::UCH
<br />POLICIES AC'd,REGATL I InITS St IOWN MAY I tAVC OLIN RrDUCE•D vy PAID CLAIMS
<br />ILTR 1 POLICY EFFECTIVE POLICY PXPIRAT'ION
<br />TYPE OF INSURANCE
<br />POLICY NUMBER pA7t (MMIDDMY} I DATE (plwotvYY LIMITS
<br />GENERAL LIABILITY 1'ACII OG(:URkrNCE $1,000,000
<br />}'A, X[ CDWEK0AI.GCNER 1iABILITY DGBLO200639-014 04/01/04 04/01/05 Itkr11,WAG_IAny onttfire) 550,OOQ
<br />CLAIM.: MADr I x I Dort I MCU t XP ,Any vi* "emn) S5,000
<br />PERSONAL r.AOVINJURY 51 000,000
<br />(a' NAL AGORI: (.A 1 r LIAR s APPI It'PER.
<br />P.) ICY I X I PRJI COT - 1 or -
<br />AU -1 OMOWLE
<br />CAUTOMOBILE LIABILITY
<br />$ ANYAUTO
<br />ALL OYVNCD AL705
<br />X .SCHEDUIfD AUTOS
<br />,X HIRED AU 103
<br />X NUN-OWNEDAUIOS
<br />GARAGE LIABILITY
<br />ANY AU 1 O
<br />GL ACGnt:t;aT£ PSR PR(:It:(:T
<br />$5,000,000 POLICY CAP
<br />72 LIEN' UM3156
<br />OTHER
<br />r
<br />(:t NrP.ALAGGKI C,ATE z2,000,000
<br />PROnUCTS COMrYOP AGG S2,000,000
<br />EXCESS LIABILITY
<br />C
<br />x I OCCUR I CLAIMS MA01 BE2 681073
<br />04/01/05 t1 nawdrR,t)
<br />DEDUCUIHr
<br />RCTENTI(IN S
<br />WORKERS COIAPENSATION ANP
<br />i1
<br />FMPLOYERS'LIABILITY 11776673-04
<br />OTHER
<br />r
<br />(:t NrP.ALAGGKI C,ATE z2,000,000
<br />PROnUCTS COMrYOP AGG S2,000,000
<br />DESCRIPTION OF OPEkA710N5/LOCATEONSA+EKICI-GSIEXCLUS ADDEo 9Y CNDORSEM
<br />10 days notice of cancellation for nonpayment of premium.
<br />CERTIFICATE HOLDER N AODITIoNAL INSURED: msuRCR LETTER. A CANCELLATION
<br />TOWHO-1 I SHOULD ANY OF THE ABOVE DESCR18ED POLICIES BE CANCELLED BEFORE THE EXPIRATIQI
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 GAYS wRrrrF-N
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THC LEFT, BUT FAILURt= TO DO 50 SHALL
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THC INSURER, ITS AGENTS OR
<br />To Whom It May Concern
<br />�ACORD CORPORATION 1988
<br />I COMBINED 51NCi1 r. LIMIT
<br />$1,000,000
<br />04/01/04
<br />04/01/05 t1 nawdrR,t)
<br />Noon Y INJURY
<br />$
<br />par vt5w)
<br />BODII Y IN.IURY
<br />5
<br />(per Knnnnt)
<br />PkOPERTY DAMAGE
<br />$
<br />ucidw4)
<br />AUTO ONI Y C A AGCII IIAT
<br />S
<br />'I(IIERTHAN EA AGC
<br />$
<br />AUi0ONLY. AGG
<br />$
<br />LAI:) I OCCURI U N(:1
<br />$4,000,000
<br />04/01/04
<br />04/01/05
<br />ACA;M GATE
<br />14,000,000
<br />General
<br />S
<br />Liability
<br />$
<br />s
<br />X I 10— LIMI15I CR
<br />04/01/04
<br />04/01/05
<br />C.L InC11ACCIDE.Nf
<br />$1,000,000
<br />r.L. DISI ASE: CACMI'i oyrr
<br />S1,000,000
<br />1 1 DISC.ASI POI ICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPEkA710N5/LOCATEONSA+EKICI-GSIEXCLUS ADDEo 9Y CNDORSEM
<br />10 days notice of cancellation for nonpayment of premium.
<br />CERTIFICATE HOLDER N AODITIoNAL INSURED: msuRCR LETTER. A CANCELLATION
<br />TOWHO-1 I SHOULD ANY OF THE ABOVE DESCR18ED POLICIES BE CANCELLED BEFORE THE EXPIRATIQI
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 GAYS wRrrrF-N
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THC LEFT, BUT FAILURt= TO DO 50 SHALL
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THC INSURER, ITS AGENTS OR
<br />To Whom It May Concern
<br />�ACORD CORPORATION 1988
<br />
|