Laserfiche WebLink
-� MILCO-2 OP ID:CL <br /> CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDM'YY) <br /> 10128/13 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> INTACT <br /> PRODUCER 559-447.460 NAME: Carmen De Los Santos <br /> Der Manouel Ins&Fin Svcs Inc PHONE FAX <br /> Der Manouel Insurance Group (AIC, <br /> Afc No Ext):559-447-4600 Afc No): 559-447-4586 <br /> P.O. Box 28906 <br /> E-MAIL <br /> RSS:cdelossantos@_dmig.com <br /> Fresno, CA 93729-8906 <br /> Robert C.Keller INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:United Specialty Insurance Co. <br /> INSURED Milcogeneral, Inc. INSURER B:State Compensation Ins. Fund 35076 <br /> PO Box 9726 <br /> INSURER C: <br /> Fresno,CA 93794 <br /> INSURERD: <br /> INSURER E: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> A X COMMERCIAL GENERAL LIABILITY X OS111583 03/18113 03/18/14 AMA T R NT D 100,00 <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE I OCCUR MED EXP(Any one person) $ 5,00 <br /> X Owner/Cont Prot. PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 <br /> FX—IPOLICYF—1 PRO LOC $ <br /> AUTOMOBILE LIABILITYG <br /> Ea acIMIF <br /> cident $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROaccdenDAMAGE $ <br /> HIRED AUTOSI J AUTOS <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR Id CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION <br /> WORKERS COMPENSATION X I WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY TRY LIMIT ER <br /> B ANY PROPRIETORIPARTNERIEXECUTIVE Y� 904685513 03/01/13 03/01114 E.L.EACH ACCIDENT $ 1,000,00 <br /> OFFICERIMEMBER EXCLUDED? N 1 A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,00 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) <br /> Project: Starbucks Benjamin Holt & 25 Stockton, CA. <br /> Endorsement Attached: CG20100704 <br /> Certificate Holder/Additional Insured: County of San Joaquin <br /> ER TF HOLDFR CANCE <br /> SANJO-2 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> County of San Joaquin ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Department of Public Works <br /> 1810 E Hazelton Ave AUTHORIZED REPRESENTATIVE <br /> Stockton,CA 95201 ne� <br /> �q ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />