Insurance - Theresa Kasprzyk 2019-07-03iii pini m � �
ACC>RLY
CERTIFICATE
LIABILITY INSURANCE
AM
` � ' m a � t w z : .. r. i ♦ ♦ e i r. • r a : : °; �. w i ! • t � s ; + s .: : w � :. a .. � - :
W# e � e t :. s • w s = - x s - . w � - � F.e :. ;: a s ...w - ,,x x - w :..
..
Staterarm STATE FARM INSURANCE
.v x
MARK R
- # AGENT
81 3D MCFADDEN AVE SUITE 206
►2•
SUR
V*STMINSTER CA 92083 WSUREA A State rarm General Insurance
Company
MUM a
Ir
DSA TERRASIAR MEDIA
13861 JASPERSON WAY
INSUKR E:
VVESI MINSTER- CA
f
92683
COVERAGES NUMBER:
REVISION
rt b.
' I #
"! a
xxxux
♦
SHOLILD ANY OF TW ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WtLL BE DELIVERED IN
ACCORDANCE
POLICY
* -.0
The Costa
Sanitary Distom its elected and a ppo;nted
fr
insuredsoffidals, agents, officers, volunteers and employees are ....... ---
290 Paularino _ Mesa, CA 92626
MR
...: ,...
0 i989-20%ACORD CORPORATION. All rights reserved.
# (20 16103) ACORD name and logo are mg1stered of i' M
ADDITIONAL- OR CONTRACTORS
11 t111111 rs s s
Named Insured:
FASB RZYK, THEF.ESA
''38,61 JASPERSON WAY
Name And Address Of Additional Insured Persons Or Organization:
7`1,77' C_4 WFISA SAN'TTARY T T?77CT 17S E . _'' : APPI(.AI NVI'
Vi t° F `CT T S NOENTS OFFETCF-RS VC.AUNTFERS & EMPLCYEES
ML NO AV
:COSTA VRSA CA
INSURED of s
SECTION!`s to
in-
clude, as an additional t or
shownorganization t but only
with respect to liability for"bodily injury,
s,s t or "personal
advertis-
ingcaused, in wholeor •
a. ongoing •R •
Your or
(2) The acts or omissions of a
on your behalf;
in the performance • ongoing ssM
for additional -• o
Productsb. s - -• Operations
-Your worW' performed for that additional
insured and included in the "products -
completed operations hazard".
Paragraph•subject to the
s •
affordeda. The insurance to the additional
only applies •
permit-
ted by
CMP -4786. t
'age 1 of 2
coverageIf provided to the aw •
required by a or agree-
ment,
provided s the
additional -s will notbe broader
that iu are required by s
insured,or agreement to provide for such addition -
c. If the contract or s between
e the additional -s is governed by
Californias + m Section+ or
2782.05, the insurance provided • the
additional -• is the lesser of
• -t for the satisfactionr de-
fense
or • obligation iCall-
t♦- Section 2 82 or
2782.05 fort bt or
You are requiredby •
agreement provide for such ad
`
We have no duty E defend or indemnify the
additional s`endorsement un-
til
or tendered to
2. Any insurance provided to the additional in -
a claim
+r , t #respect
+ - t
_+� t • or
t t
t - tTM age.
respect3. With s the ito the
nsurance afforded
i tr • the following is addedto
SECTION 11 — LIMITS OF INSURANCE -
If coverage provided to the additional insured
is required contract agreement, additional
we will ry on behalf of the
will be t e lesser of amount
a. Required the contract or agreement, or
shownb. Available under the applicable Limits Of
Insurance Declarations,
endorsementThis ♦ ap-
plicable
!# t
beclaratit
4. With respect tothe insurance afforded • the
additional r#the followingis added to
Paragraph
of
GENERAL
a
a. See to it that we are notified as t
practicable ofan'*occurrence" or anof-
fense
aclaim.To the
extent possible, notice should include,
How, t where
the "occur-
rence"
or offense took
(3) The nature t location of
or damage • out t
rence or t
b. Tender th- # indemnity of
claim or to us and to all other
ers t may have Insurance+ ntial
available additional insured: and
c. Agree
ance, the additional insured has for d
fense or damages for which we wou
trot t « • under
S. VVdh respect #[the insurance afforded ..#
ditional insured, following replaces SE0
TION 11 —LIABILITY of Paragraph
Insurance of
COMMON
., POLICY
primarya. This insurance is toand will no
seek contribution from other
available to the additional insured,, providei
that the additional " # is a named in
othersured under such
b. Regardless of any agreement betweel
you #the additionalinsured,
ance is excess over other
primary.whether ! M "' or t l
any otherbasisfor additional in
sured has been added as an additional in
sured on other policies.
There will be norefund of premium
this endorsement
(2) The names !addressesof
jured persons and witnesses,- and All other policy provisions apply.
Copynght, State Farm Mutual AutomoWte
IncWes oopytighted