Loading...
Insurance - Ghai's Tree Services and Landscaping - Workers Comp - 2019-02-14Policy Number: Date Entered: 2/14/2019 A� o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Cheryl Hart—Munoz Insurance 26413 Jefferson Ave Suite F Murrieta, CA. 92562 CONTACT NAME: PHONE C No Ext): (951) 600-0500 FAX No : (951) 332-8000 E-MAIL chart2@farmersagent.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ INSURER A: State Fund INSURED GHAI ' S , INC INSURER B INSURER C: JOSUE HERNANDEZ—ANTONIO 811 WEST 19TH ST SUITE 522 COSTA MESA, CA 92 627 INSURER D: INSURER E: INSURER F: L; vtHAGES CERTIFICATE NUMBER: RFVISInN NIIURFQ- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR, INSD WVD , POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS AUTHORIZED REPRESENTATIVE -� COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE (� OCCUR DAMAGE TO RENTED Li i PREMISES (Ea occurrence) $ i MED EXP (Any one person) $ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GEN'L GENERAL AGGREGATE $ PRO- POLICY El LOC ! JECT i PRODUCTS - COMP/OP AGG $ OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED ! PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE( AGGREGATE _ $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ( A ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A 9242003-18 11/28/2018 I11/28/2019 E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE! $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 r 000 r 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GERTIFIGATE HOLDER CANCFI I ATInN ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced usinq Forms Boss Plus software. www.FormsBoss.com; Impressive Publishinq, LLC 800-208-1977 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced usinq Forms Boss Plus software. www.FormsBoss.com; Impressive Publishinq, LLC 800-208-1977 IMPORTANT - THIS IS NOT A BILL. SEND Nn Mnucv «----.?c&Acarr ac curt nccn HOME OFFICE SAN FRANCISCO POLICY DECLARATIONS CALIFORNIA WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY POLICY THESE DECLARATIONS ARE A PART OF THE WORKERS' COMPENSATION POLICY INDICATED HEREON. CONTINUOUS POLICY 9242003-18 Nothing herein contained shall be' held to vary, alter, waive or extend any of the terms, conditions agreements or limitations of the Policy other than as herein stated When countersigned by a duly authorized officer or representative of the State Compensation Insurance Fund, these declarations shall be valid and form part of the Policy. rc AUTHORIZED REPRESENTATIVE BROKE COPY PRESIDENT AND CEO ,OUNTER IGNED 1N1 ISSUED AT SAN FRANCISCO DECEMBER 19, 2018 POLICY L PAGE 4 OF SCI POR 1 8li1A IRE J- 0 14