Insurance - AB & R Plumbing - 1999-10-15 Certificate#34037628 • Issue Date: 10/15/1999
•P.O. Box 13456 CERTIFICATE OF INSURANCE RECF, TVED
Sacramento, CA - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
95813-3456 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES OCT U p �nnn
NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I JJJ
(916)566-1000 BELOW. THIS FORM SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES.
COSTA MESA SANITARY DISTRICT
Insured: Certificate Holder:
A. B. &R. Plumbing, Inc.; DBA: Costa Mesa Sanitary District
2284 Rutgers Dr. •Attn: Dawn Schmeisser
Costa Mesa, CA 92626 P. O. Box 1200
Costa Mesa, CA 92628-1200
COVERAGES: 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 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
TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.._ _ _The Insurance Corporation of New York CA IC10016458 02
Commercial General Liability Policy Period: 2/1/1999 to (Continuous until cancelled)
• Description Limit of Insurance
General Aggregrate Liability Limit(Other Than Products-Completed Operations) $1,000,000
Products-Completed Operations Aggregate Liability Limit $1,000,000
Each Occurrence Limit - $1,000,000"
Personal And Advertising Injury Liability Limit $1,000,000
Tenant's Real Property,Legal Liability $50,000 Any One Occurrence
Medical Expense Limit-Any One Person $5,000
Each Occurrence Deductible Applies to Property Damage $500
SPECIAL INFORMATION - - CANCELLATION •
RE: Plumbing operations done by, or on behalf of Should any of the described policies be
the named insured. cancelled, the issuing company will endeavor to
mail 30 days written notice to the certificate
holder. But failure to mail such notice shall
impose no obligation or liability of any kind
upon the company, its agents or representatives.
j
Anne Lehman
Authorized Representative
fIi' If you have,an accident:
Interinsurance Exchange of the
Automobile Club Gct the names antl addresses oC. -all persons in the other vehicle s EVIDENCE OF(L�ABILITY INSURANCE -all persons otherwise involved(in the accident,for example as
yv. \ot
pedestrians:
NAMED INSURED t�13`F'l� \V VV -all e esnIans;
—�° MYERS, ROBERT K. AND COLLEEN Get the driver's license number of the person(s) who drove the
other vehicle(s), and the vehicle(s) license plate, including the
state of registration.
POLICY NUMBER G 4002890 Do not admit responsibility for or discuss the circumstances of
EFFECTIVE DATE 09/22/99 EXPIRATION DATE 09/22/00 the accident with anyone other than the police or an authorized
Auto Club claims representative.
This policy provides at least the minimum amounts of liability Do not disclose your policy limits to anyone.
insurance required by the CA VEH CODE SECTION 16056 for the Immediately report any claim to us at 1-800-672-5246
specified vehicles and named insureds and may provide coverage for (1-800-67CLAIM), 24 hours a day, 7 days a week.
other persons and other vehicles as provided by the insurance policy. For policy changes,call 1-800-924-6141.
IT500564
E1097
VEHICLES DESCRIBED ON POLICY: DRIVERS NAMED ON POLICY:
Year Make Vehicle Identification No.(VIN) Last Name First
1979 CHEV CGL1697192839 MYERS, ROBERT KIRK PATRIC
1998 TOY() 4TAVL52N3WZ174244 MYERS, COLLEEN ANNA
1987 CHEV 1GCGG35K1H7178282 . •
1999 DODGE 2B4FP25B3XR209466
ITS0056o
E1097
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