2019/08/01 S T Moll Inc dba Integrity Tire Certficiate of Liability InsuranceCERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY)
1 8/1/2019
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(les) 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 endarsement(s).
PROOUCER CONTACT
YouZoom Insurance Services, Inc NAME:
PHONE
6900 College Blvd AIC. - . . . 4 (AA%, W: 877-8&5-1833
E-MAIL
Ste 1000 A65REss. AMServiceCenterO-arruwh�Ladgrp.00m
Overland Park KS 66211 WSURER(S) AFFORDING COVERAGE I NAIC #
INSURED STMOLLI-01 INSURER B: American Guarantee and Liability Insurance 26247
S T Moll Inc
dba Intgrity Tire INSURER C: Great American Alliance Insurance Company 26832
3223 W Florida Ave INSURER D:
Hemet CA 92545
COVERAGES CFRTIFIrATF N11 IIURFR- r,'ARAx;n,.)Q7 01=1110inki K11 IRAOCO
- - - - - - - - - - - - - ---
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 ADDL SUBR� POLICY Err POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER (MM/DD/YYYY), LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
__LMM/DD/_YYYY)
EPK1655749-00
8/1/2019 8/1/2020
EACH OCCURRENCE
$1,000,000
$100,000
PREMISES (Ea Qccurrence)
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$
OEN'L AGGREGATE LIMIT APPLIES PER:
PRO-
POL3CY F-1 JECT F1 LOC
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000.000
$
OTMER:
B
AUTOMOBILE
LIABILITY
EAP1655750-00
811/2019
8/1/2020
COMBINED SINGLE UMrr
(Ea aQN!Pno
$1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
X
—15'ROPERTY —DAMAGE
(Per a dent)
$
C
X
UMBRELLA LIAB
X
JOCCUR
UME188553-00
8/1/2019
8/1/2020
EACH OCCURRENCE
s4,000,000
AGGREGATE
$4,000,000
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTION$ n
Prod/Comp Op!2q
$4.000.000
WORKERS COMPENSATION
PER
AND EMPLOYERS'LIABILrrY Y/N
ANYPROPRIETOR/PARTNER/EXE1_
OFFICER/MEMBER EXCLUDED?
N/A
STATUTE
I JOTH-
ER
$
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
(Mandatory in NH)
if yes, describe under
$
E.L_ DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS below
$
B
Garagekeepers
EAP1655750-00
8/1/2019
8/1/2020
Blanket Limit
960,000
OMRIPTioN or OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Garagekeepers includes On -Hook coverage.
Covered Locations included under the blanket Garagekeepers Limit on the Policy:
3223 W. Florida Ave Hemet CA 92545
24901 Sunnymead Blvd Moreno Valley CA 92553
1267 N Waterman Ave San Bernardino CA 92404
1350 E Washington St Colton CA 92324
34470 Yucaipa Blvd Yucaipa CA 92399
15109 Bear Valley Rd Hesperia CA 92345
See Attached...
�,Ily CIT ivieniTee
City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Menifee ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Rd AUTHORIZED REPRESENTATIVE — — —
Menifee CA 92586 Yot4Zoom,1n4vxa*iceSe"14ew Ince
(9 ISUU-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY
YouZoom Insurance Services, Inc
POLICY NUMBER
CARRIER
ALWI I 1UNAL H hMAH K�i
AGENCY CUSTOMER ID: STMOLLI-01
LOC #:
AnnITIMIAll D=RAADVQ 42t%LJII=n111 C
NAIC CODE
NAMED INSURED
S T Moll Inc
dba Intgrity Tire
3223 W Florida Ave
Hemet CA 92545
EFFECTIVE DATE:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
26920 Newport Rd Menifee CA 92584
27802 Aliso Creek Rd # D1 50 Aliso Viejo CA 92656
(c) 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD