2020/01/01 Blackmore Co, LLC Certificate of Liability Insurance ,4v►zv� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
12/30/2019
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(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 CONTACT Carrie Stubblefield CISR
NAME:
James G Parker Insurance Associates PHONE (559)222-7722 �C Nu; (559)222-1724
License#0554959 ADDREAIL SS: CarrieStubblefield@jgparker.com
P 0 BOX 3947 o INSURER(S)AFFORDING COVERAGE NAIC#
Fresno 1 Insurance Co of the West .27847
p INSURERA:
INSURED ' INSURER B:
Blackmore Co LLC INSURER C:
Blackmore Equipment Co INSURER D:
27840 Del Rio Rd INSURER E:
Temecula CA 92590 INSURERF:
COVERAGES CERTIFICATE NUMBER: 20-21 WC REVISION NUMBER:
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.
IN SR TYPE OF INSURANCE POLICY Y yy POLICY Y E%P LIMITS
LTR I WVD POLICY NUMBER µµIOpIYWY MMIOOIYYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR -PREMISES tE occurrence $
MEDEXP(Any one person $
PERSONAL&ADV INJURY $
GE14LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $
J PRO-
POLICY PRRO ❑ LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANYAUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
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 X STA UTE OTH-
ANDD EMPLOYERS'LIABILITY YIN 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $
A OFFICER/MEMBEREXCLUDED? �Y N/A WSA504537501 01/01/2020 01/01/2021
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
CERTIFICATE HOLDER CRY OT IvIenifee CANCELLATION
lyUerk
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 r C 92586 zs p4g:
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