Loading...
2016/07/15 Dino Perugino Certificate of Liability InsurancePERUDI7 OP ID: EF '4kk � CERTIFICATE OF LIABILITY INSURANCE DA07/22/2016TE Y) 07/22/2016 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 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 Supple -Merrill &Driscoll Inc. Insurance Agents and Brokers P. 0. Box 2408 Pasadena, CA 91102 CONTACT Erika Fuentes PNHME: FAX Arc No E,tt :626-795-9921 ac No :626-577-6656 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Supple -Merrill & Driscoll Inc. INSURER A: Mercury Insurance Group 11908 INSURED Dino Perugino 702 S. Treanor Ave INSURERB: San Dimas, CA 91773-3420 INSURERC: INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: RFVISICMI NI IMRFR- 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. 1�TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DA D PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ JECT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO ALL SCHED AUTOS�ED X AUTOSULED NON -OWNED HIREDAUTOS AUTOS 040104120149615 07/15/2016 01/15/2017 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 25,00 BODILY INJURY (Per accident) $ 50,00 PROPERTY DAMAGE (Per accident) g 2S,OO COMP/COLL $ 500/50 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ DED RETENTION 5 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 2006 CHRYSLER 300C SED 4 2C3LA63H26H509160 2001 CHEVROLE SILVERAD PKP 4 2GCEC19T911396791 L911A 10 Ltl a 4 W-1I 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 Supple -Merrill & Driscoll Inc. U0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD