2020/02/04 Craig, Gary DBA Bob & Gary's Certificate of Liability InsuranceCERTIFICATE OF LIABILITY INSURANCE DATE
01/30/20 0 (MMIDDIYYYY)
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 m;y. require;an gndorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
JAMES FREAD, STATE FARM AGENCY _NAE: State farm General Insurances
PHONE
9923 CHANNEL RD 4FX N :819-938-1607
AIL
9atcf i; LAKESIDE, CA 92040 E MD
} INSURERS AFFORDING COVERAGE NAIC 11
7 INSURER A: State Farm General Insurance COI11DanV 25151
INSURED CRAIG, GARY DBA BOB AND GARYS INSURER B: State Farm Mutual
23377 BLUE GARDENIA LN INSURER C: state Farm Fire an
MURRIETA, CA 92562 INSURER O:
COVERAGES CERTIFICATE NUMBER- 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.
INSR
LTR
TYPE OF INSURANCE
A
S BR
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MMIDD/YYYY
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE IS] OCCUR
Y
❑
90EHU2846
02/04/2020
02/04/2021
'
EACH OCCURRENCE
$ 2,000,000
DAMAGE TO RENTED
PREMISES lFa occurrence
$ 300,000
MED EXP Any oneperson)
$ 5,000
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ 4.000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
PRODUCTS - COMP/OP AGG
$ 4,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
�(
❑
2007 GMC (4481)
392 5973-D13-55A
02/06/2020
02/06/2021
COMBINB
Me acciden SINGLt: LIMIT
$ 1.000.000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Peracddenl
$
COMP/COLL
$ 1,000
C
X
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
Y
❑
90EHU2861
02/04/2020
02/04/2021
EACH OCCURRENCE
$ 1.000.000
AGGREGATE
$
DED RETENTION $
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICE/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
e
N / A
❑
90-EB-L917-7
02/01/2020
02/01/2021
WC STATU- OTH-
Y LIMITS ER
E.L EACH ACCIDENT
$ 1,000.000
E.L, DISEASE- EA EMPLOYEIi
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CITY OF MENIFEE IS NAMED AS ADDITIONAL INSURED
JOB DESCRIPTION: LEASED PREMISE
LOCATION: APN#3600500005-01, LOT5-MB234-108TR-22542. NEWPORT ROAD MENIFEE CA 92586
CITY OF MENIFEE
29714 HAUN ROAD
SUN CITY CA 92586
L.ANV ,IzLLA I IUN
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
n 19BB-2010 ACORD CORPORATION- All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.8 01-23-2013