Loading...
2019/07/24 Roger K. Kobata Associates, Inc. Certificate of InsuranceCERTIFICATE OF INSURANCE This certifies that STATE FARM FIRE AND CASUALTY COMPANY. Bloomington. Illinois ® STATE FARM (3ENERAL INSURANCE COMPANY. Bloomington, Illinois ❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario ❑ STATE rARM FLORIDA iNSURANCE COMPANY. Winter Haven, Florlda ❑ STATE FARM LLOYDS, Dallas. Texas insures tho ful lowing policyholder for the coverages indicated below: Narne of policyholder ROGER KOBATA M-D Address of policyholder Location of operations Description of operations 15417 CORFIET STREET, SANTA FE SPRING: ;, CA 1 4=7 FORNE'_' S'I'RLET, SANTA E'E SPRTWGFS, CA. 9�'570 LANDSCAPE A-RCBITECT The policies listed below have been issued to the po€icyholder for the po€icy periods shown- The insurance described in these lodicies is subject to all the terns exclusions, end conditions of those policies. The timits of liability shown r'nay have been reduced by any paid claims. POLICY PER10E LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration fate (at beginning of policy period) �.� BODILYINJURY AND l�' � F'r 92-841995-5 Comprehensive r5 0 l� .';.5 r'2�/2L _Eusiness Liability --- -- - ------ PROPERTY DAMAGE - This msorance lnC€odes; © Products - Completed 6perntions ❑ Contractual Liability Underground Hazard Coverage ❑ Person$I Injury ❑ Advertising Injury Each OcCCurrence $1, DOD, W30 General Aggregate $ 2, 000, 000 Explosion Lazard Coverage 0 Collapse Hazard Coverage Products — Completed $ © Operations Aggregate POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Data (Combined Single Limit) Umbrella Each Occurrence $ 0 Other Aggregate Part 1 STATUTORY Part 2 BODILY INJURY 92-Mk-K011-4 Workers' Corn pen sation 07J 4119 07{24/20 and Employers Liability Each Accident $ =, 0go, off i Disease Each Employee $ 000, 0!?o Disease - Policy limit $ 1, 000, 0.--.,7 POLICY PERIOD - LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Ey ration Date (at beginning of policy period) THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS 09 ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREK If any of the described policies are cailce[ed before its expiration date, Statr? Farm will try to mail a written notice toahowever, [der �C days before Name and Address of Carlifir~ase do€oer cancel€an#ail to mail such notice, no obigs be imposed on Slate CITY OF MENIFEE, Farm or itn i 5. 29'114 HAUN R7 MENIFEE CA 92586 Signature of Authorized ffepreeentative AGRIT Q'�l03_G20 rrtle Oita Agent'3 Code Slarrip 550-1294 a 3 0-19" Printed in U.$ A Richard4VGaadl,AgentLie.*U419466 IN 904 F ImperialHighway Brea, CA 92821-5612 rich-goedI.hUf6 statefarm,rom Bus 714-529-3936 Fax 714-529-4355