2021/07/24 Roger Kobata and Associates558-994 a.3 04-1999 Printed in U.S.A.
CERTIFICATE OF INSURANCE
This certifies that STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Name of policyholder ROGER KOBATA AND ASSOCIATES
Address of policyholder 15417 CORNET STREET, SANTA FE SPRINGS, CA 90670
Location of operations 15417 CORNET STREET, SANTA FE SPRINGS, CA 90670
Description of operations LANDSCAPE ARCHITECT
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY
(at beginning of policy period) Effective Date Expiration Date
92-841995-6 Comprehensive 05/27/22 05/27/23 BODILY INJURY AND
Business Liability PROPERTY DAMAGE
This insurance includes: Products - Completed Operations
Contractual Liability
Underground Hazard Coverage Each Occurrence $ 1,000,000
Personal Injury
Advertising Injury General Aggregate $ 2,000,000
Explosion Hazard Coverage
Collapse Hazard Coverage Products – Completed $
Operations Aggregate
EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
(Combined Single Limit) Effective Date Expiration Date
Umbrella Each Occurrence $
Other Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
92-GA-K011-4 Workers' Compensation 07/24/21 07/24/22
and Employers Liability Each Accident $ 1,000,000
Disease Each Employee $ 1,000,000
Disease - Policy Limit $ 1,000,000
POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY
(at beginning of policy period) Effective Date Expiration Date
560-7563-F03-75 2017 TOYOTA 06/03/22 12/03/22 1,000,000 CSL
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Project: FY2022/23 ON-CALL LANDSCAPE DESIGN AND INSPECTION
SERVICES
City of Menifee and its officers, employees, agents and
authorized volunteers
Name and Address of Certificate Holder
CITY OF MENIFEE
29714 HAUN RD
MENIFEE CA 92586
If any of the described policies are canceled before its
expiration date, State Farm will try to mail a written
notice to the certificate holder 30 days before
cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State Farm
or its agents or representatives.
Signature of Authorized Representative
AGENT 06/22/2022
Title Date
Agent’s Code Stamp
AFO Code F419
DocuSign Envelope ID: 7A0A9C06-C016-48C2-A4CF-5EF23F8F3E6C