2023/01/17 Act 1 Construction, Inc.Slatefann STATE FARM@&.
PO Box 2368
Bloonington lL 61 702-2368
DATE OF NOTICE: FEB 03 2023
CODE:
704
AT1 23
m1m5 m93
CITY OF ].IEN I FEE
29E44 HAUN RD
llEN I FEE CA 9?546-6539
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDFESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFOBMATION.Fr::tld
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
Slale Farm Mulual AutomobilE lnsurance Company 1045'FACEA
NAMED INSURED: POLICY NO: 277 9,160.903-75M COVERAGE:
ACT 1 CONSTRUCTTON tNC YB/MAKE/MODEL: NONOWNED AUTO -BI_AND
PD LlABlLlrY
I ++q orH sr VINiCAMPER:I! ruORCOCE 92860.1758 AGENTNAME: TONY FREEMAN
E aGENT PHoNE: (so9)s42-6464
8 ENDoRSEMENT No: 6o28BU PoLlcY EFFEcrlvE
c 6165CS JAN 17 2023 UNTIL TERMINATED
fi POLICY MESSAGES: This polrcy shown above sup€rsedes policy# 2779160-751.
H The policy includes a oss payable clause protecting the additional insured's interesl in lhe described car lo lhe sxtenl o, the insurance
i oroviOed ind subiect io a oolicy grovisions. The additional insured will be given 30 days nolice ii the policy iS lerminated. Until SUch notice
J is provrded, rt shatt be preslrnei itrat tfre required renewal prsmiums have been paid. The additional insured must notily us within 10 days ol
!i any change ot interest or ownershipcoming to lheir atlention. Failur€ to do so will render this policy null and void.
E
ADDITIONAL INSUBED'S NOTICE OF COVERAGE
Stale Farm Mutual Aulomobile lnsurance Company
NAMED INSURED: POLICY NO: 711 4075"423.75E
Acr 1 CoNSTRUCT|ON rNc YR/MAKSMODEL: 2015|NTL TANKTRK
444 6TH sr VIN/CAMPEH: SHAMMMMM6FL600331
NORCO CA 92860-1758 AGENTNAME: TONY FREEMAN
AGENTPHONET (9os)942-6464
ENDORSEMENT NO: 6028BU
1045.FACEA
COVEHAGE:
BIAND PD LIABILIW
SlMIL
$2000 DEo. coMP.
$2000 DE0. coLL.
POLICY EFFECTIVE
JAN 17 2023 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersed€s policy47114o75'75D.
The poticy includ€s a loss payable ciause protecting ttie additional insured's interesi in lhe dsscribed car lo the extenl o, the insuranc€
proviOedlnOsO;ecf fo atipolicy provisions, The additional insured will be given 30 days notice the polrcy rs terminated until such notice
is prouiOed, it st a'tt be preslmed ihat the ,equired renewal premiums havo been paid. The addilional insurod must nolily us within i0 days ol
any change ol interesl or ownership coming to their attention. Failure to do so will render lhis policy null and void.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
Slals Farm Mulual Automobile lnsuranco Company
NAMED INSURED: POLICY NO: 5OO 1614-C31.75O
ACT 1 CONSTRUCTION INC YB/MAKE/MODEL: 2015 FOBD UTILTRK
444 6TH sr VIN/CAMPER: 1 F08W3E63FE808507
NORCO CA 92860.1758 AGENT NAME: TONY FREEMAN
AGENTPHONE: (sos)e42-6464
ENOORSEMENT NO: 60288U
1O45.FACEA
COVERAGE:
BI AND PD LIABILIry
$ 1 l\.fl1
$2OOO DED, COMP,
s2000 DED. coLL.
POLICY EFFECTIVE
JAN 17 2023 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 5001614-75P
Ttre oolicv inctudes a toss oavabie ciause prot€cting ltie additio;al inaured's inl€rest in the describ€d car to lhe exient ol the insurance
proriO"Jino sroir.i to irt'priticy provisioni. The additional insured will bo giv€n 30 days notice il the policy is terminated. Untll such notice
^ is provioeo, it strait be presumed ihat the required r€nowal premiums have been paid. The additional insured must notily us wilhin 10 days ol
fi any cfrange ol interesior ownershrp comingio lheir all€nlion. Failure lo do so will render this policy null and void.
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
Stale Farm Mulual Automobile lnsuranca Company 1045-FACEA
NAMEO INSURED: pOLtCy NO: 569 4oi2-817-75H COVEBAGE:
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 1997 FORD PICKUP BIANo PD LIABILITY
444 6TH ST VIN/CAMPER: 3FTHF25F3VijA5935O $ 1 MIL
NORCOCA 92860-1758 aGENi'HIUE: ioNv rReer,leu $2000 DED. coMP.
eGEHr pxoNg: (9a9)942-6464 s20o0 DED' coLL'
ENDOBSEMENT NO: 6028BU pOLtCy EFFECIVE
PoLlcY MESSAGES: This policy shown abov€ supersedes policy# 5o94ot2-75c. JAN 17 2023 UNTIL TERMINATED
The policy includes a loss payable claus€ protectino the additional insured's inlerest in lhe described car lo lh6 extent o, the rnsurance
provided and subjecl to all policy provisions. The addilional insured will be given 30 days notice il lho policy is t6rminaled, Until such notice
is provided, il shall be presumed that the required renewal pr€miums hav€ been paid. The addilional insured must nolily us within 10 days of
any change ol interest or ownership coming to lh€ir attention. Failure to do so will render thas policy null and void.
AODITIONAL INSUBED'S NOTICE OF COVERAGE
State Farm Mutual Aulomobile lnsurance Company 1045-FACEA
NAMEO INSUHED: pOLtCy NO: 614 6670-Es1-7sF COVERAGE:
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 2019 FORD PICKUP BIAND PD LlABlLrrY
444 6TH ST VIN/CAMPER: 1FT8W3BT3KEEM541 $ I MIL
NoRco cA s2860-17s8 AGEIiiihlitE: ToNy FHEEMAN $2000 DED coMP'
AGEltt iH-iiNt' isos;s+z-o+o+ $2000 DEo' coLL
ENDORSEMENT NO: 6o2dBU pOLtCy EFFECTIVE
JAN 17 2023 UNTIL TERMINATEDPOLICY MESSAGES: This poticy shown above supersed€s poticy* 6146670-75E.
Th€ policy includes a loss payable clause prot€cting the addilional insured's interest in the describBd car lo the extent ol lhe insurance
provided and subject to all policy provisions. The additional insured will be given 30 days nolico il the policy is terminated. Unlil such nolice^ is provded, ilshallbe presumed lhat the required renewalpremiums have be€n paid. The additionat insured musl notily us wilhin 10 days ol$ any change ol inleresl or own€rshrp coming to thear attenlion. Failuro to do so will render this policy null and void.
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ADDITIONAL INSUREO'S NOTICE OF COVERAGE
Slale Fa.m Mutual Aulomobile lnsuranco Company 1045.FACEA
NAMED INSURED: pOLtCy NO: 647 88s1.E20-7sE COVERAGE:
ACT l CONSTRUCTION INC YR/MAKEiMODEL: 2019 FoRD PIoKUP BIANo Po LIABILITY
444 6TH ST vlN/CAMpER: 1FTEW1EpgKKc61s71 $ r MtL
NORCO CA 92860-1758 AGENT NAME: TONY FREEMAN $2000 DED, coMp.
4GEiltifitt't\ii: 1s-odlsaz-ono+ $2000 DED coLL'
ENDORSEMENT NO: 6o2BBU poLtcy EFFECTTVE
PoLlor MESSAGES: This poricy shown above supersedes policy# 6478891-75D. JAN 17 2023 UNTIL TERMINATED
I he poircy includes a loss payable clause prolecting th€ aodilional rnsured,s inl€rest in lhe described car lo lhe extenl ol the inSuranceprovided and subject to all policy provisions. The additional insured will b€ given 30 days notice il the poticy is terminated. Until such noticeis provided, itshall be presumed that the roquired ren€wal premiums have -been paid. ine aoOitionar iniuied musl notily us wilnin to oays otany change of interesl or ownership coming to their attention. Failure 10 do so will render this policy null and void.3
ADDITIONAL INSURED'S NOTICE OF COVERAGE
Stats Farm Mulual Automobi16 lnsuranc€ Company
NAMED INSURED: PoLICY No: 501 7554.E27-75o
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 2016 FOFID PICKUP
444 6TH ST VIN/CAMPEH: 1 FTEXI C PXG KE25255NORCO CA 92860-]758 AGENT NAME: TONYFREEMANAGENTPHONE: (sos)942-6.64
ENDORSEMENT NO: 6028BU
BCXl
1045-FACEA
COVERAGE:
BI AND PO LIABILITY
$1MIL
$2000 DED. COMP.
62000 DEO, COLL.
POLICY EFFECTIVE
POLIC'Y MESSAGES: This poricy shown above supersedes poricy# 5017554-75N. JAN 17 2023 UNTIL TERi'INATED
The policy includes a loSS payable clause protecting lhe add rO;al iniured's rnterest rn lhe described car to the exlent Ol lhe rnsuranceprovloeo and subjecl lo all policy provrsrons. The addrtronal Insured will be Orven 30 days notice il the policy rs terminated. Untrl such nolicois provded. il shall be presumed thal lhe required renewal premiums have ;een paid. ihe ;ddit,o;, Inlu%J must noidf us wtrnin r o oays otany change ol inleresl or ownershrp coming to their atlentidn. Failure to do so wi renOer rfr;s portv nurianO roiO.- - ' -
Xafufann STATE FARMo&.
PO Box 2368
Bloonington lL 61 702-2368
DATE OF NOTICE: FEB 03 2023
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
AODRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
7AA
23
001006 0093
CITY OF IIEI{ I FEE
29844 HAUN RD
I{ENI FEE CA 92586-6539P,1,i*i
tuE
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ADDITIONAL INSUBED'S NOTICE OF COVEHAGE
State Farm Mutual Aulomobile lnsurance Company 1045-FAoEA
NAMED INSUBED: POLICY NO: 580 5701,A07"75I COVERAGE:
ACT 1 CONSTRUCTTON tNC YR/MAKBMODEL: 2007 FORD ptCKUp BIAND PD LIABILITY
! ++1olr-si' - viHlcltupEn: i rrpxr zsozrocz r ss $r'o|lto.o. "o*.iI NORCO CA 92860.1758 AGENTNAME: TONY FREEMAN 6zooo oEo. CoI-I.,E AGENT PHONE: {909)942-6464I ENDoHSEMENT No: 6o2dBU PoLlcY EFFEcrlvEc JAN 17 2023 UNTIL TERMINATED
E POLICY MESSAGES: This policy shown abov€ supersedes policy# 5805701-75H.
i The policy includes a loss payable clause protecting ths additional insured's intorest in the described car 10 lhe exl€nt ol the insurance
E provided and subtect to all polrcy provisions, The additional insur8d will be given 30 days noiice it lhe policy is terminated. Unlil such notice
; is provided, it shall be presumed that ihe required renewal premiums have been paid. The addiiional insured musi nolify us within 10 days ol
g any change ol rnteresl or ownership coming to their attention. Failure lo do so will render this policy null and void.
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ADDITIONAL INSUREO'S NOTICE OF COVERAGE
State Farm Mutual Automobilo lnsuranco Company 1045-FACEA
NAMED INSURED: POLICY NO: s93 73s4-811-751 COVEBAGE:
AcT 1 oONSTRUCTIoN INC YR/MAKE/MODEL: 2017 FORD UTIL TRK AI AND PD LIABILITY
444 6TH ST VIN/CAMPER: 1 FD8W3ET7H EE07815 $ 1 MIL
NoRCocA s2.6o-i758 iCEI+pAf$i, ;?-U[#..,.JF-
- -
*3333BEB:33[
ENDORSEMENT NO: 6o28BU POLICY EFFECTIVE
JAN 17 2023 UNTIL TERMINATED
POLICY MESSAGES: This policy shown abovo sup€rsedes policy# 5937394-75H.
The policy inctudes a toss paya6le ciause protecting the addilional insured'S interesl in the described car to the exl€nl ol lhe insurance
provided ind subject to all poticy provisions. The addilional insured will bs given 30 days notice il lh€ policy is lerminaled Until such nolice
'is proriOea, it ifra'iiOe p,esilmed ihat the required renewal pr€miums have been paid. The additional insured musl notily us within 10 days ol
any change ol interest or ownership com ing io their allenlion. Faiiure lo do so will render this policy null and void
AODITIONAL INSURED'S NOTICE OF COVEBAGE
Stalo Farm Mulual Aulomobilo lnsurance Company 1045-FAoEA
NAMED INSURED| POLICY NO: 711 4o74-A23-75E COVERAGE:
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 2013 INTL TANK TRK BI AND PD LIABILITY
444 6rH sr viNidauiEi: l Hrl\rMAALsDJ2s4o3z !r'#b.D. "or".NORCOCA 92860.1758 AGENTNAME: TONY FREEMAN 5iOOO OEO. COU,
AGENTPHONE: (9os)942-6464
ENDoRSEMENT NO: 6o28BU PoLlcY EFFECTIVE
JAN 17 2023 UNTIL TEBMINATED
POLICY MESSAGES: This policy shown above supsrsedes policy* 7114074'75D.
Itre poticy incluOes a toss payabb ciause protecting the addrtional insur€d's interest in lho described car lo iho extont ol th€ insurance
prorifeO inO suOiect to all'poticy provisions. Tho aidilional insured will be gven 30 days notice il the policy is terminated. LJnlil such notice
^ L provroeO, it strj be presume6 inal lhe required r€newal premiums have b€en paid. The additional insured musl notily us within 10 days ol
$ any change ot interest or ownership comino io lheir atlention. Failure to do so will render this policy nulland void.
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
Stale Farm Mutual Aulomobilo lnsurance Company 1045-FAoEA
NAMED INSUBED: pOLtCy NO: 568 9s44,8r6-75c COVERAGE:
ACT l CONSTHUCTION INC YR/i,AKE/MODEL: 2OO5 FOHD PICKUP BIAND Po LIABILITY
444 6TH ST VIN/CAMPER: 1FTRX12W25NB28O65 $1MlL
NORCOCA 92860-1758 AGENT NAME: TONY FREEMAN $2000 DED coMP'
AGENT PHONE: (909)942-6464 $2000 DEo coLL'
ENDORSEMENT NO: 6ozdsu pOLtCy EFFE6IyE
PoLlcY MESSAGES: This poticy shown above supersedes poticy# s689544-75F. JAN 17 2023 UNTIL TEBMINATED
The policy includ€s a loss payable clause protecling the addilional insured's interest in lhe described car 1o the exient ol lhe insurance
provided and subjecl to all policy provisions. The addilional insurad will b€ gaven 30 days notice il the policy is terminaled. Until such notice
is provided, it shall be presumed that lh€ required renewal promiums have been paid. The additional insured must noiily us wilhin 10 days oi
any change o, interest or ownership coming to their altenlion. Failure to do so will r€nder this policy null and void.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
Stato Farm Mutual Automobile lnsurance Company 1045-FACEA
NAMED INSURED: pOLtCy NO: 462 ss14-E27-7sp COVEFAGE:
ACT I CONSTHUCTION INC YR/MAKE/MODEL: 2016 FORD PICKUP BIAND PD LlABlLlw
444 6TH ST VIN/CAMPER: 1 FTEX1C88GFA21257 $lMlL
NoRcocA s2860-i7s8 aGEHT'iihLiE: roNy FREEMAN $2000 DEo coMP'
aGEur Fxo'[E: r's-os)s+z-o+6a $2000 DED coLL'
ENDORSEMENT NO: 6ozdeu poLtcy EFFECIVE
JAN 17 2023 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes poticy# 4629314-750.
The policy includes a loss payable clause proiecting the additional insured's inlerest in the described car lo the extent of the insurance
provided and subiocl lo all policy provisions. The additional insured will be givon 30 days notice il the FDthy is lerminated. Until such notice
is provided, il shall be presumed lhat the requirod renewal premiums have 6een paid. The additional lnsured must notify us within 1O days ol
any change ol interest or ownership coming lo their attention. Failure to do so willrender this poticy nulland void.
ADDITIONAL INSUBED'S NOTICE OF COVERAGE
Stats Farm Mutual Automobile lnsurance Company 1045-FACEA
NAMED INSURED: pOLtCy NO: s69 1347-Br7-z5E COVERAGE:
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 2OO7 FOBD PICKUP BIAND PO LIABILITY
444 6TH sT VINiCAMPER: 1 FTpx12s37KD42 i 45 $1MrL
NORCO CA 92860-1758 AGENT NAME: ToNY FREEMAN *9q9 PE9 99I4P
A9_ENIPIONE: (909)942-6464 $zuuo UEU' coLL'
ENDORSEMENT NO: 6o28BU PoLIcY EFFECTIVE
JAN 17 2023 UNTIL TERMINATEDPOLIC_Y MESSAGES: Thrs poticy shown above supersedes poticy# 5691347-75D,
The policy rncludes a loss payable claus€ protecting the additional in;ured's interesl in the d€scribad car to the extenl o, the insuranceprovided and subj€cl to allpoticy provisions. Theadditional insu red will be given 30 days notice il the poticy is ierminaled. Untilsuch noticeis provided il shall be presumed that the required r€newal premiums have been paid. ihe additionat insu/ed must n;tiit us wrthin to days otany change ol interesl or ownershp comrng lo their attention. Failure to do so wi rend€r lhis policy nult and void.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
Slalo Farm Mutual Aulomobile lnsurance Company
NAMED INSURED: PoLIcY No:614 3101-E t 5-75c
1045-FACEA
COVERAGE:
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 2019 FoRD PICKUP BI AND PD LIABILITY
444 6TH ST VIN/CAMPER: 1FTEW1oPoKKD279,4 $1MIL
NORCO CA 92860-1758 AGENT NAME: TONY FREEMAN $2000 DED. coMP.
A9-EltFl:6i[tL isos)gnz"o+or $2000oEo coLL
ENOORSEMENT NO: 6o2dBU poLtcy EFFEoIVE
PoLlor MESSAGES: This poricy shown above supers€des poricy* 6143 i o r -75F. JAN 17 2023 UNTIL TE RMINATE D
The policy includes a loss payable clause protecting tlie additioriat in;ured's inlerest in the describ€d carto ths extenl of the insuranceprovided and subiect to all policy provisrons. The additional insured will be grven 30 days notice il the polic, is1;rminated. untit sucn noticea :t_?E:d-"^d: 1.s,1?l_9:,p-,_"::1-ll!,rLlh" reqdired renewal premiums have -been paid. ite aoo ionar iniuiio mutr noi'ry us w,tnin ro oays or
i any cnange ol rnteresl or ownership coming to lheir attenlion. Failure to do so will render lhis policy nu and void.
9
BCXr
stitlefafm STATE FARMq,&.
PO Box 2368
Bloonington lL 61 702-2368
DATE OF NOTICE: FEB 03 2023
CODE:
NOTE: PLEASE NOTIFY STATE FABM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFOHMATION.
704
ZJ
001006 0093
CITY OF ]'IEN I FEE
29844 HAUN RD
I'IEN I FEE CA 9?5A6-6539ffi
8
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ADDITIONAL INSUHED'S NOTICE OF COVERAGE
Stale Farm Mutual Automobile lnsurance Company 1045-FACEA
NAMED INSURED: POLICY NO: 636 1132-A02.75I covERAGE:
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 2019 FOBD UT|L TRK BIAND PD LlABlLlry
444 6rH Sr VIN/CAMPER: iioewserr recszssa $rlllto.o. "orr.NORCOCA 92860-1758 AGENT NAME: TONY FREEI\IIAN iiooooEo.coli.AGENTPHONE: (909)942-6464
ENDORSEMENT NO: 6ozdgu PoLIcY EFFEoTIVE
JAN 17 2023 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 6361132-75H.
Th€ policy includes a loss payabl6 clause protecting the addilional insured's interest in the described car to the exlent of lhe insurance
provided and subject to all policy provisions. The additional insured will be given 30 days notice il the policy is ierminaled. Until such nolice
is provided, it shall be presum€d lhal the required renewal premiums have been paid. The additional insured must noli,y us within 10 days o,
any change ot inlerest or ownarship coming 10 iheir attenlion. Fail!re to do so will render lhis policy null and void.
ADDITIONAL INSUBED'S NOTICE OF COVERAGE
Stale Farm Mutual Aulomobile lnsuranco Company 1045-FACEA
NAMED INSURED: POLICY NO: 609 8506-Bo7-75H COVERAGE:
ACT 1 CONSTRUoTIoN INC YR/MAKE/MODEL: 2OO4 FOBD PICKUP BIAND PD LIABILITY
444 6TH ST VIN/CAMPER: 1 FTRFI 4544 Nc22o2o $ 1 [/tll
NoRco cA e2s6o-17s8 AGENT NAME: roNY FREEI\,IAN I3*P RER !Pl4P'AGENTPHONE: (9os)942-6464
ENOORSEMENT NO: 6O28BU PoLIcY EFFECTIVE
JAN 17 2023 UNTIL TERI/INATED
POLICY MESSAGES: This policy shown above supersedes policy# 6098506-75G.
The policy ancludes a loss payable clause protecting ihe addilional insured's interest in the described car to the €xtent of the insurance
provided and subiect lo all policy provisions. The additional insured will be given 30 days notice il the policy is lerminaled. Until such nolice
^ is provided, it shall be presumed lhat the required renewal premiums have been paid. The additional insured must noli,y us within 10 days ol
N any change ol inlerest or ownership coming lo lheir atlenlion. Failure to do so will render this policy null and void.
I
ADDITIONAL INSURED'S NOTICE OF COVEHAGE
Stale Farm Mutual Automobile lnsuranca Company 1045'FACEA
NAMED INSURED: POLICY NO: 685 6946-C24.75G COVERAGE;
ACT 1 CONSTRUCTIoN INC YR/MAKE/MODEL: 2011 FORD PICKUP BIAND PD LIABILITY
444 6TH ST VIN/CAMPER: 1 FTFX1CT8BFC74225 $ 1 MIL
NoRCocA e2860-1758 aGeHr HafuE: roNY FREEMAN 33333 BEB 33HAGENTPHONE: (e09)942-6464
ENDORSEMENT NO: 6O28BU POLICY EFFECTIVE
JAN 17 2023 UNTIL TERI\,lINATED
POLICY MESSAGES: This policy shown above supersedes policy# 6856946-75F.
The policy includes a loss payable clause prolecling tho addilional insured's interesl ir lhe described car lo lhe extenl o, lhe insurance
provided and subject to all policy provisions. The addilional insured will be given 30 days nolice if the policy is terminated. Unlil such notice
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured musi notify us wilhin 10 days ol
any change of inlerest or ownership coming to lheu attention. Failure lo do so will render this policy null and void.