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r-- <br />a CERTIFICATE OF LIP <br />THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONI <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENS <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITI <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />ImNURIANT: If the certificate holder is an ADDITIONAL INSURED, the <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of <br />this certificate does not confer rights to the certificate holder in lieu of s <br />PRODUCER <br />StelteFar #. <br />CAL.,. <br />INSURED <br />Eric Shawn Hoge <br />DBA Master Wash <br />PO Box 11835 <br />San Bernardino CA 92423 <br />BILITY INSURANCE DATE IMMIOOIYYYY) <br />ozl2vzozo <br />Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />ITE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />he policy, certain policies may require an endorsement. A statement on <br />ach endorsement(s). <br />Co"T <br />NAMFACT Dan Ching <br />PHONE EM - 909 798 2990 PAX 909 798 0843 <br />AfC No : <br />E-MAIL <br />dnn.chin c s3 <br />ADOREss: 5- 9 @sfatefarm.com <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER A : Siate Farm 25178 <br />INSURER B <br />INSURER C : <br />INSURER D: <br />INSURER E <br />rNSURER F <br />COVERAGES CERTIFICATE NUMBER; <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHEf <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIE <br />^EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM <br />LTR TYPE OF INSURANCE <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE [—] OCCUR <br />I <br />'L AGGREGATE LIMIT APPLIES PER: <br />POLICY171 PRO- ❑ <br />JECT LOC <br />OTHER: <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />AOWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLA LIAR OCCUR <br />EXCESS LIAB H .., .1— <br />APPROVED <br />Y I I V84 4038 C22 75 109/22/2019 109122/202C <br />utV Ht ILNTIONS <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? ❑ NIA <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES iACORD 109, Additional Remarks Schedule, may be attached if more space Is requi <br />Certificate holder is additional insured. <br />TE H <br />RCVISILJN NUPAULK: <br />IED NAMED ABOVE FOR THE POLICY PERIOD <br />DOCUMENT WITH RESPECT <br />TO WHICH THIS <br />ED HEREIN IS SUBJECT TO ALL THE TERMS, <br />i. <br />LIMITS <br />EACH OCCURRENCE <br />$ <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL &ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COMPIOPAGG <br />$ <br />5 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODiLY INJURY (Per person) <br />S 1,000,000 <br />BODILY INJURY (Per accident) <br />$ 1 ,(00,000 <br />PROPERTY DAMAGE <br />Per accident <br />5 1,aaa,aaa <br />5 <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />$ <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />S <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />ad) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Riverside ACCORDANCE WITH THE POLICY PROVISIONS. <br />3900 Main St <br />Riverside CA 92522 AUTHORIZEP REPRESENTATIVE <br />r <br />O 1988-2015ACORD C RPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />1001486 132849.12 03-16-2016 <br />