HomeMy WebLinkAboutPermit Miscellaneous 1992-9-14
1\:; IS NOI MJ INSURANCE POLICY. THIS IS ONL Y A VERIFIGA1ION OF INSURANCE. IT DOES NOT IN ANY WAY AMENO, F.XH:M.I OH ~,ll L j
",()JLH,\GE PI10VIUED BY lHE POLICIES LISTED BELOW,
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O~A tJH IT6 C/;VUP ::J6W6t.6fL-.1
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dlis i~ to certity fhat policies for the above named ifiSured Bre in force as follows:
This In,erim Certlllrete As To Evidence of Insurance shall expire sixt~ days from t 1-:. , AM" '
q I tJ t 19 i..~ess cancelled prior to such date by wrlUen notice to the named.insuted.
0.. Please is~ue 'a Permanent Cortificate
COVERAGE
NOT
COVERED
Ii!J Owned
lB Hired
[B , Non-Owned
[B Employer's Non-Ownership
Contingent Liability
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Inli\Jllld .
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MARGIN
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741 7896
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TRUCK INSURANCE EXCHANGE
INTERIM CERTIFICATE AS TO EVIDENCE OF INSURANCE
TOB
TOB
o 34q/- O(J~ /
~P;;-li;-':-i~;;;'I:i;t~:" .
7 ].-/ }/ - 3 Y. ______.. ..,.
Agen, POllC)" ,",vi" l,ier,'
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F~;V;-:CAriC:'0-' ..,
h,I,cy' .Wvit'l:~;;.r~...""
COMBINED LIMITS OF LIABILITY
AUTO
LIABILITY
Bodily Injury
$
$
$
,000 sactl f,lAfSOtl
,000 each 00(' ,irrunc!l
,000 each OCCUlror..:.o
Property Damage
Singla Limit liability for Coverages cttecked [X] above
GENERAL. LIABILITY
[ M&C - OL T
DOwners & Contractors
Contractual. $ _.________ .000 ~~:~~1,~~f''2~':
Elevators Property Damage $ _____ ,000 each i.:;CUlrO,'\Ln
- 0 ~~o~~~re~"8~~~ations $ ,______ ,000 ~~lr~~;I~QrA'.i.l~
._____._ _____._.__,_.,,_...__ n_ ... .,._... ..... ...
SIngle Urn II Liabllily tor Coverages checked !XI abovo J ^" .
$ -!-t_1L.'t!!.0- ,000 6~Ctl lJr..CII.flllIlCl'
___~_ _.___....~...m_.________.__..._n_~:!J----QD~- ...:.~ ~~~~rl~ttr.I;__.,.
~
1%1.
~
o
$
,q.oo C3(,h CoI.;CUrI&flr'l:'
-,---- .-.-.- --. --........ .
- -- ---
. ..__... __.0 n.....__. _...._......_.__ _.... ._____.._____.______'_.._ .
" ,
Bodily Injury
$ _ .__ ,000 each pnl!:.'t,(1 ~ '.
$ __~_.____~__ .000 elJ(;h (oCClll I!il,:
o
CARGO
$
$
--.-,.....-..~~~._~.~". .~'_.,-
1000 earh \'IJhicle
__...-::.:=_:.000 e::t('~.~~I!~I':::,~_____.
o D CO:~::::~:ON Statuto,,,
* Includes Goods or Products Warranty, Written Lease of Premisos, Easement Agroement, Municip31 0rdiflO'\',"o
Agreement1 Sidetrack Agreement, Elevator or Escalator_ Maintenance Agreement only, unless accornp3ulod ~IY
specific enaorsement provlding additional Contractual Coverage"
/ D~'t...,. De:r:::'....'
OWNED
Al,T..-J.
M.JnIU:S.
"
(;QVEfIEIJ \.
VEAR. MAKEL!!.PE OF BODY, LOAD CAPACiTY
_~t?~!!!~~!.CAT!e..t! NlIMO!:R
1.~!;1 .,
DII,;n~)
SH(!\tN
POLICY NUMBER
"mbrella Liability
,000 rclalnf.ld linm
each OCCUfIEtnc(,
399r0931 0
$
$ -----
$
II the Interim Certificate As To Evidence Of Insurance is 10 be cancelled prior to the expiration dale, we Shllll
provide ____ days edvance nolleeln writing 10 whom this certllicete Is Issued. VENN VH.f.NAS
, FARMERS INSURM<r;,: GP.OUP
870 WfST CEliT,;NNIH
SPBlNGFlELD, OR \;'/4'/']
L.... Ilo.n (W) 741-22BO (H) 48,;..\,1{;9
Number
Cllnilice.le i'5suec11o:
Criv Or:: SP(2.../rVGFJ€o/-E
,lP~~ G~,O~L- ~~~~ :/7 n 7 Co~nl.rsign.d ~ ___.___.: ..__...
. /Aulhorlro6 Rep,es."lal'~.
*. fJol Applicable in T exes, V
'* '" '* In Texas the aggregate also applies to ownerG and contraclors proltlclive, conlraclual and' or compleled operallons.
b6-0514 2.9(1 1651 W/200 C/1200
Nall1u
And
Addreu
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