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11/15/2010 12 :52 2813480869 M OSULLIVAN INSURANCE PAGE 05/05 <br /> • � ' <br /> Commercial Certificate of Insurance , S :°°p�-, sr. FARM E RS <br /> Agency • Christopher O'Sullivan <br /> Narne • 20202Iiighw ;sy59N Ste 305 Issue Date (MM/DD/YY) 11/15)201D <br /> Sr. • Humble, TX 77338 -2403 <br /> Address • 2S1-548-0868 This certificate is issued as a matter of information only and confers no right <br /> upon the certificate holder. This certificate does not amend, extend or alter tht <br /> coverage afforded by the policies shown below. <br /> 5t, 19 Dist. 25 , Agent 374 <br /> Companies Providing Coverage: <br /> Insured company A Truck Insurance Exchange <br /> ;FRiSBIE- JONES, ANITA Lau= <br /> Name • A&W JONES COLLISION Company B Farmers Exchange <br /> Latta <br /> & • 1603 W MAIN ST Company C Mid - Century Insurance Company <br /> Address • LA PORTE, TX 77571 <br /> Company D <br /> itttot <br /> Coverages <br /> This is to certify that the policies of insurance listed below have been issued to the Insured named above for the policy period indicated. Notwithstanding <br /> any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance, <br /> `° afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by <br /> paid claims. <br /> Co. Type of Insurance Polio Number Policy Effective Policy Expiration Limits <br /> Lt. y Date pvtM/DDD/vv1 Date (i , /DD/YY) <br /> General Liability General Aggregate $ <br /> Commercial General Products- Comp /OPS <br /> A <br /> Liability <br /> $ <br /> Personal & <br /> - Occurrence Advertising .injury $ <br /> Contractual - Incidental Fach O ttrrence $ <br /> Only Fire Damage <br /> (Any one rue) $ <br /> Owners & Contractors Prat, Medical Expense <br /> (Any nne pcssnn) $ <br /> A Aatnmahife Liahiti , Combined Single <br /> 604863824 11 /15/2010 11/15/2011 Limit <br /> Ali Owned Commercial $ <br /> Autos Bodily Injury <br /> ( Scheduled Autos (Per perm] $ <br /> Hired Autos Bodily Injury $ <br /> ?c Non -Owned Autos <br /> x Garage liability Property Damage $ <br /> - Garage Aggregate $ 2,000,000 <br /> Umbrella Liability Limit • $ <br /> Workers' Compenii ation Statutory <br /> and Each Accident $ <br /> Disease • Each F $ <br /> Employers' Liability Disease - Policy Limit $ <br /> Description of Operations/Vehicles/Restrictions/Special items: <br /> Location: 1603 W Main St La Porto TX 77571 <br /> Garage Keepers Pol#£04863324 Eff 11/15/10-11/15/11 $100,000 per location/ Deductible $500 per auto/ $2500 per incident <br /> Certificate Holder Cancellation <br /> City of La Pe rte Should any of the above described policies be cancelled befog the expiration date <br /> Name 604 West Fairmont Parkway thereof, the issuing company will endeavor to mail 30 days written notice to the <br /> & • La Porte TX 77571 certificate holder named to the left, but failure to mail such notice shall impose nt <br /> A' cirlrzrsc obligation or liability of any kind upon the cos an ' atfg or representatives. <br /> -----.'-------2., . <br /> Authorized Representative <br /> 24137 a -fl' C opy Distribution: Service Center Copy and Agent's Co py H. <br />