HomeMy WebLinkAboutInsurance Certificate: Mediation Works
Jun 231001 :18p
JON SNOWDEN S I A II: I-AKM
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CERTIFICATE OF INSURANCE
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This certifies that
STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
STATE FARM GENERAL INSURANCE COMPANY, Bloomington,llIinois
STATE FARM FIRE AND CASUALTY COMPANY, Aurora, Onlario
STAT!: FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
181
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o
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o STATE FARM LLOYDS. Dallas, Texas
insures the following policyholder for the coverages indicated below:
Policyholder 11E::>IATIOK WORKS, A CO/-:)1VNITY OI5PU:S RESOLUTIO~:
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CENTER
33 N CSNTRAL AVE S73 219
MEDFOR~, CR 97501
same as ab::n:e
Address of policyholder
Location of operations
Desc,iption of operations
BJSINESS OfFICE FO~ICY
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance descnbed in Ihese 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 PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period)
Comprehensive BODILY INJURY AND
97-3G-"3222-6 Business Liability 03/31/2010 : 03/3:../2D1::. PROPERTY DAMAGE
----------------------- ----- -tiProd~ds-:-Compl;.;ted-Ope;,;t:ons- - --- -.- - ______n. --. ---. ,-
This insurance includes:.
o Contractual Liability Each Occurrence $1, coe, CJC
o Personal Injury
o Advertising Injury General Aggregate $ 2, o~o, COC
0
0 Products - Compieted $
0 Operations Aggregate
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit)
o Umbrella Each Occurrence S
o Other : Aggregate S
POLICY PERIOD Part I - Workers Compensation - Statutory
Effective Date : Expiration Date
Workers' Compensation Part II - Employers Uability
and Employers Liability Each Accident S
Disease - Each Employee S
, Disease - Policy Limit S
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period)
97-BG-9222-6 CNOC . 0:: !31/2ClO : 03/31/2011 $l,GOO,CJC
:'SOOJCDOJ02JSJ2 Pro: Liaci::'i~y 1l/01l2C09 , 11/01/2010 n, COO, CJC
. :
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGA TIYEL Y
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Name and Address of Certincate Holder
:ITY 0= A~3~kKD ITS O:FICE~S,
~MPLOY~ES S kSENTS
20 ::: EArN .3T
-",SELl'.H:l OR rHS20-13SC
If any of the described policies are canceled before
their expiration date, State Farm will try to mail. a
written notice to the certificate holder 30 clays before
cancellation. If however, we fail to' mail such notice,
no oblig 'on or ilabililywill be imposed on State Farm
or i.ts 9 ts or' presentative
Slgnat ized Represent U
AGENT D6/23/2Jl8
TiUe Date
Jon Snm...den
Agent Name
Te~ephoneNJmber'{541J 482-2~61
Agent's Code Stamp
Agent Code 9A13
AFO Code FO 3
556-994 a 6 Printed in U-s'A. Rev. 05-09.2006