Loading...
1993-1101_CAPITAL & COUNTIES USA_Insurance Certificate ACOIaO CERTIFICI OF INSURANCE ISSUE DATE(MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE S 1.1:I. 1"I y Curt:L':ii :I:I')iS o r rakers POLICIES BELOW. :':I.(:?f:; M it:i.r'I ;:;'k:r~e 3:;ii COMPANIES AFFORDING COVERAGE COMPANY A LETTER t..:l"I t.)I•.{X:{ (:11"i(.J Li l''' COMPANY " f► – .! i LETTER Z-rrt— rn INSURED rn C COMPANY ` C p . r :). :1. k,':1.I. i• Cour)r)'(•,:I.E.s L.�::)f9 y I.1•i f:: a LETTER m m y 0 1. (.,i::c.1.SI. i:l rt.):L Ct S...e y t .:..!..:: COMPANY DLETTER -- - - -_ - ,— 1 SoFr :1I C 4:1. 1.: COMPANY E � LETTER COVERAGES 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 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 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 PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) ::•. -•v r....,.,,...,...,:•y .) ,� �. .i.i..� .t!' /Cj.�:t GENERAL AGGREGATE $ :.:.1)l)l)4. )t) I�j GENERAL LIABILITY ,h,.!,",`? ,`..:,1. ,L .../ ,: .L:' ... ' COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 20;)r,)O{,)l,)O !CLAIMS MADE3 X OCCUR.'. PERSONAL&ADV. INJURY $ .I.000000 OWNER'S&CONTRACTOR'S PROT! EACH OCCURRENCE $ :1.000')00 I 3 FIRE DAMAGE(Any one fire) $ 50oo MED.EXPENSE(Any one person) $ 5 l.)(:,)O AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS ? BODILY INJURY $ 'SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS A._ EACH ACCIDENT $ AND ----- DISEASE—POLICY LIMIT $ EMPLOYERS' LIABILITY DISEASE—EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS I...:I:CENSE ACRE:I:::ME N T•s 1...01.1 ;?1.!y y •T'I'iA(:;•T' :I.::?9,::4 ATTA (: C.):'0:I.0 : C)f;, A:Cll:+a:'T':C(:)NA1... :I:NN•acLIRE::(:I :I:NF(:)F:i`icfI.T-:I:(:ji''-! CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL RIKIt]XXX-IX K4 (:':I: T'Y' OF SAN •..11.1f`iN (.,'r11=':I:`: T I ,f'ii''Il.lMAIL -y"DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE DEPT OF ENO « .!:sl...t:(l:i . LEFT, XiXrXD(a)(I X-06(NALX>MU Xrk)(0604-KrXXXXX400414114 -rX1KT4D� ::... 4c:.0 1)..,...1.1 ():)I:::....i�iTl (,1 [UFA IXIiM(M XIXMCYXIXEXl .MG144 (X-XXAKA (FXI( XittltU1(XXX9( :.;rlit ... �t.1 f I I'': C:f I I" :1::.: (I:f"11 ti(.1y CA 926 •! AUTHORIZED REPRESS T TIVE ACORD 25-S (7/90) ©ACOR J. POLICY NUMBER: 35'"-21 OMMERCIAL GENERAL LIABILITY 111 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. `ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Rome of Peres' er OrgenizeIon: CITY OF SAN JUAN CAPISTRANO (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 0