1993-0815_C.B. ELECTRIC_Insurance Certificate ISSUE DATE(MM/DD/YY)
PRODUCF.R , + THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
R W TURN: INSURANCE BROKERAGE CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
34071 LA PLAZA SUITE 210 POLICIES BELOW.
DANA POINT CA 92629 COMPANIES AFFORDING COVERAGE
( 714 ) 240-8350
( 714 ) 240-1436 FAX COMPANY A
LETTER SAFECO INSURANCE COMPANY
COMPANY B
INSURED LETTER FINANCIAL INDEMNITY COMPANY
C B Electric COMPANY C
114 Avenida Sierra LETTER
San Clemente CA 92672 COMPANY D
(714 ) 492-3013 LETTER
COMPANY E
LETTER
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)
A GENERAL LIABILITY GENERAL AGGREGATE $1,000, 000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $1,000, 000
CLAIMS MADE X1 OCCUR. SL 2285548 07/23/93 07/23/94 PERSONAL&ADV.INJURY $1,000,000
OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $1, 000,000
FIRE DAMAGE(Any one fire) $ 50, 000
MED.EXPENSE(Anyoneperson) $ 5, 000
B AUTOMOBILE LIABILITY
COMBINED SINGLE
ANY AUTO LIMIT
ALL OWNED AUTOS
BODILY INJURY
X SCHEDULED AUTOS (Per person) $250 000
HIRED AUTOS C3822874 06/22/93 11/23/93
BODILY INJURY
NON-OWNED AUTOS (Per accident) $500 000
GARAGE LIABILITY
PROPERTY DAMAGE $100, 000
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM / / / / AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION STATUTORY LIMITS
AND / EACH ACCIDENT $
DISEASE--POLICY LIMIT $
EMPLOYERS'LIABILITY —
DISEASE--EACH EMPLOYEE $
OTHER
/ / / /
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
ALL OPERATIONS OF THE NAMED INSURED
ADDITIONAL INSURED: SEE PAGE TWO (2 ) ATTACHED TO THIS DOCUMENT
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF SAN JUAN CAPISTRANO EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
32450 PASEO ADELANTO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
SAN JUAN CAPISTRANO, CA. 92675 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
ATTN: RON S IEVE RS AUTHORIZED REPRESENTATIVE
ACORD:25 S ;
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•
• PAGE 2 9-15-93
' CHARLES D BROWN DBA C. B. ELECTRIC
CERTIFICATE TO CITY OF SAN JUAN ET AL
ADDITIONAL INSUREDS :
The City and the Community Redevelopment Agency, its elected
or appointed officers, officials , employees and volunteers
are included as insureds with gard to damages .
INSURED: CHARLES D BROWN - DBA: C B ELECTRIC
§AFECO®
POLICY NUMBER: SL 2285548 COMMERCIAL GENERAL LIABILITY
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
COMMERCIAL LIABILITY CATASTROPHE COVERAGE PART
SCHEDULE
Name of Person or Organization: **
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.
**
CITY OF SAN JUAN CAPISTRANO
ATTN: RON SIEVERS
32450 PASEO ADELANTO c -
SAN JUAN CAPISTRANO, CA 92675 z''� fir? C30
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10/12/93 QN/EC PSWR AC4 ROBERT W. BURNS INSURANCE BROKER 17-7240
Copyright, Insurance ServicesROffice, Inc., 1985
V°Iv r� *Registered trademark of SAFECO Corporation.
CG 20 10 11/85 PRINTED IN U.S.A.