1997-0403_HOLLAND-LOWE CONSTRUCTION, INC._Insurance Certificate AC41I:11,, CERTIFICA OF INSURANCE
ISSUE DATE (MM/DD/YY)
" � ... .....:........4/....3/1997.....
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
SP IB Insurance Agency, Inc. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
PO Box 9055 POLICIES BELOW.
Mission Viejo, CA 92690 COMPANIES AFFORDING COVERAGE
(714) 582-5220 Fax (714) 582-3512
COMPANY A CNA/TRANSCONTINENTAL INS. CO.
LETTER
COMPANY B CNA/VALLEY FORGE INSURANCE CO.
INSURED LETTER
MARKEL CEMENT CONTRACING INC. COMPANY C SAFECO INSURANCE COMPANY OF AM
JEZOWSKI & MARKEL CONTRACTORS LETTER
748 NORTH POPLAR COMPANY
ORANGE, CA 92668 LETTER t
6Ce'SO
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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 L�J<
LTR DATE (MM/DD/YY) DATE(MM/DD/YY)
A GENERAL LIABILITY GENERAL AGGREGATE $ 2, 000, 000
X COMMERCIAL GENERAL LIABILITY 1 73265222 PRODUCTS-COMP/DP AGO. $ 1, 000, 000
CLAIMS MADE X OCCUR. 04/01/97 0 6/ 01/ 97 PERSONAL 11 ADV.INJURY $ 1, 000, 000
X OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 1, 000, 000
X PD DED $500 FIRE DAMAGE(Any one fire) $ 100, 000
MED.EXPENSE(Any one pereo 5, 000
AUTOMOBILE LIABILITY COMBINED SINGLE
B X ANY AUTO 1 73265298 LIMIT $ 1, 000, 000—.3
A� 23ALL OWNED AUTOS
04/01/97 06/ 01/ 97 BODILYINJURY� +
SCHEDULED AUTOS (Perperson) �
n)p r- Y' ^' I� rn
X HIRED AUTOS BODILY INJURY 1 m
X NON-OWNED AUTOS (Per accident) ��✓�r D
GARAGE LIABILITY
PROPERTY DAMAGE $ -
EXCESS LIABLRY EACH OCCURRENCE s5, 000, 000
A X UMBRELLA FORM 1 7319 04/01/97 06/01/ 97 AGGREGATE s 5, 0 0 0, 0 0 0
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION X STATUTORY LIMITS
C AND WC 2199693-F 04/01/97 04/ 01/98 EACH ACCIDENT $ 1, 000, 000
EMPLOYERS' LIABILITY DISEASE-POLICY LIMIT $ 1, 000, 000
DISEASE-EACH EMPLOYEE $ 1, 000, 000
OTHER
A LEASED & RENTED 1 73265222 04/01/97 06/ 01/ 97 CONTRAC EQUP $290, 079
EQUIP- $30, 000 CONTENTS $145, 000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
RE:SUBCONTR.#1016C-5,JOB# 1016C PREVENTATIVE ST.MAINT.1996-97;VIA
CALIFORNIA/CAMINO LAS RAMBLAS,AVENIDA AEROPUERTO,MISSION HILLS &
CAPISTRANO VILLAS SPEED BUMPS.CERT.HOLDER IS NAMED ADDIT'L INSURED
W/RESPECTS TO GL PER G-17957-C. (10 DAYS NOTICE OF CANCEL FOR NON-PAY)
CERT CATS<HQ iEI ..> CANOEEL1&TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL EOE6
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
CITY OF SAN JUAN CAPISTRANO LEFT, B sH
LIABRATY S -: SEIdTATIVES.
32400 PASEO ADELANTO AUTHORIZED REPRESENTATIVE
SAN JUAN CAPISTRANO CA 92675
$409:00:$i*cimosior7-
erik
p2' 1 73265222- MARKEL CEMENT CONTRACTING INC.
Fvr A:1 tha Commit",t cc<Yw:d'k%
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
operations hazard".
WHO IS AN INSURED (Section II) is amended to
include as an insured any person or organization 2. T ,a Limits of Insurance applicable to the
(called additional insured) whom you are required to additional insured are those specified in the
add as an additional insured on this policy under: written contract or agreement or in the
Declarations for this policy, whichever are less.
1. A written contract or agreement; or These Limits of Insurance are included within and
not in addition to the Limits of Insurance shown in
2. An oral contract or agreement where a certificate the Declarations.
of insurance showing that person or organization
as an additional insured has been issued; but 3. A person's or organization's status as an
additional insured under this endorsement ends
the written or oral contract or agreement must be: when your operations for that additional insured
are completed.
a. Currently in effect or becoming effective during
the term of this policy; and The insurance provided to the additional insured does
not apply to "bodily injury", "property damage", "per-
b. Executed prior to the "bodily injury", "property sonal injury", or "advertising injury" arising out of an
damage", "personal injury", or "advertising In- architect's, engineer's, or surveyor's rendering of or
jury". failure to render any professional services including:
The insurance provided to the additional insured is 1. The preparing, approving, or failing to prepare or
limited as follows: approve maps, drawings, opinions, reports, sur-
veys, change orders, design or specifications;
1. That person or organization is only an additional and
insured with respect to liability arising out of:
2. Supervisory, inspection, or engineering services.
a. Premises you own, rent, lease, or occupy: or
Any coverage provided hereunder shall be excess
b. Your ongoing operations performed for that over any other valid and collectible insurance
additional insured by or for you. available to the additional insured whether primary,
excess:contingent or on any other basis unless a
The insurance provided to the additional insured written contract specifically requires that this
does not apply to "bodily injury" or"property insurance be primary.
damage" included within the "products-completed
G-17957-C
(Ed. 07/96)