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1988-0531_BLAIR PAVING, INC_Insurance Certificateof The Nationwide Insurance Companyated below certifies that the insurance a by the policy or policies numbered and desrAtted below is in force as of effective date of this certificate. This Ce ate of Insurance does not amend, extend, or otherwise alter the Terms and Conditions of Insurance coverage contained in any policy or policies numbered and described below. Certificate Holder's Name and Address: F CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 ATTN: BRIAN PERRY Insured's Nome and Address: BLAIR PAVING, INC. 4226 EAST LA PALMA AVENUE ANAHEIM, CA 92807 Insurance in force only for hazards indicated by X. "SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREON, THE INSURANCE COMPANY WILL XNDEAXWX)TA MAIL 30 DAYS WRITTEN NOTICE TO THE Description of Operations/Locations/ ABOVE NAMED CERTIFICATE HOLDER, BIRD(XXNXntR)DOXKWXX35ftKMRM)C�fi XWXXN Xft Vehicles/Restrictions/Special Items OBXY4ffXWXpRXDaN9JUXX)MXKt(XXdDCMIROt)KXKIR)CANFJ7MX" JOB: SAN JUAN CREEK DRIVE OL /�Q SAN JUAN CAPISTRANO, CA `5 NATIONWIDE MUTUAL INSURANCE COMPANY NATIONWIDE MUTUAL FIRE INSURANCE COMPANY NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANY Columbus, Ohio SANDIE LOCKLIN, #212/ `T(��� q(2 IC'a iv Dote C2rtifdate Issued Countersi ned at: ORANGE, CA "' Secret°`y Presidem -os 31v1. .. 5/31/88 9 Authorized Representative DESCRIPTIVE SCHEDULE TYPE OF INSURANCE POLICY NUMBER AND POLICY EFFECTIVE POLICY EXPIRATION LIMITS OF LIABILITY ISSUING COMPANY DATE DATE GENERAL LIABILITY General L Premises -Operations NATIONWIDE INSURANCE Aggregate 2,000,000. n COMPANY Pr. Comp. Op. Agg. 2,000,000. Products -Completed Operations 73 PR 006171-5004 2/28/88 2/28/89 Each Occurrence 2,000,000. 91 Personal and Advertising Injury Any One Person or Organization 2,000,000. n Medical Expense Any One Person 5,000. L Fire Damage Legal Ajay One Fire 50,000. ❑ Other Liability t ' AUTOMOBILE LIABILITY`' INSURANCE �`". �.,�/Fy"'' �.. 8yOily Injury OCCURRENCE Comprehensive Form NATIONWIDE ;,,•,._,�- Ifach Person) V1 COMPANY _,�_ ® Owned .�, Bodily Injury (Each Accident) IN 73 BA 006171-0001 2/28/88 2/28/89 Hired Property Damage ® Non -Owned Bodily Injury and Property Damage 2,000,000. Combined EXCESS LIABILITY NATIONWIDE INSURANCE Bodily Injury and CE Umbrella Form COMPANY 73 CU 006171-0005 2/28/88 2/28/89 Property Damage Occ A99 Combined 3,000,000. ❑ Workers' Compensation STATUTORY LIMITS Bodily Injury Each Accident and by Accident Bodily Injury Policy Limit ❑ Employers' Liability by Disease Bodily Injury Each Employee by Disease Insurance in force only for hazards indicated by X. "SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREON, THE INSURANCE COMPANY WILL XNDEAXWX)TA MAIL 30 DAYS WRITTEN NOTICE TO THE Description of Operations/Locations/ ABOVE NAMED CERTIFICATE HOLDER, BIRD(XXNXntR)DOXKWXX35ftKMRM)C�fi XWXXN Xft Vehicles/Restrictions/Special Items OBXY4ffXWXpRXDaN9JUXX)MXKt(XXdDCMIROt)KXKIR)CANFJ7MX" JOB: SAN JUAN CREEK DRIVE OL /�Q SAN JUAN CAPISTRANO, CA `5 NATIONWIDE MUTUAL INSURANCE COMPANY NATIONWIDE MUTUAL FIRE INSURANCE COMPANY NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANY Columbus, Ohio SANDIE LOCKLIN, #212/ `T(��� q(2 IC'a iv Dote C2rtifdate Issued Countersi ned at: ORANGE, CA "' Secret°`y Presidem -os 31v1. .. 5/31/88 9 Authorized Representative