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1995-1018_BRONGO CONSTRUCTION_Insurance Certificate ae���.i�e 1r'� � 1 � r { SjjRtfltil ISSUE DAM tOH8195 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 IYheatman Insurance Services POLICIES BELOW. 18425 Burbank Blvd. ......... ........ ..........._. ..............._. ....... suite 610 COMPANIES AFFORDING COVERAGE Tarzana CA 91356.2809 ......... .._..... ...... .._._ ........_._ ..... LETTER OMPANY A CNA INSURANCE COMPANY COMPANY B INSURED : LETTER COMPANY C Bronpo Construction, Inc. LETTER 33159 Camino Capistrano OD ........ ..._._._._.. .. ................ ......... ............. COMPANY D San Juan CopistraneCA 92675.0000 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, NOTWITHSTM;DING 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,ODA'Y) DATE(MWDDNY) A GENERAL LIABILITY At 29146444 02/05/95 02105196 GENERAL AGGREGATE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY _ PRODUCTS-COMPIOP AGG. 'S 1,000,000 CLAIMS MADE X OCCUR. : PERSONAL&ADV. INJURY $ 1,000,000 OWNER'S&CONTRACTORS PROT, EACH OCCURRENCE 1,000,000 '., FIRE DAMAGE(Any one fire) '$ 50,000 MED.EXPENSE(Any one person)-:S 5,000 A AUTOMOBILE LIABILITY A9 29148458 - 02105195 02105196 : COMBINED SINGLE LIMIT $ 5000000 ANY AUTO X:ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Peram) '$ X HIRED AUTOS - BODILY INJURY X NON-OWNED AUTOS .(Per accident) GARAGE LIABILITY ' PROPERTY DAMAGE E ......:... _.......... ....._... ........ ........ ........._._ ........ ........ ............. _...._ ........... .._...... EXCESS LIABILITY - EACH OCCURRENCE $ '.UMBRELLA FORM AGGREGATE I$ OTHER THAN UMBRELLA FORM STATUTORY LIMITS WORKER'S COMPENSATION ............... _...... ..._.... EACH ACCIDENT '$ AND DISEASE-POLICY LIMIT $ EMPLOYERS'LIABILITY DISEASE-EACH EMPLOYEE $ OTHER O C y t-O 01 JOB RIRIVER STREN OF ET DRA NAGE NIMPROVEMENTS CIDP NO. 145 in-"�r�- m CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS PER THE TERMS OF THE An 3C cr m BLANKET ADDITIONAL INSURED ENDORSEMENT G17957-B ATTACHED TO THE POLICY. 0 v ~ 3 C3'1FI�ATE,I344DER _ _ �`ANCELiJ4TtDN .; SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL KHHHX90®KXAXXXXXX CITY OF SAN JUIN CAPIS7RAN0 MAIL 30 x DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ATTIC. BRIAN PERRY, SR. CIVIL LEFT, BXIR7BR1llO(EJ(RXXdO[Q(16H61AXIi811HH)BH6`CXAfER®�XK)(9EXT61A[K79(&WXXXXXX 32400 PASEO ADELANTO MBKHXXa1(AXK)BM x)oawo )oFKRHNTB60=kX B00(XX SAN JUAN CAPISTRANCA 92675 'EXCEPT In DAYS FOR NON PAYMENT OF PREMIUM AUTHORDED REPRESENTATIVE ERIC D. BERNARDY ppRCF &t718i?I ' �A�QRtk St14V0l1t41 N ilk .s. M CNA • • i'w All the Cemml<me"G Y"a Make' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (called additional insured) whom you are required to add as an additional insured on this policy under: 1. A written contract or agreement; or 2. An oral agreement or contract where a certificate of insurance showing that person or organization as an additional insured has been issued; but: the written or oral contract or agreement must be: (a) currently in effect or becoming effective during the term of this policy; and (b) executed prior to the "bodily injury," "property damage," "personal injury," or "advertising injury." The insurance provided to the additional insured is limited as follows: 1. That person or organization is only an additional insured with respect to liability arising out of a. Premises you own, rent, lease, or occupy or b. "Your work" for that additional insured by or for you. 2. The limits of insurance applicable to the additional insured are those specified in the written contract or agreement or in the Declarations for this policy whichever are less. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. The insurance provided to the additional insured does not apply to "bodily injury", "property damage", "personal injury" or "advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including: 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, design or specifications; and 2. Supervisory, inspection, or engineering services. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. THIS ENDORSEMENT IS A PART OF YOUR POLICY AND TAKES EFFECT ON THE EFFECTIVE DATE OF YOUR POLICY UNLESS ANOTHER EFFECTIVE DATE IS SHOWN BELOW. POLICY CHANGE NO. EFFECTIVE DATE OF THIS POLICY CHANGE COUNTERSIGNED DATE AUTHORI ED REPRESENTATIVE lonpEi G-17957-B (ED. 09/92) ISSUE DATE (MM/DD/M OF Ns . ER 1 Ap� R NVE : 10/18195 ............. ....... 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 Whostmon Insurance Services POLICIES BELOW. 18425 Burbank Blvd. suite BID COMPANIES AFFORDING COVERAGE Tomono CA 91350-2809 COMPANY A TRANSPORTATION INS. CO. ETTER COMPANY B INSURED LETTER COMPANY C Brongo Construction Inc. LETTER 33159 Camino Capistrano #D COMPANY D SonJuon Capistrano CA 92675 LEDER COMPANY E ..................... .......................... .......... .......... ............................... 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 (MMA)DNY) DATE(MM/DONY) ........................... GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&ADV.INJURY $ OWNERS&CONTRACTORS PROT. EACH OCCURRENCE :$ FIRE DAMAGE(My we fire) MED.EXPENSE(My ow person).$ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per mt.) HIRED AUTOS BODILY INJURY (Per accldmt) $ NON-OWNED AUTOS GARAGE LIABILITY PROPERTY DAMAGE $ 'EXCESS UABIURY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE11 OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS A AND WC 1 29148461 02/01/95 02/01/96 EACH ACCIDENT 1000000 DISEASE-POLICY LIMIT S 1000000 EMPLOYERS'LIABILITY . ....... DISEASE-EACH EMPLOYEE It 1000000 OTHER DESCRIPTION OF OPERATIONS(-0CATIONSIVEHICLESISPECIAL ITEMS JOB: RIVER STREET DRAINAGE IMPROVEMENTS CIP NO. 145. ALL OPERATIONS OF THE NAMED INSURED/EVIDENCE OF COVERAGE. ............. A ..... ...-1-1-11-111-.11-11...... .......... ............................ ........ ........ ....... ............ . . ... ................. it SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL=11101311DODDOXXXXXX CITY OF SAN JUAN CAPISTRANO MAIL 30 , DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ATTM. BRIAN PERRY, SR. CIVIL LEFT, Ma)BMXXKKU-WDWANEX)MMgR)GHaLXVARRIXXID�XXXXXXX 32400 PASEO ADELAMTO )MKXDCXRK)aPDMaKDQ70M)DgLXMK4=)4XKA)GDMX)B(XDGGGOaXKMXXXXXXX SAM JUAN CAPISTRAMCA 92675 'EXCEPT In DAYS FOR NON PAYMENT OF PRFMIIJM AUTHORIZED REPRESENTATIVE ERIC D. BERMARDY ........... . .......