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
........... . .......