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1977-0816_C.T. & F, INC_Insurance CertificateCERTIFICATE OF INSURAN Primary 2 ® (Insurance) The Exchange or Company designated on the reverse side as number . ❑ Excess Insurance) Excess over Primary with Company designated on reverse side as letter When countersigned by an authorized representative of the Company, this certific�yp§s�?des any previously issued certificates and certifies that the following policy(ies) have been issued to the Insured for the cov age indlcac lr�ll��xx'/'/VVtificate is subject to all of the terms, condi- tions and limitations set forth in the described policy(ies) and endorsemeo fth770, It is furdes�d as a matter of information only and does not change, modify or extend the policy(ies) in any way. b //// e tfp r Named . C T u F INC 13 q Address lJ u5 -i L I UL OAK '37-=T (- `t % I` h, 1� cess Polic or Certificate Number [TELL GARDENS CA X0201 H '/,� 24 67 307 0372 �4 58C Agent Policy Number C? Effective from: -16-71 To: at which time this certificate becomes void ® or until cancelled if this box "X"d. LIMIT(S) INCLUDE 5) BOTH PRIMARI AND EXCESS (if excess applicable) OWNED AUTO- MOBILES, IF COVERED *Includes Goods or Products Warranty, Written Lease of Premises, Easement Agreement, Municipal Or- dinance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless ac- companied by specific endorsement providing additional Contractual Coverage. I YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY IIDENTIFICATION NUMBER POLICY NUMBER Umbrella Liability It is hereby agreed that upon cancellation or termination of this policy or policies /from any cause the Company will moil THIRTY l 30 ) days notice in writing thereof to the other Interest shown below. Other CITY OF SAN JUAN CAP I STRANO Interest 321100 PASEO ADELAN I TO SAN JUAN CAPISTRANO, CA 92675 ATT.N: CITY CLERK **Not applicable in Texas ***Applicable in Texas only 5&0167 6-77 1171 MINTED IN US& ©I LAST 3 DIGITS SHOWN $ ,000 retained limit $ each occurrence aggregate (OKLAHOMA CERTIFICATE) In the event of any material change in or cancellation of said policies, the Company will make every effort to notify the party to whom this certificate is Issued of such change or cancellation, but the Company undertakes no responsibility by reason of any failure so to do. of cancellation of the primary coverage outomati- rrminotes excess coverage. A breakdown of the r limits and the excess limits will be provided up- '(-,� -,?-tom COVERAGE COMBINED LIMITS OF LIABILITY COVERED COVERED AUTO LIABILITY © H Owned & H I RED Bodily Injury $ ,000 each person ❑ I-)iT 1AMY7Non-Owned $ each occurrence ❑ Employer's Non -Ownership Property Damage $ ,000 ,000 each occurrence Contingent Liability GENERAL LIABILITY Bodily Injury $ ,000 each person** ❑ ® IM&C - OLT Owners 8 Contractors $ ,000 each occurrence Contractual* $ ,000 aggregate products Elevators Property Damage $ ,000 each occurrence ❑ ® Products and/or $ ,000 aggregate products - Completed Operations owners 8 contractors protective*** —contractual ***_and/or completed operations*** $ 100 ,000 each occurrence Single Limit Liability for Coverages checked ® above $ N I L ,000 aggregate products ❑ ® CARGO $ ,000 each vehicle $ ,000 each occurrence WORKMEN'S COMPENSATION Statutory *Includes Goods or Products Warranty, Written Lease of Premises, Easement Agreement, Municipal Or- dinance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless ac- companied by specific endorsement providing additional Contractual Coverage. I YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY IIDENTIFICATION NUMBER POLICY NUMBER Umbrella Liability It is hereby agreed that upon cancellation or termination of this policy or policies /from any cause the Company will moil THIRTY l 30 ) days notice in writing thereof to the other Interest shown below. Other CITY OF SAN JUAN CAP I STRANO Interest 321100 PASEO ADELAN I TO SAN JUAN CAPISTRANO, CA 92675 ATT.N: CITY CLERK **Not applicable in Texas ***Applicable in Texas only 5&0167 6-77 1171 MINTED IN US& ©I LAST 3 DIGITS SHOWN $ ,000 retained limit $ each occurrence aggregate (OKLAHOMA CERTIFICATE) In the event of any material change in or cancellation of said policies, the Company will make every effort to notify the party to whom this certificate is Issued of such change or cancellation, but the Company undertakes no responsibility by reason of any failure so to do. of cancellation of the primary coverage outomati- rrminotes excess coverage. A breakdown of the r limits and the excess limits will be provided up- '(-,� -,?-tom