Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
1977-1120_C.T. & F, INC_Insurance Certificate
Primary CERTIFICATE OF INSURANCE* ® (Insurance) The Exchange or Company designated on the reverse side as number 2 , ❑ (Exss Insunce) Excess over Primary with Company designated on reverse side as letter When countersigned by on authorized representative of the Company, this certificate supersedes any previously issued certificates and certifies that the following policy(ies) have been issued to the Insured for the coverage indicated. This certificate is subject to all of the terms, condi- tions and limitations set forth in the described policy(ies) and endorsements thereto. It is furnished as a matter of information only and does not change, modify or extend the policy(ies) in any way. Named Insured Address Effective from: To: LIMIT(S) INCLUDE(S) BOTH PRIMAR' AND EXCESS (if excess applicable) OWNED AUTO- MOBILES, IF COVERED C T& F INC 683 LIVE OAK ST BELL GARDENS CA 90201 11-20-77 Excess Pt or certifirote Number 29 67 307 972 34 58C Agent policy Number at which time this certificate becomes void IN or until cancelled if this box -X"6. *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 I IDENTIFICATION NUMBER POLICY NUMBER Umbrella Liability N Is hereby agreed that upon cancellation or termination of this policy or policies from any cause the Company will mall THIRTY ( 30 ) days notice In writing thereof to the other Interest shown below. Other Interest CITY OF SAN JUAN CAPISTRANO 3o2400 PASEO ADELANITO SAN JUAN CAPISTRANO CA 92675 ATTN: CITY CLERK s*Not applicable in Texas ***Applicable in Texas only 9-77 1231 PRINTED IN USA. Q 1 LAST 3 DIGITS SHOWN 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. Notice of cancellation of the primary coverage automati- cally terminates excess coverage. A breakdown of the primary limits and the excess limits will be provided up- on demand. CountersignedL . , t�Abthbri ads Representative - �L_ COVERAGE COMBINED LIMITS OF LIABILITY COVERED NOT COVERED AUTO LIABILITY ® ❑ Owned & HIRED Bodily Injury $ ,000 each person ❑ ® AN"" Non -Owned $ ,000 each occurrence ❑ ® Employer's Non -Ownership Property Damage $ ,000 each occurrence Contingent Liability GENERAL LIABILITY Bodily Injury $ ,000 each person ** M&C - OLT $ ,000 each occurrence ❑ © Owners & Contractors Contractual* $ ,000 aggregate products Elevators Property Damage $ ,000 each occurrence ❑ ® Products and/or $ ,000 aggregate products Completed Operations owners & contractors protectives** —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 F1 FA 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 I IDENTIFICATION NUMBER POLICY NUMBER Umbrella Liability N Is hereby agreed that upon cancellation or termination of this policy or policies from any cause the Company will mall THIRTY ( 30 ) days notice In writing thereof to the other Interest shown below. Other Interest CITY OF SAN JUAN CAPISTRANO 3o2400 PASEO ADELANITO SAN JUAN CAPISTRANO CA 92675 ATTN: CITY CLERK s*Not applicable in Texas ***Applicable in Texas only 9-77 1231 PRINTED IN USA. Q 1 LAST 3 DIGITS SHOWN 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. Notice of cancellation of the primary coverage automati- cally terminates excess coverage. A breakdown of the primary limits and the excess limits will be provided up- on demand. CountersignedL . , t�Abthbri ads Representative - �L_