1977-0201_C.T. & F, INC_Insurance CertificateCERT#ICATE OF INSUR WCE
Certificate Holder:
r
City of San Juan Capistrano
32400 Paseo Adelanto
San Juan Capistrano, Calif.
A
NAME OF INSURED:
C. T. b F., INC.
6853 Live Oak St.
Bell Gardens, Ca.
RECEIVED
FEB 2 111G AM Ill
92675 CITY OF
SAN JUAN
CAPISTRANO J
90201
Date: 2/1/77
THIS CERTIFIES THAT THE INSUREDS NAMED ABOVE ARE INSURED FOR:
A
I. COMPREHENSIVE GENERAL AND AUTOMOBILE LIABILITY: All Operations, covering the liability imposed by law or
assumed under contract for Personal Injury to persons or Damage to Property of others.
COMPANY AND POLICY NUMBER TERM
ADMIRAL INSURANCE CO.
POLICY N 6 CG 1846 8/6/76 - 77
MAINE BONDING fa CAS.
POLICY #VW 002113 11/1/75 - 76
LIMIT
$300,000 CSL Comprehensive
General Liability
$3,000,000 Excess of
Primary $300,000
FARMERS EXCHANGE
93723158 8/20/76 - 77 $300,000 CSL Automobile
II. STATUTORY WORKMEN'S COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE: Liability
All California operations and all states endorsement.
COMPANY AND POLICY NUMBER TERM EMPLOYERS' LIABILITY LIMIT
III. OTHER INSURANCE AS SHOWN BELOW.
INCLUDES: COMPREHENSIVE PERSONAL INJURY AND PROPERTY DAMAGE LIABILITY,
CONTRACTUAL LIABILITY, CONTRACTOR'S PROTECTIVE LIABILITY, AND PRODUCTS
AND COMPLETED OPERATIONS.
IV. SPECIAL PROVISIONS PERTAINING TO THIS CERTIFICATE:
Installation of Traffic Signal Del Obispo St. at Blue Fin Dr.
It is understood and agreed that the certificate holder is included as an additional
insured Wt only as respects the operations of the named insured in respects to work
performed for the city.
In the event the above policies should be cancelled, assigned or the amount of coverage reduced during the policy term, the
undersigned will give THIRTY (30) days' written notice to the above name holder of this CERTIFICATE by registered mail.
This certificate of insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by Policy
Numbers shown hereon issued by Companies shown hereon.
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By: / r
77
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INSURANCE BROKERS
130 EL CAMINO DRIVE
BEVERLY HILLS, CALIFORNIA 90212
12131 878-1100
FORM C-100 TW Ril 7 .11
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