1977-0222_C.T. & F, INC_Insurance CertificateCERTOICATE OF INSURWE
Certifit:ote Holder:
r
CITY OF SAN JUAN CAPISTRANO
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CALIFORNIA
In
NAME OF INSURED: C. T. &. F . , INC.
Date.RLwlenVIV 18, 1977
fEe 11 I so PH III
CITY OF
SAN JUAN
CAPISTRANO
J
THIS CERTIFIES THAT THE INSUREDS NAMED ABOVE ARE INSURED FOR:
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 LIMIT
Admiral Insurance Company 8-6-76 $300,000 Combined Single
#6CG1846 to Limit Bodily Injury and
8-6-77 Property Damage
II. STATUTORY WORKMEN'S COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE:
All California operations and all states endorsement.
COMPANY AND POLICY NUMBER TERM EMPLOYERS' LIABILITY LIMIT
III. OTHER INSURANCE AS SHOWN BELOW.
Maine Bonding & Casualty Co. 10-25-76 $1,000,000 Excess of Primary
#003541 to General and Automobile
10-25-77 Liability
IV. SPECIAL PROVISIONS PERTAINING TO THIS CERTIFICATE:
Installation of traffic signal at the instersection of:
Del Obispo St. and Blue Fin Dr.
It is understood and agreed that the certificate holder is included
as an "Additional Insured" but only as respects the operations of
the named insured in respect 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 hepon issued by Companies shown hereon.
Bv: i f w
Ronald B. Mer
rats s
or/d
INSURANCE BROKERS
130 EL CAMINO DRIVE
BEVERLY HILLS, CALIFORNIA 90212
12131 879-1100
FORM C-100 TVV RFV 7.00