1975-0507_CAL FED ENTERPRISES_Certificate of Insurance•
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THIS IS TO CERTIFY THAT THE COMPANY INDICATED BY AN "X" HAS ISSUED
THE POLICY OR POLICIES LISTED. THIS CERTIFICATE OF INSURANCE NEITHER The Maryland
AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COV-
ERAGE AFFORDED BY SUCH POLICY OR POLICIES. M s
NAME ANO ADDRESS OF INSURED:
Zellner Communities, Inc.
4000 Birch St.
Newport Beach, California 92660
IssDEO AT REQUEST OF
City of San Juan Capistrano �pCttftlE[tp of�1tS1IrFl1lCP
San Juan Capistrano, Ca. 92675
❑ OZ MARYLAND CASUALTY COMPANY
❑ 07 NORTHERN INSURANCE COMPANY OF NEW YORK
❑ 08 ASSURANCE COMPANY OF AMERICA
TYPE OF INSURANCE
POLICY NUMBER
POLICY PERIOD
LIMITS OF LIABILITY
WORKMEN'S COMPENSATION AND
STATUTORY WORKMEN'S COMPENSATION
EMPLOYERS' LIABILITY
,000 EMPLOYER'S LIABILITY
GENERAL BODILY INJURY
EACH OCCURRENCE AGGREGATE
LIABILITY
GL -28302247
1/15/75-78
$ 1,000 ,000$ .000
GENERAL PROPERTY DAMAGE
EACH OCCURRENCE AGGREGATE
LIABILITY
II
11
$ 1'000 '000 $ '000
AUTOMOBILE BODILY INJURY
EACH PERSON EACH OCCURRENCE
11
II
$ 1,000 1000 $ •000
AUTOMOBILE PROPERTY DAMAGE
EACH OCCURRENCE
LIABILITY
11
11
$ 1,000 ,000
CHECKMATE POLICY (BLANKET
EACH OCCURRENCE AGGREGATE
EXCESS LIABILITY COVERAGE)
UB -16078164
11
$ 1,000 ,000 $ 1,000 000
Such of the following extensions of coverage are in effect as are indicated by ®:
GENERAL LIABILITY
® COMPREHENSIVE POLICY FORM
® EXPLOSION AND COLLAPSE HAZARD EXCLUSIONS DELETED
® UNDERGROUND HAZARD EXCLUSION DELETED
® BROAD FORM PROPERTY DAMAGE LIABILITY COVERAGE
® CONTRACTUAL LIABILITY IAS DEFINED IN POLICY)
® PRODUCTS AND COMPLETED OPERATIONS COVERAGE
0
AUTOMOBILE LIABILITY
® COMPREHENSIVE POLICY FORM
® EMPLOYER'S NON -OWNERSHIP AND HIRED AUTOMOBILE COVERAGE
0
DESCRIPTION AND LOCATION OF OPERATIONS TO WHICH ABOVE POLICIES APPLY:
IN THE EVENT OF CANCELLATION OF THE INSURANCE THE COMPANY FEES TO GIVE
NOTICE TO THE PARTY AT WHOSE REQUEST THIS CERTIFICATE IS ISS
DATE: 3/4/75 By
Authorized Representative
i
3499 Rev. B-73