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1975-0507_CAL FED ENTERPRISES_Certificate of Insurance• n 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