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1977-0202_CROSBY COMPANY, T.J._Insurance Certificate r ®® CERTIFICATE OF INSURANCE Issued to: Named Insured and Address: City of San Juan Capistrano, T,J, Crosby dba: T.J. Crosby Co. , 32400 Paseo Adelanto and Tim Crosby, Individual San Juan Capistrano, California P.O. Box '#16489 92675 Irvine, California 92713 We hereby certify that the following described insurance is in force at this date with: Midland Insurance Company THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS,EXTENDS, OR ALTERS THE COVERAGE AFFORDED BY THE POLICY OR POLI- CIES INDICATED IN THIS CERTIFICATE. LOCATION OF RISK: TYPE OF INSURANCE: Umbrella Liability POLICY OR CERTIFICATE NO.: # UL 389247 PERIOD: From March 6, 1976 To March 6, 1977 LIMITS OF LIABILITY: Difference between primary* and $1,500,000. CSL *General Liability $500,000. Each Occurrence/$500,000. Aggregate Bodily Injury $100,000. Each Occurrence/$100,000. Aggregate Property Damage Auto Liability $250,000. Each Person /$500,000. Each Occurrence Bodily Inj . $100,000. Each Occurrence Property Damage Should the above mentioned contract of insurance be cancelled during the above named policy period, we, the Undersigned, will endeavor to give 10 days written notice to the holder of this document, but failure to give such notice shall impose no obligation of any kind upon the Undersigned or upon the Companies. WORLDWIDE FACILITIES, INC. Dated_February2 , 147 7 cglk�rr I3y W b Additional Insured Endorsement naming City of San Juan Capistrano as Additional Insured request in compliance with requirement with the City of San Juan Capistrano to be handled under separate cover and forthcoming within estimated fourteen (14) days. ' • ENDORSEMENT e Effective Date is aewaidratiaa of tis yrawim 4wmedo it la &Octad the talloviwt sattiftl is bedw rwwad as an additiawal lbewad radar tilt Bona!& ** may as raapaet tis "NWA "s at Wo Jawad bawedr !moi 4Wkb Ess agar IXVW0WW0W is of st>easts and aiirw im in ftm irow empl twat aiti Wo laa/ii at fobs .jab being lib awUaMr dae is 00MUast oawt #3 ol".00 ]Et to ftdbar atn I Yb .*=drag obs abwe **tiff as as atdditiaaal iwwsad MAU tot OWN* to Ines&&* tis 0WWWW'a lidta of lialdlitr as apadtiad M on dasiaeatUM at this palloy. Effective MUM 12:01 AM Standard Time, this Endorsement No. � attached to and made a rt of Policy No. S7 of MIDLAND INSURANCE COMPANY issued to • r*% �'o Cb.. (The information above is required only when this endorsement is issued subsequent to preparation of the policy.) Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, agreements or limitations of this policy other than as above stated. is _ t .................... .. ... 1. e ..... .... ................... . ...... ........ .... .... ..... Karl E. lo.�rf jSacretarr lames P. Craig, Praudient By GCSA-%A-rrrs�/t-�"1� 2/477 at Auth,vris.d Represao tat ive FORM UND.NO.262 (4/]61 laM EXTRA COPY, REPLACES UND.NO.45 ENDORSEMENT s Effective Date 7/31/77 In consideration of the premium charged, it is agreed the following entity is herby named as an additional Insured larder this policy, bgt only as respect the operations of the Named Insureds Specified as Job for major improvements of streets and sidewalks in San Juan Capistrano with the length of the job being 120 calander days in contract cost $31,148.00 It is further agreed thatnaming the above entity as an additional insured shall not serve to increase the Company's limits of liability as specified on the declarations of this policy. Effective 1/31/77 12:01 AM Standard Time, this Endorsement No. 10 attached to and made a part of Policy No. n7'.389247 of MIDLAND INSURANCE COMPANY issued to T. J Crosby Co (The information above is required only when this endorsement is issued subsequent to preparation of the policy.) Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, agreements or limitations of this policy other than as above stated. ............` . .�. .. ...... Karl L Dierr, Seaelary �y Jamas P. Gm 9, Presrdsm By b'�i�-� 4,4 . /[ z 2/4/77 ak Avrhal:ed Represan move FORM UND.NO.262 (4/76) 10M PRODUCI;:'S COPY nrr, nrFc ¢gyp. NO. 45 Allen Jayne Insurance, Inc. 1833 W. Olympic Blv Los Angeles, CA 900M /� . �AMM� (feral cafe ol 4. njurance INSURANCE COMPANIES G=Great American Insurance Company A=American National Fire Insurance Company AG=Agricultural Insurance Company (Herein called the Company) AA=American Alliance Insurance Company In the event of concelation of the policies designated beIow,X Kthe Company 06 mail 10 days prior notice thereof to: NOTE: This Certificate of Insurance neither City of San Juan Capistrano .32400 Paseo Adelanto affirmatively nor negatively amends, extends, San Juan Capistrano+ CA 92675 nor alters the coverage afforded by the policy or policies numbered in this certi- L _J ficote. The Company(ies) as designated below certify that the following insurance policies have been issued to: NAME OFINSURED ADDRESS OF INSURED T.J. Crosby IBA: T.J. CROSBY CO. P. 0. Box 16489, Irvine, CA 92713 o TYPE OF INSURANCE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY BODILY INJURY PROPERTY DAMAGE WORKMEN'S COMPENSATION PC 8952637 9-29-76 STATUTORY NO COVERAGE and EMPLOYERS' LIABILITY 9-29-77 $ 100 000. NO COVERAGE COMPREHENSIVE EACH GENERAL LIABILITY $ OCCURRENCE $ OCCURRENCE $ AGGREGATE $ AGGREGATE MANUFACTURERS'AND $ OACH CCURRENCE CONTRACTORS' LIABILITY $ OCA CCURRENCE $ AGGREGATE OWNERS' AND CONTRACTOR $ EACH OCCURRENCE PROTECTIVE LIABILITY $ DACH $ AGGREGATE OWNERS' LANDLORDS AND TENANTS' LIABILITY $ OACH EACH CCURRENCE $ OCCURRENCE COMPLETED OPERATIONS AND $ EACH EACH OCCURRENCE $ OCCURRENCE PRODUCTS LIABILITY $ AGGREGATE $ AGGREGATE COMPREHENSIVE $ EACH PERSON AUTOMOBILE LIABILITY $ EACH EACH OCCURRENCE $ OCCURRENCE EACH PERSON OWNED AUTOS $ OEACH CCURRENCE $ OEACH CCURRENCE O~ $ EACH PERSON QQ HIRED AUTOS $ OEACH EACH CCURRENCE $ OCCURRENCE OTHER NON-OWNED $ EACH PERSON AUTOS $ OCCURRENCE $ EACH OCCURRENCE COMMERCIAL UMBRELLA $ each Occurrence, aggregate where LIABILITY applicable, in excess of Primary insurance recorded. 0 DESCRIPTION AND LOCATION OF OPERATIONS AND AUTOMOBILES COVERED JOBr Major Improvements of Streets and Sidewalks in San Juan Capistrano. This Certificate is not valid unless countersigned by an authorized representative of the Company./�� Qy/I/�•�''�� February?, 1977 mt "`A�RIZEO flEP� SENTAT E F.40021&7f76 ORIGINAL Allen Jayne Insurance, Inc. 1833 We Olympic Div L � 41 oa Angeles. CA 90 AROERWM eputicate o/ k4urance JLINSURANCE COMPANIES G=Great American Insurance Company A=American National Fire Insurance Company AG_`�M Instr,�Ce n„0., (Herein called the Company) Ak •�v =tom Cama Will In the event of cancelation of the policies designated below, The Company mail 10 days prior notice thereof to: r � NOTE: This Certificate of Insurance neither City of Sen Joan capLattgoD 32400 yeile* Adelanto affirmatively nor negatively amends, extends, nor alters the coverage afforded by the Soo JUsn Capistromo, CIA 92675 policy or policies numbered in this terti- L_ _J ficate. The Company(ies) as designated below certify that the following insurance policies have been issued to: NAME OFINSURED ADDRESS OF INSURED T.J. Crosby ESAo T.J. CXMW CO. !. O. ftn 16499, IrvifM. CA 92713 o TYPE OF INSURANCE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY BODILY INJURY PROPERTY DAMAGE WORKMEN'S COMPENSATION STATUTORY NO COVERAGE and EMPLOYERS' LIABILITY 9,29.77 $ NO COVERAGE COMPREHENSIVE EA E CH GENERAL LIABILITY $ OCCURRENCE $ OCCURRENCE $ AGGREGATE $$R AGGREGATE MANUFACTURERS'AND OCCURRENCE CONTRACTORS' LIABILITY $ OEACH C OCCURRENCE AGGREGATE OWNERS'AND CONTRACTORpp $ EACH $ PROTECTIVE LIABILITY OCCURRENCE $ AGGREGATE OWNERS' LANDLORDS AND TENANTS' LIABILITY R W EAC oCCuRRENCE $ OEACH CCURRENCE COMPLETED OPERATIONS R AND OCCUREACH RENCE $ OCCURRENCE PRODUCTS LIABILITY $ AGGREGATE $ AGGREGATE COMPREHENSIVE $$ EACH PERSON AUTOMOBILE LIABILITY 2 OCCURRENCE OEACH CCURRENCE $ EACH PERSON OWNED AUTOS $ EACH OCCURRENCE $ EACH OCCURRENCE O~ $ EACH PERSON p QQ HIRED AUTOS $ OCCURRENCE $ OEACH CCURRENCE J OTHER NON-OWNED $$ EACH PERSON 2 AUTOS OEACH CCURRENCE S OCCURRENCE COMMERCIAL UMBRELLA $ each occurrence, aggregate where LIABILITY applicable, in excess of Primary insurance recorded. 0 DESCRIPTION AND LOCATION OF OPERATIONS AND AUTOMOBILES COVERED Jane Nsjor Itrprovaysats of Streets and 314swlal s is Sao Joon Capistrano. This Certificate is not valid unless countersigned by an authorized representative of the Company. AUTHORIZED REPRES TATIV F./0021 A—8-T5 Allen Jayn a Ins. Inc. 1833 W. Olympic Blvd tweLL gl CPBWFor Los Angeles, CA 90006 CERTIFICATE OF INSIIRANCE • The City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 THIS IS TO CERTIFY as to the existence of insurance,as of the date of execution hereof,with Harbor Insurance-Company, as described below: Name of Insured: T. J. Crosby .DBA* . T. J. CROSBY CO. , ETAL Address of Insured: P. 0. Box 16489, Irvine, CA 92713 Location of Risk: Major Improvements of Streets and Sidewalks in San Juan Capistrano Kind of Insurance: Comprehensive General Liability Policy No. 125940 period from 10-15-76 to 10-15-77 Limits: Bodily Injury each person $ 500,000. each accident $ 500,000. aggregate $ 500,000. Property Damage—each accident $ 100,000. aggregate $ 100,000. Kind of Insurance: Comprehensive Automobile Liability Policy No. 125940 period from 10-15-76 to 10-15-77 Limits: Bodily Injury each person $ 250,000. each accident $ 500,000. aggregate $ 500,000. Property Damage each accident ' $ 100,00o. aggregate $ 100,000. Kind of Insurance: Policy No. period from to Limits: It is hereby understood and agreed that the certificate holder will be given ten (10) days written notice before any reduction of coverage or cancellation of this insurance is effective. This.Certificate of Insurance is issued as a matter of information only and does not in any way amend, alter or vary the coverage afforded by the policy or policies referred to herein and such policy or policies are subject to endorsement,alteration,transfer,assignment and cancellation according to the terms,conditions and provisions of such policy or policies. Dated at Los Angeles, California this 2nd day of February, 1977 ET RAWFORD p (SEE OVER) CX C.CS�^U BY m{ _m Jayne Insu nc , Inc. mt ENDORSEMENT IT IS UNDERSTOOD AND AGREED THAT THE CITY OF SAN JUAN CBPISTRANO IS (ARE) NAMED HEREWITH AS AN ADDITIONAL INSURED UNDER THE POLICY BUT ONLY IN CONNECTION WITH CONSTRUCTION BY T. J. CROSBY CO. OF MAJOR IMPROVEMENTS OF STREETS AND SIDEWALKS IN SAN JUAN CAPISTRANO. Allen Jayne I sn an�p Inc. Allen J,ayn a ins. Inc. 1833 V. Olympic Blvd tweLL & CrawFar Los Angeles, CA 90006 CERTIFICATE OF INSURANCE The City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 THIS IS TO CERTIFY as to the existence of insurance,as of the date of execution hereof,with Harbor Insurance Company, as described below: Name of Insured: T. J. Crosby DEA: T. J. CFADSEY CO., 3TAL Address of Insured: P. O. Box 16489, Irvine, CA 92713 Location of Risk: Major Improvements of Streets and Sidewalks in San Juan Kind of Insurance: Capistrano Comprehensive General Liability Policy No. 125940 period from 10-15-76 to 10-15-77 Limits: Bodily Injury each person $ 500,000. each accident $ 500,000. aggregate $ 500,000. Property Damage each accident $ 100,000. aggregate $ 100,000. Kind of Insurance: Comprehensive Automobile Liability Policy No. 125940 period from 10_15-76 to 30-15-77 Limits: Bodily Injury—each person $ _ 250,000. each accident $ 500,000. aggregate $ 500,000. Property Damage—each accident ' $ aggregate $ 100,000. 100.000. Kind of Insurance: Policy No. period from to Limits: It is hereby understood and agreed that the certificate holder will be given ten (10) days written notice before any reduction of coverage or cancellation of this insurance is effective. This.Certificate of Insurance is issued as a matter oY information only and does not in any way amend, alter or vary the coverage afforded by the policy or policies referred to herein and such policy or policies are subject to endorsement,alteration,transfer,assignment and cancellation according to the terms,conditions and provisions of such policy or policies. Dated et this day oftR11F(&Z11S'r" y' Los Angllas, California 2nd Er 197 (MM OvZJQ BY -AILL-en Jayne Z Inc mt ENDORSEMENT IT IS UNDERSTOOD AND AGREED THAT THE CITY OF SAN JUAN CAPISTRANO IS (ARE) NAMED HEREWITH AS AN ADDITIONAL INSURED UNDER THS POLICY BUT ONLY IN CONNECTION WITH CONSTRUCTION BY T. J. CROSBY CO. OF MAJOR IMPROVEMENTS OF STREETS AND SIDEWALKS IN SAN JUAN CAPISTRANO. , Allen Jayne In ra , Inc. 0 ENDORSEMENT • NO F> 22 INSURED DBA: T. J. CROSBY CO. , ET AL YY PRODUCER ALLEN JAYNE INSURANCE INC. POLICY THE EFFECTIVE DATE OF THIS ENDORSEMENT IS FEBRUARY 2, 1977 NO' 125940 TYPE OF COVERAGE COMPREHENSIVE GENERAL LIABILITY INCLUDING AUTOMOBILE BFJ/fCS ADDITIONAL INSURED B (CONTRACTING OPERATIONS - FORM 11) IT IS AGREED THAT SUCH INSURANCE AS IS PROVIDED BY THIS POLICY FOR BODILY INJURY LIABILITY - EXCEPT AUTOMOBILE, AND PROPERTY DAMAGE LIABILITY - EXCEPT AUTOMOBILE APPLIES TO THE ADDI- TIONAL INSURED NAMED HEREIN BUT ONLY WITH RESPECT TO OPERATIONS PERFORMED FOR SUCH ADDITIONAL INSURED BY THE NAMED INSURED SUBJECT TO THE FOLLOWING PROVISIONS: A CONDITIONS 1. LIMITS OF LIABILITY. THE LIMITS OF LIABILITY AFFORDED THE ADDITIONAL INSURED SHALL NOT EXCEED THE LIMITS OF LIABILITY REQUIRED BY THE TERMS OR PROVISIONS OF THE PROJ- ECT SPECIFICATIONS, CONTRACT OR AGREEMENT BETWEEN THE NAMED INSURED AND THE ADDI- TIONAL INSURED BUT IN NO EVENT TO EXCEED THE LIMITS OF LIABILITY PROVIDED BY THIS POLICY. 2. THE INSURANCE PROVIDED BY THIS POLICY APPLIES SEVERALLY AS TO EACH INSURED EXCEPT THAT THE INCLUSION OF MORE THAN ONE INSURED SHALL NOT OPERATE TO INCREASE THE LIM- IT OF THE COMPANY'S LIABILITY. INCLUSION HEREIN OF ANY PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED SHALL NOT AFFECT ANY RIGHT WHICH SUCH PERSON OR ORGANIZATION WOULD HAVE AS A CLAIMANT IF NOT SO INCLUDED. 3. NOTICE OF CANCELLATION. THE COMPANY AGREES WITH THE ADDITIONAL INSURED TO PROVIDE TEN (10) DAYS WRITTEN NOTICE BY CERTIFIED MAIL OF REDUCTION IN COVERAGE OR CAN- CELLATION OF THIS INSURANCE. B EXCLUSIONS. THE INSURANCE PROVIDED BY THIS ENDORSEMENT DOES NOT APPLY TO: 1. DAMAGES ARISING OUT OF ANY PROFESSIONAL SERVICES PERFORMED BY OR FOR THE ADDITIONAL INSURED, INCLUDING: (a) THE PREPARATION OR APPROVAL OF MAPS, PLANS, OPINIONS, REPORTS, SURVEYS, DESIGNS OR SPECIFICATIONS AND (b) SUPERVISORY, INSPECTION OR ENGINEERING SERVICES. 2. LIABILITY ASSUMED BY THE ADDITIONAL INSURED. Nuorm ADDITIONAL INSURED PROJECT OR CONTRACT DESCRIPTION THE CITY OF SAN JUAN CAPISTRANO MAJOR IMPROVEMENTS OF STREETS AND 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, SIDEWALKS IN SAN JUAN CAPISTRANO CALIFORNIA 92675 (TERM OF JOB: 120 CALENDAR DAYS) NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY. ALTER. WAIVE OR EXTEND ANY OF THE TERMS. CONDITIONS. OR LIMITATIONS OF THE POLICY TO WHICH THIS ENDORSEMENT IS ATTACHED OTHER THAN AS ABOVE STATED. fflRBOR INSURAtNCE COMPANY 447 DA n°LOS ANGELES, CALIFORNIA THIs STEL °Ar of MARCH, 1977 °Y AUTH&IHE nVE LAB 608 HU 8003-3 (ED. 3-'Z)f20M 6/76)