1980-0521_CROSBY COMPANY, T.J._Insurance CertificatetOfdm '
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NAME AND ADDRESS OF AGENCY
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COMPANIES AFFORDING COVERAGES
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LETTER
COMPANY
LETTER
This Is to certify that policies of Insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requlrement, tern or condition
of any contractor other document with respect to which this certificate maybe issued or may pertain, the Insurance afforded by the policies described herein Is subject to all the
terms, exclusions and conditions of such policies.
COMPANY
POLICY
Limits of L ab II
n ousan s
LETTER
TYPE OF INSURANCE
POLICY NUMBER
EXPIRATION DATE
EACH AGGREGATE
OCCURRENCE
A
GENERAL LIABILITY
GC
4 43I5W
TO/le,Wl
BODILY INJURY
E
f
13 COMPREHENSIVE FORM
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®PREMISES -OPERATIONS
PROPERTY DAMAGE
f
f
®EXPLOSION AND COLLAPSE
HAZARD
® UNDERGROUND HAZARD
PRODUCTS/COMPLETED
OPERATIONS HAZARD
® CONTRACTUAL INSURANCE
BODILY INJURY AND
PROPERTY DAMAGE
E
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5000
S ��r.'((��tt
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BROAD FORM PROPERTY
I� DAMAGE
INDEPENDENT CONTRACTORS
COMBINED
PERSONAL INJURY
af/�f
f HIM
PERSONAL INJURY
AUTOMOBILE LIABILITY
BODILY INJURY
E
(EACH PERSON)
!
A
COMPREHENSIVE FORM
ComC.��t
56 C MVID
p/E
10%15/80
BODILY INJURY
E
OWNED
(EACH ACCIDENT)
HIRED
PROPERTY DAMAGE
f
NON -OWNED
BODILY INJURY AND
PROPERTY DAMAGE
E500,
COMBINED
EXCESS LIABILITY
UMBRELLA FORM
V4 363M
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_ 10/1„7/ 80
BODILY
BODILY INJURY AND
PROPERTY DAMAGE
Elft
6
OTHERTHAN UMBRELLA
COMBINED
FORM
WORKERS' COMPENSATION
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STATUTORY
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and
56 k6 702W W
10/154
EMPLOYERS' LIABILITY
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(E/GM RCCIpEHT)
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
JIM. Calle Aspera Widening
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will mail days written notice to the below named certificate holder, '
NAME AND ADDRESS OF CERTIFICATE HOLDER:
71a 19N
DATE ISSUED: ^ '
CM OF SAM JOAN CAPISTRAMtJ
32400 PAM AOELAW
San JUAN CAPISTRAMO, CA. 92675
AUTHO D REPPESENTATIVE
ACORD 25 (1.79)