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1980-0521_CROSBY COMPANY, T.J._Insurance CertificatetOfdm ' . . •; . NAME AND ADDRESS OF AGENCY -� ' COMPANIES AFFORDING COVERAGES IBlB W Ol C BLVD t COMPANY A - _ LOS LETTER „ t M. PI 1COMPAN tw : B'a"1IlWEJR1Vf4i FYal Vr gifr LETTERY NAME. AND ADDRESS OF INSURED t /� - COMPANY ■ - tlaallTteIRD I� /�/ [MII If'VFEI ./. CD I��w�q�♦• '^cif t�+Ia� ♦ LETTER V wrr COMPANY D yE�f. 2M la, Sth i)fSLC{ G... .. SANTA NAa CA.ICAtfaafraa anfEt ANAOs 0-1iN1�/{ 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 ,. ®PREMISES -OPERATIONS PROPERTY DAMAGE f f ®EXPLOSION AND COLLAPSE HAZARD ® UNDERGROUND HAZARD PRODUCTS/COMPLETED OPERATIONS HAZARD ® CONTRACTUAL INSURANCE BODILY INJURY AND PROPERTY DAMAGE E -- ff 5000 S ��r.'((��tt sw* 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 �E Ctpp� _ 10/1„7/ 80 BODILY BODILY INJURY AND PROPERTY DAMAGE Elft 6 OTHERTHAN UMBRELLA COMBINED FORM WORKERS' COMPENSATION . STATUTORY C and 56 k6 702W W 10/154 EMPLOYERS' LIABILITY a • t (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)