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1980-0521_CROSBY COMPANY, T.J._Insurance Certificate (2)
911ertifirate of Insuranrnio NAME AND ADDRESS OF AGENCY AFFORDING COVERAGES ALLEN JAYNE 1M5.INC.COMPANIES • I 1,833 W. OLYMPIC kvq COMPANY e LOS ANGELES, CA 90M LETTER al HARTFORD TNSI]RANr.F COMPANY TEL: (213) 362.6331 COMPANY LETTER B INSURANCE COMPANY OF THE WEST NAME AND ADDRESS OF INSURED COMPANY LETTERETTER C HARTFORD INSURANCE COMPANY T.J. CROSBY CO., INC. COMPANY D 2836 W. 5th STREET SANTA ANA, CA.IFORNIA LETTER COMPANY E LETTER This is to certify that Dolydes of insurance listed below he" been issued to the insured named above and are in force at this time. NoUNthstanding any reQuImment, term or condition M any contract or other document with respect to which this certificate may be 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 o 8 I In Thousands LETTER TYPEOFINSURANCE POLICY NUMBER EXPIRATION DATE EACH AGGREGATE OCCURRENCE A GENERAL LIABILITY 56 C 431570 10/15/80 BODILY INJURY $ $ ® COMPREHENSIVE FORM ® PREMISES—OPERATIONS PROPERTY DAMAGE $ S ® EXPLOSION AND COLLAPSE ® HAZARD UNDERGROUND HAZARD ® PRODUCTS/COMPLETED OPERATIONS HAZARD BODILY INJURY AND ® CONTRACTUAL INSURANCE PROPERTY DAMAGE $ 500, $ 500, ®BROAD FORM PROPERTY COMBINED LJ,I DAMAGE INDEPENDENT CONTRACTORS PERSONAL INJURY s INCL PERSONAL INJURY AUTOMOBILE LIABILITY BODILY INJURY : (EACH PERSON) A COMPREHENSIVE FORM 56 C 431570 10/15/80 BODILY INJURY $ OWNED (EACH ACCIDENT) HIRED PROPERTY DAMAGE s NON -OWNED BODILYM AND PROPERTY DAMAGE COMBINED EXCESS LIABILITY BODILY INJURY AND © UMBRELLA FORM UC 363632 10/15/80 PROPERTY DAMAGE $1,000, $1,000, B IL1 OTHERTHAN UMBRELLA COMBINED FORM WORKERS' COMPENSATION STATUTORY C anL1ABILITY 56 WB 702857 W 10/15//80 , EMPLOYERS' $ (crcn mrNT) OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES JOB: Calle Aspero Widening Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- pany will mail _i_ days written notice to the below named certificate holder,%XjXX0)0tXXK )4f6XSX X�XXd(d(s�xiW�tic�ilXd(�XXX�Qi(oC�XrX1zXX�(KOGbXAiDiXXax�avjsX�(TYaX NAME AND ADDRESS OFCERTIFICATE HOLDER: May 21, 1980 DATE ISSUED: CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANTO San JUAN CAPISTRANO, CA. 92675 v AUTH0 ED REP)IIESENTATIVE ACORD 26 (1.79) -