1998-0917_ORTEGA II_Insurance Certificate %.mn I irIL.R I c ur IfV,Ur[HNI.c
gUCH IMSURANCE. Ila RESPECTS THI SEREST OF THE CERTIFICATE HOLDEI .L NOT BE CANCELED OR OTHERWISE
TERMINATED WITHOUT GIVING 10 DA 'RIOR WRITTEN NOTICE TO THE CERT! FE HOLDER NAMED BELOW, BUT IN NO
EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE
DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW.
ThIs certifies that: [ ] STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington. Illinois. or
CI STATE FARM FIRE AND CASUALTY COMPANY of Bloomington. Illinois
has coverage in force for the following Named Insured as shown below.
Named Insured FRIESS COMPANY BUILDERS INC. — _
Address of Named Insured 31 658 RANCHO VIEJO RD SUITE B
SAN JUAN CAPISTRANO, CA 92675-2777
POLIGYNLIMBfR P47 3958-F19-75 P43 8807-D14-75B C99 7185-C25-75 L36 7527-A15-75C
EFFECTIVE DATE
OFpot.ICY 6/19/98 04/14/96 03/7419A OR/1 c/g$ .- -
DESCRIPTION
VEHICLE 98 GMC DUMP 89 FORD F250 PU 98 gmc VAN 90 FORD F350 PU
VEHICLE
LIABILITY COVERAGE [ J YES Q NO Eij YES n NO [g YES Q NO ;F-' YES [] NO
LIMITS OF LIABILITY ..-
a. Redly Injury
• Person
Each AccId4nt 1 -4-
b. Properly Dealings
Each Accident •
C. Dodly Wtxy$Ropey
Dem‘p Single Levi
_ Each Accident 1 , 000, 000 1 . 000.000 1 .O01L O0 1,nnn nnn
PHYSICAL DAMAGE n YEg 0 NO Q YES [J NO 0 YES El NO Li YES [I] NO
COVERAGES
a. Comprehensive $ Deductible $--- Deductible $ Deductible $ - Deduetble
[1 ^ l -
YES n NO [] YES
Q Np Q YE3 n NO (� YE9 L) NO
b. Col siool $— DeOuctble S_- - Deductble $ _ Deductible $ Deductible
-
EMPLOYER'S r-^�
NON-OWNERSHIP [' J YES ` , NO [x] YES [ ] NO Cil YES [ ]NO 4 YES n NO
COVERAt .
HIRED • • • ERAGE n YES n NO [ ] YES r j NO L$'YES [ ] NO Lid YES [ 1 illNO
�.—� AGENT 8323 09/17/98_
Signature of Authorized Representative T rile Agent a Code Number Data
Name and Address of Certificate Holder _ Name and Address of Agent
CITY OF SAN JUAN CAPISTRANO AND I
CAPISTRANO VALLEY WATER DISTRICT JOHN H. McMAHAN, AGENT
AND S. ALLAN SCHWARTZ & ASSOC. LIC. #0576973
32400 PAS EO ADELANTO STATE FARM INSURANCE COMPANIES
SAN JUAN CAPISTRANO, CA 92675
32221 CAMINO CAPISTRANO 8105
SAN JUAN PLAZA 661-0485
L 1.015 1D SAN JUAN CAPISTRANO, CA 92615
11,(D) O ---1-1 01 1+ he
�
.
col c
0),
32400 PASEO ADELANTO MEMBERS OF THE CITY COUNCIL
SAN JUAN CAPISTRANO,CA 92675 4
U JOHN GREINER
(949)493-1 171 mfAAruAUA WYATT HART
(949)493-1053(FAX) IfIAIIISNfI 1961 GILJONES
176 DAVID M.SWERDLIN
ik
• (16 • CITY MANAGER
GEORGE SCARBOROUGH
•
September 9, 1998
Friess Company Builders, Inc.
31658 Rancho Viejo Road, Suite B
San Juan Capistrano, California 92675
Re: Renewal of Automobile Liability Certificate of Insurance (Ortega II-Construction of Water
Facilities Burger King/Del Taco)
Gentlemen:
The Automobile Liability Certificate of Insurance,regarding the above-referenced project,expired
on August 30, 1998. In accordance with your agreement, the insurance certificate needs to be
renewed for an additional period of one year.
Please forward the updated certificate to the City,attention City Clerk's office,by August 18, 1998.
If you have any questions, please contact me at (949) 443-6310.
Thank you for your cooperation.
Very truly yours,
/CA1 /
Dawn M. Schanderl
Deputy City Clerk
Cheryl Johnson, City Clerk
Craig Harris, Senior Engineering Technician
DRUG USE
IS
di 'A
San Juan Capistrano: Preserving the Past to Enhance the Future
•
Project
FRIESS COMPANY BUILDERS, INC. Management
General
Contracting
FAX TRANSMITTAL Liccnse#706656
To: Dawn Schanderl, Deputy City Clerk
Company: City of San Juan Capistrano
Fax Number: 493-1053
Business Phone:
From: Camela Torrance
Fax Number: (714) 248-8433
Business Phone: (714) 487 9700
Date And Time: 9/17/98 4:24 PM
Pages With Cover: 2
Regarding: Automobile Certificate of Insurance
Comments:
Following please find the updated certificate of insurance you requested.
If you need anything else, don't hesitate to call me directly at (949) 248-1112, ext. 118.
Thank you.
If you do not receive all of the pages indicated or receive illegible copies, please call us
immediately.
31658 Rancho Viejo Road, Suite B • San Juan Capistrano,CA 92675 Tel(714)487-9700 Fax(714) 248-8433