1998-0519_OLIVER-MAHON ASPHALT, INC_Insurance Certificate ISSUE DATE (MM/DD/YY)
>A1:I/I:I1� CERTIFICA OF INSURANCE
:;:........ • 5/19/1998
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Aylor Insurance Agency, Inc. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AWARDED BY THE
23688 El Toro Road Ste 101 POUCIES BELOW. <
Lake Forest, CA 92630 COMPANIES AFFORDING COVERA.G
(714) 581-2333 (Fax) 581-2814 in
COVER PANY MA Transcontinental Insurance' m
LE
c Y B Valley Forge Insurance Compal
INSURED
Oliver-Mahon Asphalt, Inc. Y C Continental Casualty m
LETTER
182 Wells Place
Costa Mesa, CA 92627 COMPANY D
LETTER
•
COMPANY E
LETTER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF PISURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION Lis
LTR DATE (MM/DD/YY) DATE(MM/DD/YY)
A GENERAL LIABILITY GENERAL AGGREGATE 8 2,000,000
X COMMERCIAL GENERAL LIABILITY 0129077603 PRODUCTS-COWCP AGO. S 1,000,000
CLAIMS MADE X OCCUR. 10/03/97 10/ 03/ 98 PERSONAL 6 ADV.IN,xIRY S 1,000,000
X.. OWNERS 8 CONTRACTOR'S PROT. EACH OCCURRENCE S 1,000,000
X Per Project FIRE DAMAGE(Any one fire) s 50,000
MED.EXPENSE(My one person) $ 5,000
AUTOMOBILE LIABILITY COMBINED SINGLE
B X ANY AUTO C120977617 LIMIT S 1,000,000
ALL OWNED AUTOS 10/03/97 10/ 03/98 BODILY INJURY
SCHEDULED AUTOS (Per person) S
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident)
GARAGE LIABILITY
PROPERTY DAMAGE S
EXCESS LIABILITY EACH OCCURRENCE S
UMBRELLA FORM AGGREGATE S
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION STATUTORY LIMITS
C Ay WC1063793644 04/03/98 04/ 03/ 99 EACH ACCIDENT $ 1,000,000
EMPLOYERS' UABILITY DISEASE-POLICY LIMIT S 1, 000,000
DISEASE-EACH EMPLOYEE S 1,000,000
OTHER
A In.Mar ine;Rentd C129077603 10/03/97 10/ 03/ 98 Equip. Limit 86, 626
Leased Equip. Deductible 500
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
The Certificate Holder is named as Additional Insured as respects to
all operations of the named insured per the attached CG 20 10 10 93.
*Except 10 days notice of cancellation for non-payment of premium. *
ERTI�ICATE HOLDEN . CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
City San Juan Capistrano LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
32400 Paseo Adelanto LIABILITY OF ANY KIND UPON THE COMPANY, ITS A S OR REPRESENTATIVES.
San Juan Capistrano, CA 92675 AUTHORIZED REP•Z. fVE de
• :, ACORQ.'CO: .,::RATIO•N..1
>>:ACORD' (7J90}
CL 690
e
(10-931
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 10 10 93
ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement changes the policy effective on the inception date of the policy unless another date is Indicated below.
Endorsement effective Policy No. C129077603
12:01 A.M. standard time
Named Insured Counts by
Oliver Mahon Asphalts Inc. _
(Authorized Reargintattv.i
SCHEDULE _` ;
Name of Peraan os Organiza!lam
City San Juan Capistrano
(If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED(Section II)Is amended to include as an insured the person or organization shown in the Sched-
ule, but only with respect to liability arising out of your ongoing operations performed for that Insured,
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