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1994-0329_J & W FARMS_Insurance Certificate A4.41ia). CERTIFICA' OF INSURANCE ISSUE DATE(MM/DD/YY) 3-29-94 PRODUCER 1 56 03 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE GIMLIN & UDY INSURANCE AGENCY DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 60 1 DAILY DRIVE , # 117 POLICIES BELOW. CAMARILLO, CA 93010 COMPANIES AFFORDING COVERAGE COMPANY LETTER A CALFARM INSURANCE COMPANY. COMPANY B INSURED LETTER L JOHN KOTAKE & WILLIAM KOTAKE COMPANYC rn - -a—' c-) DBA: JNW FARMS LETTER rT1 3270 1 ALIPAZ ST COMPANY • "' m SAN JUAN CAPISTRANO, CA 92675 LETTER D • rim r-71 "> -.1;0 COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY BODILY INJURY OCC. $ A x COMPREHENSIVE FORM BODILY INJURY AGG. $ X PREMISES/OPERATIONS PROPERTY DAMAGE OCC. $ UNDERGROUND PROPERTY DAMAGE AGG. $ EXPLOSION&COLLAPSE HAZARD X PRODUCTS/COMPLETED OPER. GL 4000275 2- 14-94 2- 14-95 BI&PD COMBINED OCC. $ 1 ,000,000 X CONTRACTUAL BI&PD COMBINED AGG. $ 1 ,000,000 INDEPENDENT CONTRACTORS PERSONAL INJURY AGG. $ 1 ,000,000 X BROAD FORM PROPERTY DAMAGE X PERSONAL INJURY AUTOMOBILE LIABILITY BODILY INJURY ANY AUTO (Per person) ALL OWNED AUTOS(Priv. Pass. ) BODILY Other Than (Per accident) $ ALL OWNED AUTOS( Priv.Pass. HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY BODILY INJURY& PROPERTY DAMAGE $ COMBINED •EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS EACH ACCIDENT $ AND DISEASE—POLICY LIMIT $ EMPLOYERS' LIABILITY DISEASE—EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ADDITIONAL INSURED PER FORM L9109 • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF SAN JUAN CAPISTRANO EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 32400 PASEO ADELANTO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE SAN JUAN CAPISTRANO, CA 92675 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE •• i ACORD 25 (7/90) ©ACORD CORPORATION 1990 (The Attaching Clause n completed only when this endorsement is issued subseque 'eparation of the policy.) • LIABILITY GL 20 11 (Ed. 07 66) L 9109 GIB (Ed.7-66) ADDITIONAL INSURED (Premises Leased to the Named Insured) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE STOREKEEPER'S INSURANCE This endorsement, effective 2- 14-94 , forms a part of policy No. GL 4000275 (12:01 A.M.,standard time) issued to JOHN KOTAKE & WILLIAM KOTAKE DBA: JNW FARMS by CALFARM INSURANCE COMPANY 421Z"^A4,Y%-• Sr,V P� Authorized Representative SCHEDULE Premiums Bodily Property Injury Damage Designation of Premises Name of Person or Organization Liability Liability (Part Leased to Named Insured) (Additional Insured) INCL INCL 32701 ALIPAZ ST CITY OF SAN JUAN CAPISTRANO SAN JUAN CAPISTRANO, CA 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 It is agreed that the "Persons Insured" provision is amended to include as an insured the person or organization designated above,but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises designated above leased to the named insured, and subject to the following additional exclusions: The insurance does not apply: 1. to any occurrence which takes place after the named insured ceases to be a tenant in said premises; 2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organization designated above. fAUTHENTICO Copyright, Insurance Services Office,Inc., 1978