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1994-1102_J & W FARMS_Insurance Certificate A1)411tI: CERTIFICA OF INSURANCE DATE(MMiDD,YY) 11/02/94 PRODUCER 1 56 03 THIS CERTIFICATE — ISSUED AS A MATTER OF INFORMATION GIMLIN & UDY INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 601 DAILY DR # 1 17 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CAMARILLO, CA 930 10 _ COMPANIES AFFORDING COVERAGE COMPANY A CALFARM INSURANCE COMPANY INSURED COMPANY JOHN KOTAKE & WILLIAM KOTAKE B DBA: JNM FARMS COMPANY 32701 ALIPAZ ST C SAN JUAN CAPISTRANO CA 92675 COMPANY D 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS TR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY BODILY INJURY OCC $ A X COMPREHENSIVE FORM _Elva BODILY INJURY AGG $ PREMISES/OPERATIONS PROPERTY DAMAGE OCC $ UNDERGROUND EXPLOSION&COLLAPSE HAZARD PROPERTY DAMAGE AGG $ PRODUCTS/COMPLETED OPER GL 4000275 12/31/94 12/31/95 BI&PD COMBINED OCC $ 1,000,000 CONTRACTUAL BI&PD COMBINED AGG $ 1 ,000,000 INDEPENDENT CONTRACTORS PERSONAL INJURY AGG $ 1,000,000 BROAD FORM PROPERTY DAMAGE PERSONAL INJURY AUTOMOBILE LIABILITY BODILY INJURY ANY AUTO (Per person) ALL OWNED AUTOS(Private Pass) BODILY INJURY ALL OWNED AUTOS (Per accident) (Other than Private Passenger) HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY BODILY INJURY& PROPERTY DAMAGE $ COMBINED EXCESS UABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS'UABILITY EACH ACCIDENT $ THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE - OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ OTHER :=. +C is i C7 C7O .,� DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS .,a ADDITIONAL INSURED PER FORM L9 ]09 ' v���n ,- rn .^ cZ r`� „ J'►r n 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 MAIL 32400 PASEO ADELANTO 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, SAN JUAN CAPISTRANO, CA 92675 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE PKM ACoRRt,25-N(3/93)