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
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS .,a
ADDITIONAL INSURED PER FORM L9 ]09 ' v���n ,- rn
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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)