Insurance - Jaycox - 1977-08-08 Chicago Insurance Company ale' %iv e��((i(!vV
Interstate Fira�SL�ualty Company CC �!�
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Chicago Illinois
MEMORANDUM OF INSURANCE
THIS IS TO CERTIFY THAT THE INSURANCE HEREINAFTER DESCRIBED HAS BEEN EFFECTED
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INSURED JAYCOX SANITARY SERVICE OF ANAHEIM, ET Al ,. ../ �F,c.
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PROPERTY OR LOCATION INSURED 1016 EAST KATELLA AVENUE. ANAHEIM, CALIFORNIA
COVERAGE COMMERCIAL UMBREL A LIABILITY
POLICY NO. 155C042.3 POLICY TERM: FROM JULY 15, 1977 TO FEBRUARY 1 , 1978
LIMITS OF LIA ILITY SEE NO. 3 BELOW
1 IA) BODILY INJURY (B) PROPERTY DAMAGE
EACH PERSON EACH OCCURRENCE AGGREGATE EACH OCCURRENCE AGGREGATE
2 BODILY INJURY EXCESS OF
$ EACH PERSON $ EACH PERSON
$ EACH OCCURRENCE $ EACH OCCURRENCE
$ AGGREGATE $ AGGREC, TE
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PROPERTY DAMAGE EXCESS OF -
S EACH OCCURRENCE $ EACH OCCURRENCE
$ AGGREGATE $_ AGGREGATE
3 EFFECTIVE 7-15-77 TO JULY 21 1977
$10 000 000 EACH OCCURRENCE/AGGREGATE COMDINED SINGLE LIMIT EXCESS OF GENERAL
LIABILITY-$500 000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $500,000
COMBINED SINGLE LIMIT EMPLOYERS LIABILITY .CALIFORNIA UNLIMITED
EFFECTIVE 7-21-77 TO FEBRUARY 1 1978
$5 000 000 EACH OCCURRENCE/AGGREGATE COMBINED SINGLE LIMIT EXCESS SAME UNDERLYING
AS ABOVE.
THIS DOCUMENT IS FURNISHED TO YOU AS A MATTER OF INFORMATION ONLY THE ISSUANCE OF THIS DOCUMENT DOES NOT MAKE THE
PERSON OR ORGANIZATION TO WHOM IT IS ISSUED AN ADDITIONAL INSURED, NOR DOES IT MODIFY IN ANY MANNER THE CO 'TRACT Or
INSURANCE BETWEEN THE INSURED AND THE COMPANY ANY AMENDMENT CHANGE OR EXTENSION OF SUCH CONTRACT CAN ONLY RE
EFFECTED BY SPECIFIC ENDORSEMENT OR NOTICE OF CANCELLATION.
SHOULD THE ABOVE MENTIONED CONTRACT OF INSURANCE BE CANCELLED ASSIGNED OR MATERIALLY CHANGED DURING THE ABOVE
SPECIFIED POLICY PERIOD IN SUCH MANNER AS TO EFFECT THIS DOCUMENT THE COMPANY WILL ENDEAVOR TO GIVE 30 DA VS
WRITTEN NOTICE TO THE HOLDER OF THIS DOCUMENT BUT FAILURE TO GIVE SUCI NO1 ICE SHALL IMPOSE NO OBLIGATION OF ANY KIND
UPON THE COMPANY
COSTA MESA SANITARY DISTRICT
SSUED TO OF ORANGE COUNTY ❑ CHICAGO INSURANCE COMPANY
® INTERSTATE FIRE & CASUALTY COMPANY
77 FAIR DRIVE,
COSTA MESA, CALIFORNIA
8-8-77
DATED _ BY °�lnJa+w...�._y�y` ��'`y4..a
�u Tt OR I"EO flE PRESC ;
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ENDORSEMENT NO 24
It is understood and agreed hat the folloriing i added as an
additional insured but only as respects their interest with
the operations of the named in Jred
Costa Mesa Sanitary Di trict
of Orange County
77 Fair Drive
Costa Mesa, CA
The inclusion of the above additional in. ured shall not operaLe
to Increare the Company 's limit of liability
I INTERSTATE FIRE & CASUALTY COMPANY
155 C 0.+293
Fl CHICAGO INSURANCE COMPANY
Ja,ycox San ity-y Sery ice et al
7/15/77 -
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