Gilroy Cable TV Insurance Certificates
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CERTifiCATE Of InSURAnCE
WINN
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ISSUED TO
321 FIFTH STREET
PHONE 637-4441
HOLLISTER
CALIFORNIA
CITY OF GILROY
INSURED:
GILROY CABLE TV
381 First Street
Gilroy, California
THIS IS TO CERTIFY THAT a pfa.nn~ inoultG.nee ~ FOR THE ABOVE INSURED INa
eLUDES THE FOLLOWING POLICIES OF INSURANCE COVERING AS STATED (SUBJECT TO
POLICY TERMS AND CONDITIONS) AND IN FORCE AT THIS DATE.
TYPE OF COVERAGE
WORKMEN'S
COMPENSATION
BODilY INJURY
LIABILITY Insurance
PROPERTY DAMAGE
LIABILITY Insurance
AUTO PROPERTY I'
DAMAGE
AUTO PHYSICAL
DAMAGE
COMPANY
POLICY NUMBER
EXPIRATION DATE
LIAS. LIMITS (IN THOUSANDS)
Company Of North America
4/1/70
STATUTORY
250 , 00 OEACH PERSON
500. OOOEACH ACCIDENT
EACH ACCIDENT
500,000
500, OOOEACH ACCIDENT
COMPREHENSIVE
DED. COlL.
Company Of North America
4/1/70
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COVERAGE: All operations, including vehicles.
Policy will include Cross Liability Endorsement, Hold Harmless Agreement, & Primary
Insurance endorsement.
YEAR
TRADE NAME
BODY TYPE
MOTOR NUMBER
DATE ISSUED,
March 29, 1967
INSURANCE COMPANY
Y
CC, INSURED
/
THE POLICY OR POLICIES HEREIN REFERRED -rb SHALL NOT
BE CANCELLED OR MATERIALLY CHANGED WITHOUT TEN
(10) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER.
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INSU.. .NCE COMPANY OF NORTH A .:RICA
CERTIFICATE OF INSURANCE
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UlIn" InSURHnCf
311 FIRST STREET
GILROY, CALIF. 95020
Telep"one842~8M 1
CITY OF GILROY
6TH & SO. ROSSANA STREET
GILROY, CALIFORNIA
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that the following described policy or policies have been issued to
Name and Address
of Insured-
FRANK CALIRI, BEN TSUDA, E. F. DRISCOLL DBA:
GILROY CABLE TV
381 FIRST STREET, GILROY, CALIFORNIA
accordance with the terms thereof, at the following location(s):
covering in
TYPE OF POLICY X' POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY
(a) Standard Workmen's Statutory W. C.
Compensation & $ One Accident and
Employers' Liability Aggregate Disease
I (b) General Liability 4/1/67
Bodily Iniury X AGP 13633 TO
Prem ises-Operations X UNTIL CAN- $250,000. Each Person
Elevators X CELLED
Independent Contractors X $500,000. Each Accident/Occurrence
Prod ucts X
Contractual X $500,000. Aggregate- Prod ucts
Property Damage X
Prem ises-Operations X $500,000. Each Accident/Occurrence
Elevators X $500,000. Aggregate-Prem. Oper.
Independent Contractors X $500,000. Aggregate- Protective
Prod ucts X $ 500,000. Aggregate- Products
I Contractual X $500,000. Agg regute-Contractual
I (c) Automobile Liability
Bodily Injury }
Owned Automobiles $ Each Person
Hired Automobiles
Non-owned Automobiles $ Each Accident/ Occurrence
Property Damage
Owned Automobiles }
Hired Automobiles $ Each Accident/Occurrence
Non-owned Automobiles
d)
ALL OPERATIONS
,nce afforded only for hazards indicated by X.
1. ORIGINAL
WltNNANf:NSf2Ht~N~ORTH AMERICA
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BY: A'~~"~(;1( Co ~~~.;;~;-
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the intention of the company that in the event of
elation of the policy or policies by the company,
(101 days written notice of SUGh cancelation will be
to you at the address stated above.
.<le I'RINTI!:D IN U.S.A.
insurance issued in connection with the policy (ies) indicated below.
In accordance with instructions from Our insured, we are enclosing certificates of
Date: May 3, 1967
Insured, FRANK CALIRI, BEN TSUDA, E. F. DRISCOLL DBA,
N GILROY CABLE TV
Policy 0.: AGP 13633
r CITY OF GILROY
6TH & SO. ROSANNA STREET
GILROY, CALIFORNIA
TO
WINN INSURANCE AGENCY
P. O. Box 220
HOLLISTER, CALIFORNIA
Phone: 637-4441
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