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01-0103_CAPISTRANO UNIFIED SCHOOL DISTRICT_Insurance EVIDENCE OF COVERAGE Capistrano Unified School District MEMORANDUM NUMBER: 101 This Evidence of Coverage is used as a matter of information only and confers no rights upon the Certificate Holder. This Evidence of Coverage does not amend,extend,or alter the coverage afforded by the memoranda listed below. CERTIFICATE HOLDER INFORMATION City of San Juan Capistrano Attn: City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 Coverage Period: Effective: 7-1-05 Expires 12:01 a.m.: 7-1-06 This is to certify that the Alliance of Schools for Cooperative Insurance Programs(ASCIP) Memorandum of Coverages on insurance listed below have been issued to the Covered Party named above for the period indicated. ]Notwithstanding any requirement,term,or condition of any contract or other document with respect to which this Evidence of Coverage may be used or may pertain, the coverages afforded by the Memorandum of Coverages described herein are subject to all the terms,exclusions,and conditions of such Memorandum of Coverages. TYPE OF COVERAGE LIMIT OF LIABILITY/COVERAGE General Liability $1,000,000 Combined Single Limit Per Occurrence Should any of the above coverages for the Covered Party be changed or withdrawn prior to the expiration date issued above, ASCIP will mail 30 days written notice to the Certificate Halder,but failure to mail such notice shalt impose no obligation or liability of any kind upon ASCIP,its agents, or representatives. If you have any questions,contact: Ms.Paula Chu'l'anguay,Chief Executive Officer ASCIP • 12750 Center Court Drive Suite 205 • Cerritos,CA 90703 • (562)403-4644 Authorized Representative: Date Issued: 8-1-05 *ASCIP is a joint powers authority pursuant to Article 1 (commencing with Section 6500)of Chapter 5 of Division 7 of Title 1. of the Government Code and Sections 39603 and 81603 of the Education Code, Rev 5-97 101-05106-41C Nance of Schools for Cooperative Insurance Programs 12750 Center Court Drive,Suite 205,Cerritos,CA 90703{562)403.4640 Additional Covered Party Endorsement District: Capistrano Unified School District Endorsement No. 101-05106-41A .Additional Covered Party: Description of Operations, Vehicle, or Property: City of San Juan Capistrano As respects Joint Development Agreement—Hockey Melds/Joint Facilities Maintenance Marco Foster Sports Field Coverage Period: Effective: 7-1-05 Expires 12:01 a.m.: 7-1-0.6 The coverage provided to the Covered Party is hereby extended by this endorsement to the Additional Covered Party named above in accordance with the provisions contained in the Memorandum of Coverage(MOC). The coverage extended hereby applies only with respect to liability arising out of activities in the Description of Operations, Vehicle, or Property noted above. It is intended by ASCIP in issuing this endorsement to defend and/or indemnify the Additional Covered Party only if the District is solely negligent. In issuing this endorsement, ASCIP intends and agrees to extend coverage pursuant to the terms and conditions of the MOC to the Additional Covered Party named above only to the extent that the Additional Covered Party faces liability arising out of claims, demands, or lawsuits claiming money damages on account of bodily injury or property damage as defined and limited in the ASCIP MOC. The limits of liability extended to the Additional Covered Party listed above is$1,000,000 per occurrence for liability. Authorized Representative: Date Issued: 8-1-05 ASCIP is a joint powers authority pursuant to Article 1 (commencing with Section 65€10)of Chapter 5 of Division 7 of Title 1 of the Government Code and Sections 39603 and 81603 of the Education Code. Rev 5/97 A Iliance of Schools for Cooperative Insurance Programs I2750 Center Court Drive,suite 205,Cerritos,CA 90703(562)403.4640 Kee 32400 PASCO ADELANTO i MEMBERS 4F THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92875 (9449)493-1171 SAM ALLEVATO (849)493-1053 FAX • l [aA�eA93Eo DIANE BATHGATE www.san uanca istrano.or [STBs 76 { { I96I JOE S HART 1 Fj � 1776- ,���solo ® • DAVID M.5WERDLIN O • July 22, 2005 0s Capistrano Unified School District Attn: Jan Cannon, Risk Manager 32951 Calle Perfecto San Juan Capistrano, CA 92575 RE: Compliance with Insurance Requirements —Joint Development Agreement— Hockey Fields/Joint Facilities Maintenance Marco Forster Sports Field ✓ General Liability Certificate 71112005 ✓ General Liability Endorsement Form naming the City of San Juan Capistrano as additional insured. Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 Paseo Adelanto, San Juan Capistrano, CA. If you have any questions, please contact me at (949) 443-6310. Sincerely, �G Mitzi C iz Deputy City Cler cc: Karen Crocker, Community Services Director San Juan Capistrano. Preserving the Past to Enhance the Future .....� Prima:'nn rarvriar3 ranar UC .Z7.eUU4 7:5'(HN CUSB INSURANCE No.75e P.1/4 CAPISTRANO U=D SCHOOL DISTRICT 32972 CALLS PERFECTO SAN SUAN CAPISTRANO, CALIFORNIA 92675 PACSW=COVER SHEET DATE. October 27, 2004 TO: Kathleen Springer COMPANY City of San Juan Capistrano FAX# 493«3955 FROM, Denise Tkach,Human Resources Specialist, Insurance CAPISTRANO UNIFIED SCHOOL,DISTRICT 32972 CALLE PERFECTO SAN JUAN CAPISTRANO, CALIFORNIA 92675 FAX#(949)487-0671 TELEPHONE# (949) 489-7270 FAXING 4 COPIES IF YOU DO NOT RECEIVE, ALL PAGES, PLEASE PHONE ME, MESSAGE I am Faxing certificate regarding use of facilities, both for$1,000,000 and the excess insurance that you.require. Denise Tkach s. 4CT.27.2004 7:58AM CUSD INSURANCE NO.750 P.2/4 "'hr"V 17!j Nk".1 E 0"'F 11 '0 V-1 El 111"A Ga Capistrano nified School District MEMORANDUM ER: 101 This Evidence of Coverage is used as a matter of information only and confers no rights upon the Certificate Holder, This Evidence of Coverasc does nut amend.extend,or alttr the covemge afforded by the memoranda listed below, CERTIFICATE HOLDER INFORMATION City of San Juan Capistrano Attn: Community Services Department 32400 ,Paseo Adelant© San Juan Capistrano, CA. 92675 Coverage Period: Effective: 7-1-04 Expires 12:01 a.m.: 7.1-05 Thus is to certify that the Alliance of Schools for Cooperative Insurance Programs(ASCIP)Memorandum of Coverages on insurance listed below have been issued to the Covered Parry named Above for the period indicated. Notwithstanding any requirement, term,or condition of any contract or other doeutrtent with aspect to which this Evidence of Coverage mtty be used or may pertain, the coverages afforded by the Mcrrmorandum of 'Coverages described herein tiro subject to all the terms,exclusions,and conditions of such Memorandum of Coverages, TYPE OF COVERAGE LIMIT OF LIABILITY/COVERAGE General Liability $1,000,000 Combined Single Limit Per Occurrence Should any of the above coverages for the Covered Parry be changed or withdrawn prior to the expiration date issued above.ASCII} will mail 30 days written notice to rhe Certificate I#otder,bur failure to mail such notice shall impose no obligation or liability of any kind upon ASCIP, its agents, or representatives, If you have any questions,contain Ms.Paula Chu Tanguay,Chicf Administrative Officer ASCIP • 12750 Center Court Drive - Supe 205 - Cerritos,CA 90703 - (562)403-4640 Authorized Representative: IIJZT210-� Date Issued: 6-3-04it *ASCIP is tijoint powers authority purniam to Article I (commencing with Section 6500)of Chapter 5 of[division 7 of Title I of the Government Code:and Sections 3960 and 81603 of the Education Code. Rev 5-97 141-04/05-16C l !IA\, !Bance of Schools for Cooperative Insurance Programs i27S0 Center Court Drive,Suitt 205,Ctrrttai,CA 90703(562)403-4640 OCT,27.2004 7:58A1h CUSn INSURANCE NO-750 P,3i4 Additional Clovered Party Endorsement - 01 District: Capistrano Unified School District ]C1Csem 1V�o, 0104/05-1�.�A Additional Covered Party: Description of Operations, Vehicle, or Property: City of San Juan Capistrano As respect use of various city facilities Coverag Period: Effective: 7-1-04 Expires 12:01 a.m.: 7.1-05 The coverage provided to the Covered Party is hereby extended by this endorsement to the Additional Covered Party named above in accordnncG with the provisions contained in the Memorandum of Coverage(MOC). The coverage extended hereby applies only with respect to liability arising out of activities in the Description of Operations, 'Vehicle, or Property noted above, It is intended by ASCIP in issuing this endorsement to defend and/or indemnify the Additional Covered Party only if the District is solely negligent, In issuing this endorsement, ASCIP intends and agrees to extend coverage pursuant to the terms and conditions of the MOC to the Additional Covered Party named above only to the extent that the Additional Covered Party faces liability arising out of claims, demands, or lawsuits claiming money damages on,account of bodily injury or property damage as defined and limited in the ASCI}' MOC. The limits of liability extended to the Additional Covered Party listed above is s l,000,000 per occurrence for liability. Authorized Representative: Date Issued: 6-1-D4 ASCIP is a joint powzrs authority pur5uah(w Article l (commencing with Section 65GO)of Chapter S of Division 7 of Title 1 of t(re Government Cade and Sections 39603 and B 1603 of the Education Code, Rev 5197 d Bianca of Schools for Cooperative Insurance Programs 12750 Cancer Court Drive,Suit,205,Cerritos,CA 90703($62)40-4640 OCT.27.2004•a 7.5eRm rK CUSD INSURANCELIHe FO 5163215311 TO 394g4B70GTN0.750P.0"P.4/4 Schools Excess Liability !Fund 1531,I Street, Suite 340, Sacraraento,CA.951314 Toll 1~xet(866) 456.5300; Plaine{916)321,5300;Fax(916)321-5311 �.► CERTIF'ICA'TE OFCOVERAGE Ill CERTIFICATE HOLDER 121 MEMORANDUM OF COVERAGE ISSUED TO: City CSF Sats Juan Capistrano Capistrano Unified 32440 Paseo A.dlazato '32972 Calle Perfecto Ann,Corntill Services Dept, San Juan Capistrano, CA 92675 Sari Juan Capistrano, CA 92675 CERTIFICATE#: 3266 CDS 0 3066464 DATE OF rSSUE. 10/19/1 SpA� EXPT AT;ON DATE 6/30/2005 1911401 131 DESCRIPTION OF OPERATION. As respects use of various city f-acilities FR®M; 7/l/2004 TO, 5/30/1 i [4) GENERAL &AuTo LIABILITY ISSVB D BY SELF: I LIMITS; $2 MILLION, EXCESS OF SIM LT.IC)N ' The Certificate holder identified ill item,#I is Hereby na.rned an ADDITIONAL COVERED.PARTY with respect to the- coverage described in item#4 above within the following asst3lriptiohs: (a) The ADDITIONAL COVERED rARTY operates trni authority of the education code, and for a public purpose beneficial to the MEMBER described in item 0, or (b) The MEMBER described in item #2 has, for a public purpose beneficial to the MEM]ER, entered into a contract with the ADDITIONAL'CO'1 ERFD PARTY and such contract provides for indemnification of the ADDITIONAL l COVE„ E,D PARTY by the MEMBER, Coverage eytended to the ADDMONfAL COVERED PARTY shall be ao greater than the degree of indemnity required by the contrast and in no event more than that limit afforded by the MEMORANDUM OF COVERAGE described in item#4. (c) This coverage does not extend to the sole negligence, or willful misconduct of the ADDITIONAL COVEItIED .PARTY, It is undersiuod that the SCHOOLS EXCESS LIA131LITY FUND is a. JOINT POR'IWI3S AUTHCIit,IT operating under previsions of Title 1, Division 7, Chapter S,Article 1, of the Government Code, cornmencing with Section 6500. Coverage is in effect at tris tune and will not be cancelled, limited or allowed to expire without renewal until 60 days wrinil noTlec has been given to ft certlYicate holder. However, failure to mail such a notice shall impose NO OBLIGATION OR LLA-E LI.TY UFaN'THE SCIjOOLS EXCESS LIARILJfI'It PUNT}, Then�ss r.Osborne, Executive Director LMS�c9f�,ao2.n11 .rr U519�9 �W rn-rai enrr ram .R..,. OCT 19 '04 14:46 FR SCHOOL EXCESS LIRE FD 9163215312 TO 19494833955 P.02i02 Schools Excess Liability Fund 1531 1 Street, Suite 300, Sacraento, CA 95814 m Toll Free(866) 456,5300; Photte(916)321-5300; Fax(916)321-5311 *** CERTIFICATE OF COVERAGE *** II1 CEI;T11 KATE iOLDER 121 MEMORANDUM OF COVERAGE ISSUED TO, City Of San Jua,l Capistrano Capistrano Unified 32400 Paseo Adelanto 32972 Calle Perfecto Attn: Kathleen Springer San Juar1 Capistrano, CA 92675 San Juan Capistrano, CA 92675 3 CEKTIFJCATE#; 3267 CDS#. DATE OF ISSUE: 10/20/2004 3066454 JPA# EXPIRATION DATE 6/3012005 19J1001 ' 131 DESCRIPTION OF OPERATION; The City and CE1SD to work together to provide for outdoor facilities at Marco Forster Middle School, to provide 1 maintenance of the sports fields, to provide public use, including use be community ar8onizations of the sport,5 Feld. FROM: 7/1/2004 TO: 6/31//2005 [41 GENEIUL &AUTO LIABILITY ISSUED BY SELF: LIMITS: $3 MILLION,EXCESS OF SIMILLION The Certificate holder identified in item #1 is hereby named an ADDITIONAL COVERED PARTY with respect to the coverage described in item #4 above within the following assumptions: (a) The ADDITIONAL COVERED PARTY operates under authority of the education code, and for a public purpose beneficial to the MEMBER described in item 42, or (b) The MEMBER described in item #2 has, for a public purpose beneficial to the MEcaatio into a contract with the ADDITIONAL COVERED PARTY and such contract provides for indemnificln�of the dAlbDIT1®1!'AL f COVERED PARTY by the MEMBER. Coverage extended to the ADDITIONAL COVERED PARTY shall be no !greater than the degree of indemnity required by the contract and in no event more than that limit afforded by the MEMORANDUM OF COVERAGE described in item#4, (e) This coverage does not extend to the sole fie PARTY, gligence, or willful misconduct of the ADDITIONAL COVERED It is understood that the SCHOOLS EXCESS LIABILITY FUND is a JOINT POWERS AUTRORITY operating under provisions of Title 1, Division 7, Chapter 5, Article 1, of the Government Code, eommencingwith Section 6500. Coverage is in effect at this tine and will not be cancelled, limited or allowed to expire without renewal until 60 days .wnuen notice has been given to the certificate .Bolder. However, failure to mail such a notice shall impose NO OBLIGATTQN OR LIABILITY UPON IrHE SC140OLS EXCESS LIABILI'T'Y FUND, Thomas F.Osborne,Bxecutivc D[rector -rv1SI'COfI�Jc�_rpE ver 052303 W TDTRL PRGE.02 32400 PASEO AOELANTO j MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 i%' � _ �_ � SAM ALLEVATO (949)493-1171 DIANE L.BATHGATE (949)493-1053 FAX �3n[EnnnPeBarEH ESS88LISH ED WYATT HART wwwsanjuancaplstrano.oig 1776 JOE SOTO ® DAVID M.SWERDUN , e ° LC-C June 3, 2004 v � Capistrano Unified School District Attn: Jan Cannon, Risk Manager 32951 Cade Perfecto San Juan Capistrano, CA 92675 RE: Compliance with Insurance Requirements — Joint Development Agreement — Hockey Fields/Joint Facilities Maintenance Marco Forster Sports Field The following insurance documents are due to expire: J General Liability Certificate 7/1/2004 ✓ General Liability Endorsement Form naming the City of San Juan Capistrano as additional insured. Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk' ffice, 32400 aseo Adelanto, San Juan Capistrano, CA 92675 by the above expi atio at . If y have any questions, please contact me at (949) 443-6309. Si C M u r Secretary cc: AL K'TP, Jr., Community Services Director San Juan Capistrano.- Preserving the Past to Enhance the .Futut e JUL— IVJ-->U"1'I Hu.IVFJ 1'"_C/.� a� V` r r 1 , EVIDENCE : ................., Capistrano Unified School District MEMORANDUM NUMBER. 101 This Evidence of Coverage is used as a=ttar of information only and confers uo rights€Ix n the Certificate Halder_ This Fvidence of Coverage does not amand,extend,or alter the coverage Afforded by ahe,mr inuranda li.s€ed below. CERTIFICATE SER INFORMATION . .;"< City of San Juan Ca is r j-�o Attn: Community Services Department 32400 Pasen Adelanto San Juan Capistrano, CAL 92675 sera a Period: ^'Vffective: 7.1,03 E fir ,01. a m: 74-04 This is to certify that the Alliance of Schools for(Trrnlimattive In%uranou Pi-ograms(ASCIP)lviemormidurn of Coverages on insurance listed below have been issued to the Covered Party named above for the period indicated. 1*1'ctwithstandinr any requirement,term,or condition of any contract or outer document with respect to which this Evidence of Coverage may be used ox may pertain,[be coverages afforded by the Memorandum of Coverages described herein are subject to all the terms,exclusions,and conditions of such Memorandum of Coverages. TYPE OF COVERAGE � LIMIT OF LIABILIT Creneral Liability $l„000,000 C;crmNned Single Limit Per Occurrence Should any of the.above coverages for the Coveted Pasty ire.rhangvd or withdrawn pnor to the expiration date issued above, ASCIP wilt snail 30 days written notice ro the Certificate Holder,but failure to mail such nodco shall impose no o ligatuon or liability of any kind upon ASC)?,its agents, or rMmserntatives- If you have any questions,enntact; Ids.Paula Chu Tmguay,Chief Admimstralive Officer ASCTP - 1275.0(`_anter Cmart Dive Suite 220 g C:enitos.CA 90703 m (562)403-4640 Author-zed.Rresentatt�ve: e Date Issued: .19-03 *ASCIP is a joint powers authority pursitwit to article 1 (coijrtnencing vinh Section 6.500)of Chapter S of Division 7 of Title i of the Governmtnt Code and Sections 39603 and 81603 of the Education Code. Rev 5-97 101-03104-08C Mance, fhCa for Cooperative 1rilarlace flgrarrl 127513 Carates-taint Da r,Saye 220,Cerytw,CA 90703(562)4133-4640 �u�. l.�e�r�.� �r�•,�c�ni .,..i._>a3 .a..i,..x...m rr 3 .,t... :3... , Y.a E ..� _, y .. Ad.ditio" nal, Cov' ere' d Paity E,ndqr' seme' nt,. Endorsement No. District:rict: apistr o Unified School District 101-03/04-08A r,. Additonaj Covered Par Description erali[in .� i ,... r F-e City of San Juan Capistrano As respects use of various city facilities Coverage Period. Effective.- -1®03, ides . c01 a.m.: 74-04 % The coverage provided to the Covered Party is hereby extended by this endorsement to the Additional Covered Party named above;in accordance with the provisions contained in the Memrandum of Coverage( OC).. "The coverage exmnded hereby applies only with respect to liability arising out of activities in the Description of Opetatiom, Vehicle, or property noted above. It it intended by ASCIP in issuing this endorsement to defend and/or indemnify the additional Covered Party only if the District is stalely negligent. In issuing this endorsement, ASCIP intends and agees to extend wverage pursuant to the terms and conditions of the MGIC to the Additional Covered Party named above rarely to that extent that then additional Covered Party faces liability arising rout of claims, demands, or lawsuits claiming money damages on account of bodily injury or property damage as dafined and limited in the ASCII' MOC. The limits of liability extended to the Additional Covered Party listed above is 51,000,000 pcj occurrence for liability. Authorized Representative: Date Issued: 6�9- 7 _�®sem ' ASCIP is a joint powers auttronty pursuant to Ardele 7 (commencing with Section 6500)of Chapter 5 of Envision 7 of Title 1 of ftl Cinve-Mment Code and Sections 39603 and 81603 of thr Education Caere_ Rev 5197 fliance of Schools for Cooperative InSUrance Pm9rams 42790 Cdater C Yu-n L"r.Suite 220,OEvritot,CA 90703(562)403,4W J 1.1t..,, A.-C-KeJ7 ie�•��7r€€-€ �., .L �€i�u€ter[€ i.r_. av-��� : �- �. Capistrano I fnified School District 32972 Calle Perfecto Sari Juan Capistrano, CA 92675 � July 1, 200.3 r FAX TRANSAOSSION COVER , FT N:iv J'j TO; Ms. Dawn Schanderl Deputy City C,[erk City of San,loan Capisczano Fax Number 949-493-1053 FROM: Jan Cannon, Manager, Imurance Programs Telephone: 949-489--7291 Fax Number: 949-487-0671 SV13)ECT: Certificate of lnsu.ranci: DUMBER OF PAGES: 3 (including cover Sheet) This is in resp©nse to your letter dated June 24, 2003, requesting an updated carrifica,tc of insurance.. Our records indicate that the requested c;erdficate of insurance was issued on ,lune 19, 2003. In the evert you have:not received sarrre, a copy is included with this transmission, JoaoA 3.2400 PASEO AAEC.ANTO l L IAZORFnIT16 SAN JUAN CA1'ISTftANO, CA 92$75 • s=WAlNED I' {Q�' MEMBERS OF THE CITY COUNUL (949) 493-1171 1776 DIANE 4.BATHGATE (949) 493-1053 (FAX) e • JOHNS.GEUP iviviv sanjuancaprstrano.org WYATTHART ♦ • JOESOTO DAVID M.SWERDLIN CITY MANAGER GEORGESCARBOROUGH June 24, 2003 Capistrano Unified School District Attention: Jan Cannon, Risk Manager 32951 Calle Perfecto San Juan Capistrano, California 92675 RE: Compliance with Insurance Requirements-Joint Development Agreement-Hockey Fields/Joint Facilities Maintenance Marco Forster Sports Field The following insurance documents are due to expire: V General Liability Certificate 7/1/2003 11 General Liability Endorsement naming the City of San Juan Capistrano as additional insured. Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 Paseo Adelanto, San Juan Capistrano, CA 92675 by the above expiration date. If you have any questions, please contact me at (949) 443-6310. Sincerely, ed6ut��q*ka.,T&6A�c Dawn Schanderl Deputy City Clerk cc: Al King Jr., Director of Community Services nau�use rs San Juan Capistrano: Preserving the Past to Enhance the Future ACGIOLAna DATE(MMIDDIYY) -i _::,:>:-;;:::-.::: 6127100 PRODUCER 619.23 019VED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION John Burnham & Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 610 West Ash Street JUN Zq 39 91J 1 TER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P.C. Bax 122910 i SIE COMPANIES AFFORDING COVERAGE E San Diego, CA 92112-2910 CITY CLERK COMPANY DEPARTMENT q Firemans Fund Ins. Company INSURED JUAN CAPISItRAN@ COMPANY Capistrano Unified School Dist COMPANY Attn. Jan Cannon, Risk Mgr.. C 32972 Calle Perfecto COMPANY ori Juan .Ca ist CA 92675 D ES _ OR a Oa...................... :.::::::...,:.... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS ED:TO , 0 EE SSU O THE INSURED.NAMED ABOVE FOR 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDONY) DATE(MM/DDIYYF A GENERALLIABILITY KXC80388426 7101100 7/01/03 GENERAL AGGREGATE $ 150000ao X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGG $ CLAIMS MADE OCCUR SUBJECT TO PERSONAL&ADV INJURY S OWNER'S&CONTRACTOR'S PHOT $100,000 S.I.R. EACH OCCURRENCE $ laaaa00 X WRONGFUL FIRE DAMAGE(Any one firer $ ACTS MED EXP(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ I ALL OWNED AUTOS E BODILY INJURY � $ SCHEDULED AUTOS (Per person# HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per aecidentl € PROPERTY DAMAGE I $ [ I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY I EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM € E AGGREGATE $ i OTHER THAN UMHRELLA FORM $ WORKERS COMPENSATION AND T WCRY STATU- DTH- LIMIT ER .;i... ..........-:.. .. ...i`:..- I EMPLOYERS'LIABILITY EL EACH ACCIDENT S THE PROPRIEFORI SNCL EL DISEASE•POLICY LIMIT $ PARTNERSIEXECUTIV E OFFICERS ARE: EEXCL EL DISEASE-EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS RE: USE OF PREMISES CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED �1 I1 DATE d$ 1�3R..: AIOLLA fl€iN # ?OA 111; # IIx `�....:.:.: ..... ..: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF SAN JUAN CAPISTRANO EXPIRATION OATS THEREOF, THE ISSUING COMPANY WILL ENDEAVOR 30 MAIL ATT'N: CITY MANAGER 90 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 32400 PASEO ADELANTO BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY SAN JUAN CAPISTRANO, CA 92675 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ..,.. IUTHORIZ A ED RE NTAT �n pg rh h $�tltl py�qy� INSURED POLICY NUMBER CAPISTRANO UNIFIED SCHOOL DISTRCIT KXC80388426 PRODUCER EFFECTIVE DATE JOHN BURNHAM &COMPANY 04-496-781-08 7/1!00 BLANKET ADDITIONAL INSURED ENDORSEMENT THROUGHOUT THIS POLICY THE WORDS YOU AND YOUR REFER TO THE NAMED INSURED SHOWN IN THE DECLARATIONS, AND ANY OTHER PERSON OR ORGANIZATION QUALIFYING AS AN INSURED (SECTION ll) UNDER THIS POLICY. COMMERCIAL GENERAL LIABILITY AND WRONGFUL ACTS COVERAGE FORM, SECTION Il. WHO IS AN INSURED INCLUDES THE FOLLOWING DEFINITION: d. ANY PERSON OR ORGAN]ZATION THAT YOU ARE REQUIRED BY A WRITTEN CONTRACT TO INCLUDE AS AN INSURED, SUBJECT TO ALL OF THE FOLLOWING PROVISIONS: 1. COVERAGE IS LIMITED TO LIABILITY ARISING OUT OF: ( ) THE OWNERSHIP, MAINTENANCE OR USE OF THAT PART OF THE PREMISES, OR LAND OWNED BY, RENTED TO, OR LEASED TO YOU; OR (b) YOUR ON-GOING OPERATIONS PERFORMED FOR THAT INSURED; OR (c) THAT INSURED'S FINANCIAL CONTROL OF YOU; OR (d) THE MAINTENANCE, OPERATION OR USE BY YOU OF EQUIPMENT LEASED OR RENTED TO YOU BY SUCH PERSON(S) OR ORGANIZATION. 2. THE INSURANCE PROVIDED DOES NOT APPLY TO ANY OCCURRENCE OR OFFENSE: (a) WHICH TOOK PLACE BEFORE THE EXECUTION OF, OR SUBSEQUENT TO THE COMPLETION OR EXPIRATION OF THE WRITTEN INSURED CONTRACT, (b) WHICH TAKES PLACE AFTER YOU CEASE TO BE A TENANT IN THAT 'REMISES. ONE OF THE .0otOL94TERSIGNATURE OF AUTHORIZED AGENT FIREMAN'S FUND INSURANCE COMPANIES AS NAMED IN THE POLICY PRESIDENT � J:SDR I S C O LUE N D O R S E"D O C