04-1020_ALEXANDER ENGINEERS, INC._Insurance CertificateACORD.a CERTIFICAW OF LIABILITY INSUONCE DATE w""' PRODUCER _ - THIS -CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton &Associates II �i,('I ONLY` AND CONFERS NO RIGHTS UPON THE CERTIFICATE -1 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 199 S Los Robles Ave Ste 540 a ----- - ---- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena, CA 91101 626 844-3070 - r • - ��n n [ -' I ! INSURERS AFFORDING COVERAGE INSURED INSURER United States_ Fidelity & Guaranty Alexander Engineers, Inc. - — URER a St. Paul Flre S Marine Ins. Co. 502 W. Route 66, Suite 17P'D - — — a 3 G l^:;;, S INSURER Great American Assurance Co. Glendora, CA 91740 _— — INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MIDD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS A GENERALLIABILITY BKO1226262 10/16/04 10/16/05 EACH OCCURRENCE S1 000,000 FIRE DAMAGE (My one fire)_ $1,000,000 XCOMMERCIAL GENERAL LIABILITY CLAIMS MADE LXJ' OCCUR I MED EXP (Any One person) $1 O 000 � PERSONAL 8 ADV INJURY_ $1. OOO O_OO _ GENERAL AGGREGATE 1$2,000,000 $2,000,000 �GEN'I- AGGREGATE LINT ITAPPLIES PER:I PRODUCTS -COMP/OP AGG _ POLICY PROT 'LOC I— A AUTOMOBILE LIABILITY BKO1226262 10/16/04 10/16/05 COMBINED SINGLE LIMIT _ yl ANY AUTO (Ea accident) ~ ALL OWNED AUTOS BODILY INJURY $1,000,000 :SCHEDULED AUTOS � (Per person) rX HIREDAUTOS X NON OWNED AUTOS BODILY INJURY (Per accident) $2,000,000 — PROPERTY DAMAGE I$ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ IANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY (EACH OCCURRENCE $ —�' _ 1 OCCUR �I CLAIMS MADE 1 AGGREGATE $ $ DEDUCTIBLE $ _ - $ RETENTION $ B WORKERS COMPENSATION AND ;WVA7724714 09/01/04 WCSTATU- 109/01/05 LX OFIY IMITS EMPLOYERS' LIABILITY B I E.L. EACH ACCIDENT ' $1,000,000 �E.L.DISEASE - EA EMPLOYEE$1,000,000 IE.L.DISEASE -POLICY LIMIT 11 $1,000,000 C OTHER Professional EDN5850421 1110/16/04 10/16/05 $1,000,000 per claim Liability $1,000,000 annl aggr. DESCRIPTION OF OPERATINSILOCATIONS(VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS The City of San Juan Capistrano is named as an additional Insured as respects general liability for claims arising from the operations of the named insured. City of San Juan Capistrano Public Works Director 32400 Paseo Adelanto San Juan Capistrano, CA 92675 ACORD 25-S!7/9714 ..F4 WU11441A04 SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL :6Aa7011XII Q0 MAIL30 DAYSWRITTEN NOTICETOTHE CERTIFICATE HOLDERNAM ED TOTHE LEFT, BKRWPJIX= jA"AAXiiu=X MIA0 n ACOnn CDBDrfpwrinM I Ona Policy Number: BKO1226262 Owners Lessees or Contractors (Form B) ADDITIbNAL INSURED Change(s) Effective: 10/20/04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance policy under the following: LIABILITY COVERAGE PART: Schedule Name of Person or Organization: City of San Juan Capistrano Public Works Director 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. The City of San Juan Capistrano is named as an additional insured as respects general liability for claims arising from the operations of the named insured. 13:7A40i 1;iii`&9iIRF—W4m IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS INSURANCE. CL/BF 22 40 03 95 11 11 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" needs to be completed only when this endorsement is issued subsequent to preparat-M. of the policy.) This endorsement forms a part of Policy No. WVA7724714 ' S Issuedto: Alexander Engineers, Inc. By: St. Paul Fire & Marine Ins. Co. Premium (if any) TBD We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2-5% of the California workers compensation premium otherwise due on such remuneration. Person or Organization City of San Juan Capistrano Public Works Director 32400 Paseo Adelanto San Juan Capistrano, CA 92675 WC 04 03 06 (Ed. 4-84) Schedule Countersigned by Job Description yywA,, - a, -gam,_ Authorized Representative