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04-0908_ALEXANDER ENGINEERS, INC._Insurance Certificate
Lte: 9/8/2004 Time: 10:18 AM TO: R 19494931053 1-510-452.2193 Page: 002-005 At I cur]I ACORn_. CERTIFICA OF LIABILITY INSU CE 09//08/x; D'""' PRODUCER THIS CERTIFICATE IS ISSUED .AS A MATTER OF INFORMATION Dealey, Renton & Associates 199 Los Robles Avenue #540 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY NUMBER Pasadena, Ca 91101 626-844-3070 INSURERS AFFORDING COVERAGE INSURED INSURRRA: United States Fidelity & Guaranty Alexander Engineers, Inc. INSURER B: St Paul Fire & Marine 502 W. Alosta Avenue #17 INSURRR c: Great American Assurance Co. Glendora, CA 91740 INSURER D: INSURER E'. 1�12 A!_CC THE POLICIES OF INSURANCE LISTED BELOW HAW.. BEEN ISSUED TO TIE. INSURED NAMED ABOVE, FOR THE POLICY PERIOD INDICATED. NOTWTTHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 0 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SU POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE POLICY NUMBER PoLICYEFFECPIVE EAT R, POLICY/EXPIRATION DATE(MM/DDffY) LIMITS A GENERAL LIABILITY BKO1226262 10/16/02 10/16/04 EACH OCCURRENCE S1 000 000 PIKE DAMAGE (A,, one 6«) M000,000 X COMMER^_IALGBNERALLIABILITY CLAIMS MADE 7 OCCUR MBLI RST (Any om —) $10,000 PERSOHAL &ADV INJURY S1000000 GENERAL AGGREGATE 52000000 GEN'LAGGRRGATB LIMITAFPLIES PER: PROTUCTS -COMP/OPAGG 520000 POLIR Rr LOC A AUTOMOBILE LIABILITY ANY AUTO BKO1226262 10/16/02 y�,� 10/16/w COMBINED SINGLE LIMIT (8a xcida[) $1,000,000 BODILY INJURY S '—) ALL rn- NSD AUTOS SCHEDULEDAUTOS BODILY IN.NRY $ (R,mCdO) X X HIREDAUTOS NON-OWNRD AUTOS PROPERTY DAMA03 $ (Per mcihNJ GARAGE LIABILITY AUTOONLY-3AACCIDENT S OTHSRTHAN SA ACC S ANYAUTO AUTOONLY: AGG S EXCESS LI ABI LITY EACH OCCURRENCE $ OCCCR CLAIMS MALE AGGREGA"E $ S S DEDL-71BLH S RETENTION S B WORKERS COMPENSATION AND WVA7724714 y�p 09/01/0 yu 09/01/04 XWC STATC- OfH- B EMPLOYERS'LIABILITY WVA7724714 09/01/04 09/01/05 8._. 3ACHACCIDBNT 51000000 E L. DISEASE-EAEMPLOYEE 51 000000 E... DISEASE POLI CY LIMIT S1 000000 C OTHER Professional EDN320854703 10/16/02 10/16/09 $1,000,000 per claim lability $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS/LOCATIONS/V EHICLEWEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL 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 LDANYOFTHEAI OV DESCRIBEDPC(.ICIIS BECANCELLEDBEFORETHEEXPIRATION THEREOF, THE ISSUING INSURER WILLXXRNW0 WMA1L30_DAYSWRHTEN RIOTER CERTIFICATE HOLDERNAMED TOTHE IEPT. B ACORD 25-S (7/97) 1 of 1 #S110620/MS0303 MAF © ACORD CORPORATION Lte: 9/8/2004 Timer 10.18 AM To: ® 19494931053 r • Policy Number: BKO1226262 Owners Lessees or Contractors (Form B) ADDITIbNAL INSURED Change(s) Effective: 09/08/04 1-510-452.2193 Page: 003-005 • 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. CL/BF 22 40 03 95 ,te: 9/8/2004 Time: 10:18 AM To: ® 19494931053 • Policy Number: BR01226262 Owners Lessees or Contractors (Form B) ADDITIbNAL INSURED Change(s) Effective: 09/08/04 1-510-452-2193 Page: 004-005 • 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. PRIMARY INSURANCE: 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 :le: 9/8/2004 Time: 10:18 AM To: ® 19494931053 1-510-452-2193 Page: 005-005 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 preparation of the policy.) This endorsement forms a part of Policy No. WVA7724714 Issuedto: Alexander Engineers, Inc. By: St Paul Fire & Marine 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. Schedule Person or Organization Job Description City of San Juan Capistrano Public Works Director 32400 Paseo Adelanto San Juan Capistrano, CA 92675 yykAq- Q. y4Ater ta. WC 04 03 06 Countersigned by (Ed. 4-84) Authorized Representative