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04-0104_ ALL CITY MANAGEMENT SERVICES, INC._Insurance Certificate `�ia�+31RD CERTIFICA OF LIABILITY INSU CF, OP ID A DATE( LCI-1 04/01/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISD Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone: 626-449-3870 Fax:626-449-5268 INSURERS AFFORDING COVERAGE INSURED INSURER A: Admiral Insurance Company All City Management, Inc. INSURER B. Scottsdale Insurance Company Baron Farwell INSURER C: 1749 South La Cienega Blvd. INSURER D: Los Angeles CA 90035 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 BV 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. INSR POLICYLTR TYPE OF INSURANCE POLICY NUMBER DATE(MMEFFECTI DATE MMICY ID ID DYV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CA000003653-04 04/01/04 04/01/05 FIRE DAMAGE(Any one tire) $ 50,000 CLAIMS MADE [F X1 OCCUR MED EXP(Any one person) $excluded X Owner/Cont Prot. PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO- ECT LOC lEmp Ben. excluded AUTOMOBILE LIABILRV COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE s4,000,000 B X OCCUR CLAIMS MADE XLS0021251 04/01/04 04/01/05 AGGREGATE s4,000,000 DEDUCTIBLE $ X RETENTION $ 3.0,000 $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE.POLICY LIMIT $ OTHER DESCRIPTION OF OPERATN)NS20CATK)NS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS *10 Day Notice of Cancellation for Non-Payment of Premium. Certificate Holder is named as Additional Insured, per Endorsement attached to policy. CERTIFICATE HOLDER Y I ADDITIONAL INSURED;INSURER LETTER: A CANCELLATION CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL City of San Juan Capistrano IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 32400 Paseo Adelando REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPR Michael r ACORD 25-S(7/97) CACORD CORPORATI 88 Policy Number: CG 2010 10 01 CA000003653-04 Effective Date: 07/01/03 ADMIRAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of San Juan Capistrano (Ifno entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section n—who Is An Insured is amended to (1) All work,including materials,parts or include as an insured the person or organization shown equipment f rmiahed in connection with in the Schedule,but only with respect to liability aris- such work,an the project(other than serv- ing out of your ongoing operations performed for that ice,maintenance or repairs)to be per- insured. formed by or on behalf of the additional in- H. withrespeot to the insurance afforded to these addi- sured(s)at the site of the covered tional insureds,the following exclusion is added: operations has been completed; or 2. Exclusions (2) That portion of"your work"out of which This insurance does not 1 to "bodily injury" the injury or damage arises has bear put to apply y ' j� m its intended use by any person or organize- "property damage"occurring after: tion other than another contractor of sub. contractor engaged in performing opera- tions for a principal as a part of the same project. If you are required by a written contract to provide primary insurance, than this policy shall be primary and not contributory with any other insurance available to the additional insured named in the schedule above. Form CG0001 Commercial General Liability Coverage (but only Section IV. Paragraph 4., subparagraph b) is amended accordingly and shall not apply with respect to coverage provided for the Additional luau-red named above in the schedule. Afy AUTHORIZED SIGNATL'flt6 " — ISU CURRY INSURANCE AGENCY CG 20 10 10 01 ®ISO Properties,Inc.,2000 Pare 1 of 1 MEMBERS OF THE CITY COUNCIL �$ DIANE L.BATHGATE JOHN S.GELFF � WYATT HART 32400 PASEO ADELANTO mPaAU JOE SOTO SAN JUAN CAPISTRANO,CA 92675 DAVID M.SWERDLIN (949)493.1171 tnanuxll 1961 (949)493-1053 FAx 1776 CITY MANAGER www.sanjuancapistrano.org DAVEADAMS March 2, 2004 All City Management Attn: Baron Farwell, General Manager 1749 S. La Cienega Blvd. Los Angeles, CA 90035x RE: Compliance with Insurance Requirements – Crossing Guard Services The following insurance documents are due to expire:` J General Liability Certificate 04/01/2004 \" General Liability Endorsement Form naming the City of Sa Juan Capistrano as additional insured. Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 P seo Adelanto, San Juan Capistrano, CA 92675 by the above expi ion dates. If y have any questions, please contact me at (949) 443-6309. n Maria Ka — Secretary cc: Michael Cantor, Senior Management Analyst San Juan Capistrano: Preserving the Past to Enhance the Future ,ARR-19-c005 16: 18 FROM: ISU CURRY AGENCY 6264495268 70: 19494931053 P.2 OP -1G °•TE,MMT, ACORD. CERTIFICA7 F LIABILITY INSURANC ALLCX 04/15/0s PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISO Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic 40588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR 489 E- Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone% 626-449-3870 Faxe 626-449-5268 INSURERS AFFORDING COVERAGE NAIL 0 INSURED INSURERA Admiral Insurance Company _ INSUnCRB _Scottsdale Ins_. Company All City Manageel1R�eent, Inc_ INSURER 1749 South La Clenega Blvd- INSUREA0 Los Angeles CA 90035 - - - INsuncn c. COVERAGES THE POLICIES OF INSURANCE LISTED BROW HAVE°CCN ISSUED TO'I ME INSURED NAMED MOVE COR THE POLICY PERIOD INDICATED NOTWITHSfANDIMG NVY nEOUIREMENT'PERM OR CONDITION OF ANY CONTRACT OH O'nIER DOCUMENT W ITN RESPECT TO WHICH(NIS CERTIFICATE MY BE ISSUED OR FLIT PERTAIN,TNF.INSURANC[ACCOnmo By THE POLICIES CIPSCRIDED HCRCIN IS SUWECT'1 O ALL TNF TERMS.EXCLUSIONS ANU CONDITIONS OF SUCH POLICICS AOGnCUATE UMII S SHOWN MAY HAVE DEEM RCDUCED BY PAID CLAIMS TOUCTPOLICY NUMBER ATE(M AD Y LIMITS LOW YR NSR TYPE OF INSURANCE DATE ITFEMY OATS EXPIAR GENERAL LIABILITY EACH C)=nnCNCC 31,000,000 A IOMERCIAL GENcnALLIABILITY CA000003653-05 04/01/05 04/01/06 MHEMI$FS $ 50,000 50,000 GIAIMS MADE O OCCUR LEDEXP(Anywl!IMA ) fexcluded XOGvnr/Cont _ Prot. DEDUCTIBLE $5,000 PEHSONAL A ADV INJURY $1,000,000 PER CLAIM GCNCnAL AGGREUAIE S2,000,000 °EHL AUGHEOAYE LIMIT APPLIES PER PRODUCTS�COMPPOP AGC S 1,000,000 POLICY 17 j'E Loc I Emp Ben. excluded AUTOMOBILE LIABILITY CONISINEn IE LIMIT S ANY ALTO � (EA¢elanU ALL OWNED AUTOS BODILY INJURY Sc ICDULCD AUTOS (Par pormnJ f MIRED AU LOS DODILY INJURY f NONOW NCD AUTOS (Py alpiEAin) POOPCRTY DAMAGE S IN,uoJa�q GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY 4UTD OT)'IEA THAN EA ACO f --- - ALTO ONLY AGO S EXCESSNMBRELIA WIBILDT EACH OCCURRENCE $4,000,000 B X_ OCCUR F-1CIAIMSMADE XLS0027391 04/01/05 04/01/06 AGGREGATE s4,000,000 DEDUCI VLE f X RETENTION $SD,000 S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY _ ,TORY LIMITS EM E L.EACH ACCIDENT S ANYPHVPHIMBER EXCLUDEIE%ECUI'IVE it",C RAAELIBER EXCLUDED? EL DISEASE-F.A FMPI DYES S P W L, LEPH CP YAI SPECIAL PROVISIONS DEIPy, CL DISEASEPOLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 010 day Notice of Cancellation for non-payment of premium. Certificate holder is named additional insured as respects operations of the named insured per the attached endorsement. CERTIFICATE HOLDER CANCELLATION SANJDA2 SHOULD ANY OF THE ABOVE°ESC RIBEO POLICIES BE CANCELL EO BEFORE THE EXPIRATION °ATE THEREOF,THE IOSU.G NSURER WILL ENDEAVOR TO MNL "30 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LER,BUT FAILURE TO 00 SO SMALL City Of San Juan Capistrano IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR C/o City Clerk's Office 32400 Paseo Adelanto REPRESENT A ES San Juan Capistrano CA 92675 RUTH [ 5E ATIVE M Chas - T- ur F ACORD 25(2001108) 0 ACORD CORPORA710N 198 , APR-19-2005 16: 18 FROM:ISU CURRY gGBNCY 6264495268 TO: 4931053 P.3 l'ol1ey N°1°lacr CA000003653-05 CC 2n 10 07 M Gnctuvcnatc 04/01/05 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAKETLILL.Y. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION 'I his endorsement mouilics msuranCc provided under the following. COMMERCIAL GI-NERAL LIABILITY COVERACF, f AR"1' SCHEDULE Name Of Additional Insured Persvrn(sl Or Organization(s): I.ocation(s)Of Cuvercd O rcrntttnrs The City of Sen Juan Capistrano hdow,aunn,c cared to tum Ictc this Schedule,if not shown above will be shown in the DeclarAimms A. Section 11—Who Is An Insured is amended Iu This insurance docs not apply In"buddy Injury'nr include as an additional insured the person(s)or .property damag-C occurring after urgamzaliun(s)shown to the Schedule,but only with L All work including matcnnls,parts or equipment respect at hubiluy fur "bodily injury", 'property Lirmshed m connection with such work,un did dama,m*nr"personal and advertising injury"caused, prnjeci(other than service,mahneoance or in whole or to pan,by repairs) to he performed by or on bchnif or the 1. Your acts or rnmsstons; cit additional inattrctl(s)ai the location of the 2. The acts ur umusiuns of those,kung un your euvercd uper:mons lass leen n,mpletcd.or behalf, 2. 'Chat purt,on of 'yoar work" out ul which the m the petfoi mance of your ongoing operations for the injury or damage arises has been put to u, addtUunnl msurcd(s)Tribe Incmlon(s)designated uttcndcd use by any person or nrganaatmn othci above than another contractor ur subcuntracwt cogaged to performing upwalions for a principal as a part 13. With respcn To the insurunce afforded to Ihcsc of the same project. additional insureds,the following additional exc In V nn\apply. CC 20 10 07 04 0 ISO Properties,Inc..2004 Vagc 1 of 1 13 .RNR.19-2005 16: 18 FROM:ISU CURRY#NCY 6264495268 T0: 1 94931053 PA l'oliey Number: CA0000Ulf5.1-U5 AD 06 57 l2 03 Effective Date' 04/01/US THIS ENDORSEMENT CHANGES T13E POLICY- PLEASE READ IT CAREFULLY. PRMARY/NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCMDULE ANY PERSON OR ORGANIZATION QUAT.WYING AS AN INSURED UNDER THE ADDITIONAL INSURED — OWNERS.IESSEW OR CONTRACTORS ENDORSEMENT FORM OG 20 t0 1001 ATTACIIED TO THIS POLICY. It is a6iced tont Couuncreial Genera[ Liability Covasgc 2) Wbo requires by spode written contract that this Prem CG 00 01 Section IV paragraphs 4,b. and 4.c.do not i¢swaoce is to be primary and/ca nos-coaitnlndory apply with respect to otba valid and collectible Comma- to other valid and collactihle insurance available to cul Gtocral Liabiltty wusutaooa,whether primary or excise, em pman or mgartiation available to the persan or organization shown in the Schcd- nk sad: 71it endorsentml duo rot change the scope of wvecagc piavidA to the person or organization by may Additional 1) Wbo u an insured undo an Addiboasl Luured- Imuredrndorstmtat. Owners, Wiens or Contractors cadmarnmat at- All other term;and conabtitas m imam mchas{ged. tachcd to this Palley;and AD 06 5112 03 rage 1 of 1 ate„ 0 32400 PASEO ADELANTO MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 i 4 SAM ALLEVATO (949)483-1171 m(o Aroear[e DIANE BATHGATE (949)493-1053 F" • memMm �. 1961 W1'ATT HART www.sanjuancapistrano.org 1776 JOE SOTO • • DAVID M.SWERDLIN March 14, 2005 All City Management Attn: Baron Farwell, General Manager 1749 S. La Cienega Blvd. Los Angeles, CA 90035x RE: Compliance with Insurance Requirements Insurance Requirements — Crossing Guard Services The following insurance documents are due to expire: ✓ General Liability Certificate 04/01/2005 ✓ 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 aseo Adelanto, San Juan Capistrano, CA 92675 by the above ex ' ati n da s. If have any questions, please contact me at (949)443-6309. in r u Administrativ ecretary cc: Micha I Cantor, Senior Management Analyst San Juan Capistrano: Preserving the Past to Enhance the Future 0 Pnmea an recycles wae APR-19-2005 16: 18 FROM: ISU CURRY-QGENCY 6264495268 TO: 94931053 P. 1 CURRY INSURANCE AGENCY 489 E. Colorado Blvd. Pasadena, CA 91101 F A X C O V E R S H E E T DATE: April 19, 2005 TIME: TO: Maria FAX: 949-493-1053 City of San Juan Capistrano FROM: Gayle Frye PHONE: (626) 449-3870 Curry Insurance FAX: (626) 449-5268 RE: All City Management, Inc Number of pages including cover sheet: 4 Message Mara, Here is the certificate of insurance with the endorsement. Let me know if you need anything more. ` • CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-02-2005 GROUP: POLICY NUMBER: 1805826-2004 CERTIFICATE ID: 64 CERTIFICATE EXPIRES: 10-01-2005 10-01-2004/10-01-2005 CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANDO SAN JUAN CAPISTRANO CA 92675 This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend,extend or alter the coverage afforded by the policy listed herein.Notwithstanding any requirement,term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain,the insurance afforded by the policy described herein is subject to all the terms,exclusions,and conditions,of such policy. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - RONALD FARNELL PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - BARON FARNELL SEC,TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-02-2005 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER ALL CITY MANAGEMENT INC 1749 S LA CIENEGA BLVD LOS ANGELES CA 90035 [B18,SC] PRINTED:06-02-2005 SCIF 10262E Attain the coMfim a any 1 yw see a faint wata,ma*mat reatle'OFFICIAL STATE FUND DOCUMENT PAGE 1 OF 1 ,"Ook Preferred Personnel www.PPersonnel.com May 26, 2005 City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA. 92675 Re: Cancellation of Workers Compensation Insurance Coverage for All City Management Services City of San Juan Capistrano: Please be advised that effective May 29, 2005 the certificate of workers' compensation insurance you are holding which names Preferred Personnel as the insured for providing employees to All City Management Services will be rescinded. Effective May 29, 2005 Preferred Personnel will no longer be providing employees to All City Management Services,therefore you will need to obtain a valid certificate of workers' compensation insurance from their new insurance carrier with an effective date of May 29, 2005. Yours truly, ,�ficea — Brenda Lutke Director of Administration itt� C¢sT GST/G��T� UAL 6WIl" d5v s/�os - w.f-s wo-r WD TH 7Yfi.S 60M�,0'-'y &V,OV4-7Ao ��C iSCty� 3552 Green Avenue, Suite 201, Los Alamitos, CA 90720 (562) 493-1503 Fax (562) 493-0314 ACORD C,ERTIFIC OF LIABILITY INSU CE olio/200 PRODUCER (678)919-1150 FAX 8)919-1151 THIS CERTIFICAT SSUED AS A MATTER OF INFORMATION Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 900 Circle 75 Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 1500 Atlanta, GA 30339 RECEIVED INSURERS AFFORDING COVERAGE NAIC# INSURED Corporate Personnel Network, Inc. INSURERA. AIG/American Home Assurance dba Preferred PersonINSURER B. 3552 Green Avenue 'YAS MAY 31 P 11 31 ' INSURER C. Suite 201 INSURER D: Los Alamitos, CA 90720 SACITY CLERK INSURER E: COVERAGE 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. INSR MIDUL TYPE OF INSURANCE POLICY NUMBER 1'OIJCY EFFECTIVE POl1CY E%PIRATON LIMITS ITR NIRRE DATE IMMIDDrrn GENERAL LIABIUW EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR MED EXP(My one Person) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC JECT AUTOMOBILE L MMUTY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 1242445 04/30/2005 OS/28/2005 X I WCSTATUT I O2- EMPLOYERS'LIABILITY E L.EACH ACCIDENT $ 1,000,000 A ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Kyos,tle under PRO E.L.DISEASE-POLICY LIMIT $ 1,000 000 SPECIAL PROVISIONS below , OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Providing employees for All City Management Services. Staffing agreement terminated effective 05/28/2005. rkers coMensation coverage cancelled effective 05/25/2005. CERTIFICATE CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of San Juan Capistrano BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 32400 Paseo Adel anto OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. San Juan Capistrano, CA 92675 AUTHORREDREPRESENTATIVE Martin Jones/DUNCAB 'Ips»`P1 ACORD 26(2001108) ®ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between, the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) AL • CITY OF SAN JUAN CAPISTRANO INTER-DEPARTMENTAL MEMORANDUM TO: John Shaw, City Attorney FROM: DEPT: City Attorney DEPT: p� SUBJECT: Document Review DATE: 0 PHONE EXT: NOTE: IF THIS IS A"RUSH"ITEM. PLEASE COMPLETE IN RED INK ATTACHED ARE THE FOLLOWING(please describe document,i.e. agreement,con t,consultant a nt,et�C et (1) For your approval and signature (2) F r your review and comment (3)For your informationno .(4)As requested [ ] PLEASE: � (A) Keep for your files (A)When completeedd,,return to: [ ] Ext. �l�"vlQ� ` (C) DateITime needed: U CITY ATTORNEY'S COMMENTS D �_ S f 1 A� OAa CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE 8:35:5ATE AC04-500002-349 Tnz/zoa4 e:35a3 AN PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Monument Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1310 Utica Street HOLDER. THIS CERTIFICATE DOES NOT AMEND EICTEND OR Oriskany, NY 13424 ALTER THE COVERAGE AFFORDED BELOW. Fax: ANG COVERAGE INSURED - IN ITER A: REINSURANCE COMPANY OF AMERICA, INC. CONSOLIDATED EMPLOYER MANAGEMENT SOLUTIONS, INC., PPI IN URER B: Of NY, L/C/F PREFERRED PERSONNEL OF CALIFORNI INSU 3552 GREEN AVE SUITE 200 INSURER D: LOS ALAMITOS, CA 90120 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. INSR TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE f COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any Oro FIN) f CLAIMS MADE r 1 OCCUR MEDEXP(Myp Penin) f PERSONAL&ADVIIDURY S GENERAL AGGREGATE S GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG f POLICY P LOC AUTOMOBILE UABILITY COMBINED SINGLE LIMIT ANY AUTO (Ey.x O f ALL OWNED AUTOS SOOILY RLIURY SCHEDULED AUTOS (Pw 0 ) f HIRED AUTOS BODILY INlX4Y f NONOMIEDAUTOS (Pefec t) PROPERTY DAMAGE S (Px a M) GARAGE LIABILITY AUTOONLY-EAACODENT S ANY AUTO OTHER THAN EA ACC f AUTOONLY. AGO S PA CESS LIABILITY EACH OCCURRENCE f OCCUR ❑CWMs MADE AGGREGATE f f DEDUCTIBLE f RETENTION f f RKERS COMPENSATION AND WC0501040100011 6/l/2004 5/1/2005 TA PLOYERS'LIABILITY 1000000 EL.EACH ACCIDENTf EL DISEASE-EA EMPLOYEE f 1000000 E.L.DISEASE-POLICY UNIT f 100 0 0 OTHER UNITS f UNITS $ DESCRIPTION OF OPEMTIONSILOCATIONSNEHICLESIEXCLUSIMS ADDED BY EN MENTISPECMLL PROVISIONS 1. Project Information:. PROVIDING EMPLOYEES CITY MANAGEMENT SERVICES2. Insured is afforded Workers Compensation and Employers Liability as a co-employer TRY" p or Consolidated Employers Management Solutions, Inc., PPI of NY. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI I ED BEFORE THE EXPIMTWNI DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN CITY OF SAN JUAN CAPISTRANO NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAIWRE TO DO SO SHALL 32400 PASEO ADELANTO IMPOSE NO OSUGATION OR LMBIUTY OF ANY MO UPON THE INSURER ITS AGENTS OR SAN JUAN CAPISTRANO, CA 92675 REPRFSENTAl1VEs. AUTHORRED REPRESENTATIVE ACORD 25S(7/97) 0 ACORD CORPORATION 1988 City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA. 92675 (949) 493-1171 Fax: (949) 493-1053 / FAX TRANSMISSION COVER SHEET Date: 1 To: [�14 C l/Lf 6,0 _Z-,7 Fax: 5-60)x,, 54q)- -�� /�, Re: �t�,�Q/t$ 19 � / � ��/CX�J �y Sender: aK—1 Q (C7(�UQ�Q 149 �Yj �`�/ YOU SHOULD RECEIVE AGE(S), INCLUDING THIS COVER SHEET. IF YOUDO NOT RECEI ALL THE PAGES, PLEASE CALL (949) is �� r--K- �3 pertain to general pedestrianoafety and school crossing areas. 11 . Crossing Guard Services shall be provided by the Contractor at the designated locations and at the designated hours on all days on which the designated schools in the City of San Juan Capistrano, are in session. 12 . The Contractor shall provide all Crossing Guards with apparel by which they are readily visible and easily recognized as Crossing Guards. Such apparel shall be uniform for all persons performing the duties of Crossing Guards and shall be worn at all times while performing said duties. This apparel must be appropriate for weather conditions. The Contractor shall also provide all Crossing Guards with hand held Stop signs and any other safety equipment which may be necessary . Apparel and equipment shall be pre-approved by the City Manager. 13. The Contractor shall at all times provide Worker ' s _ 1 Compensation insurance covering its employees, and shall provide and maintain public liability insurance for Crossing Guard activities with the City named as an additional insured. Such insurance shall include, but not be limited to, comprehensive general liability with a combined single limit of not less than $5 ,000,000.00 per occurrence for property damage and for bodily injury or death of persons. Such insurance shall be primary with respect to any insurance maintained by City and shall not call on City ' s insurance contributions . Such insurance shall be endorsed for contractual liability and personal injury and shall include the City, its officers, agents and interest of City. Such insurance shall not be cancelled, reduced in coverage or limits or non-renewed except after thirty (30) days written notice by Certified Mail, Return Receipt Requested has been given to the City Attorney or City Manager. 14. Contractor agrees to indemnify the City, its Officers, employees and agents against, and will hold and save them and each of them harmless from, any and all actions , claims damages to persons or property, penalties , obligations or liabilities that may be asserted or claimed by any person , firm , entity , corporation , political subdivision or other organization arising out of the negligent acts or intentional tortious acts , errors or omissions of Contractor, its agents, employees, subcontractors, or invitee, provided for herein. a) Contractor will defend any action or actions filed in connection with any of said claims, damages, penalties, obligations or liabilities and will pay all costs and expenses including attorney's fees incurred in connection herewith. ACORD CERTIFI '► _ OF LIABILITY INS NCS, OP ID A LCI-1 04DATE(/01/0 /01/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 H. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone: 626-449-3870 Fax:626-449-5268 INSURERS AFFORDING COVERAGE INSURED INSURER A. Admiral Insurance Company INSURER B. Scottsdale Insurance Company All City Management, Inc. Baron Farwell INSURER C: 1749 South La C900va Blvd. INSURER D: Los Angeles CA 90035 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. NSR POLICY EFFECTIVE PoLicy EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MWDWM DATE M LIMA GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A IX COMMERCIAL GENERAL LIABILITY CA000003653-04 04/01/04 04/01/05 FIRE DAMAGE(Any one SM) $50,000 CLAIMS MADE ®OCCUR MED EXP(My one person) $excluded Owner/Cont Plot. PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPNP AGE $1,000,000 POLICY JELOC MInp Ben. excluded AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea amid) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) E HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per axident) GARAGE UABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $4,000,000 B $ OCCUR F-] CLAIMSMADE XLS0021251 04/01/04 04/01/05 AGGREGATE s4,000,000 S X1DEDUCTIBLE $ RETENTION $10,000 TA $ WORKERS COMPENSATION AND I TORY LIMITS ER EMPLOYERS.LIABILITYE.L.EACH ACCiDENT $ E.L.DISEASE-EA EMPLOYEEA$ E.L.DISEASE-POLICY LIMIT I$ OTHER DESCRIPTIO!OF OPERATKINSILOCATIONEAIEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECULL PROVISIONS •10 Day Notice of Cancellation for Non-Payment of Premium. Certificate Holder is named as Additional Insured, per Endorsement attached to policy. CERTIFICATE HOLDER Y I ADDITIONAL INSURED;INSURER LETTER: A CANCELLATION CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *3 0 DAYS WNTTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL City of San Juan Capistrano IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 32400 Paseo Adelando REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPR I Michael Cu >• ACORD 25-S(7/97) ®ACORD CORPORATI 88 • • Policy Number: CA000003653-04 CG 20 10 10 01 Effective Date: d7/Ol/03 ADMIRAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDMONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABII M COVERAGE PART SCHEDULE Name of Person or Organization: City of San Juan Capistrano (Ifno entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) A. Section H—Who Is An Insured is amended to (1) All work,including materials,parts or include as an insured the person or organization shown egnipmemt furnished m oomection with in the Schedule,but only with respect to liability anis- such wmk,on the project(other than serv- ing out of your ongoing operations performed for that ice,maintenance or repairs)to be per- insured. formed by or ion behalf ofthe additional in- B. With respect to the insurance efforded to Those addi- sared(a)at the site of the covered tionnl insaceda,the following eerchudon is added: operations hes been completed; or 2. Exclusions ' (2) That portion of"your work"out of wirich the injury or damage arises has been pat to This insurance does not apply to"bodily injury"or its intended use by any person or organiza- "pwpmi image"occurring after: tion o1her then another contractor or sub- contractor engaged in performing opera- tions perations for a pincipal as a part of the ss= project If you are required by a written contract to provide primary insurance, then this policy shall be primary and not contributory with say other insurance available to the additional insured named in the schedule above. Form CG0001 Commercial General Liability Coverage (but only Section IV. Paragraph 4., subparagraph b) is amended accordingly and shall not apply with respect to coverage provided for the Additional Insured named above in the schedule. a 40t,AUTHORIZED SIGKATU1611 A6"z� ISU CURRY INSURANCE AGENCY CG 20 10 10 01 ®TSO Properties,Inc.,2000 pace 1 of 1 Transmit Conf _ Repart P. 1 Aug 4 2004 10:44 Fax/Phone Number Mode Start Time Page Result Note 15624028692 NORMAL 4, 10:44 0'59" 6 8 0 K Cly of San Juan Capistrano 32400 Pasco Adefanto San Juan Capistrano, CA. 92675 (949) 493-1171 Far: (949) 493-1053 FAX TRANSMISSION COVER SHEET .nate: 104 To: Lf GgI6,0/ SP�17 Fax Re: tiC�r91/x�//c�a c Flu 09k)Jo/� (('t�t/�� Sendcr. YOU SHOULD RECEIVE AGE(SI), INCLUDING THIS COVER SHEET. IF YOU DO NOT RECE ALL THE PAGES, PLEASE/CALL (949) ' fZLCIe, �[gGt�/ - 0/ 4j/ �tCa � L-O/ ��-. j ,A<gt CITY OF SAN JUAN CAPISTRANO INTER-DEPARTMENTAL MEMORANDUM TO: JohnShCity Attorney FROM: DEPT: City Attorney DEPT: SUBJECT: Document Review DATE: i PHONE EXT: NOTE: IF THIS IS A"RUSH" ITEM, PLEASE COMPLETE IN RED INK ATTACHED ARE THE FOLLOWING(please describe document, i.e. agreement, contract,consultant agr ment, et ): (c G ('�/ i! ca >� SOg�P W1 fflavi cwt co r=roh /r.��d U (�- u T7 aCc (1) For your approval and signature �J [�S (2) For your review and comment [ ] him (3) For your information (4)As requested (5) PLEASE: l�jC1 / �14 4V ` " (A) Keep for your files [ ] (A)When completed, return to: [ ] l`1 6(N 6, • Ext. (0--J c) V (C) Date/Time needed: CITY ATTORNEY'S COMMENTS G 1 w� . ( � 06 i, 06/25/2004 FRI 10:00 FAX 310#8325 All City Management Svcs + X002/002 EVIDENCE OF COVERAGE DATE(DWI 112004) Master Account THIS EVIDENCE OF COVERAGE AS A MATTER OF INFORMATION ONLY AND Mainstay Business Solutions CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Y DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P.O.Box 1126 COVERAGE BELOW Blue Lake,CA 95525 ENT11 117111:FOR 1 IN COVERAGE Staffing Client INSURER A:Mainstay Employer Occupation Indemnity and Madir l Sene6ls All City Management Services Fund INSURER 0: 1749 South La Cienega Blvd. IN Los Angeles,CA 90035 Fax:(310)202-8264 INSURER D: INSURER E- COVERAGES � COVERAGES O( QQ THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE ENTITY NAMED ABOVE FOR THE PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREME TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAV PERTAIN,THE COVERAGE AFFORDED BY THE CERTIFICATE OF COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS ANO CONDITIONS OF SUC COVERAGE.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS 4rur TYPp OF COVERAGE POUCYNUMBER POLICY EFFECTIVE POLICY EXPERAMN LIMITS DAYE(MMIOWW) DATE(MM NY) GENERAL LIABILITY EACH OCCURRENCE § COwweeICALCENCIUNIusiurrY FIRE DAMAGE(Any ane fire; § uuws uaoe Q OCCUR MEO EXP(Arty One person) § PERSONAL B ADV INJURY S OeHx AoaNCAWLfATAN L e R-. GENERAL AGGREGATE § F1 Poucv ❑ ACT LOC PRODUCTS-COMP/OP AGG 5 AUTOMOBRE LL48ILITY COMBINED SINGLE LIMIT § .1 Auro (Ea""dant) ILL owano AVros BODILY INJURY aCHIUMILEPAUTOS rya person) § NRse AVrw HONowweaAuros BODILY INJURY § ((Per eceidenl) PROPERTY DAMAGE § Per roaftnt GARAGE LIABILITY AUTO ONLY-EA ACCIDENT B ANY rw.O § OTHER THAN EA ACC S AUTO ONLY' I AGG EXCESS LIABILITY EACH OCCURANCE § Q OCCUR culwf MAOC AGGREGATE § 8 ffm.xoucnrc I✓6 S Wn s J OCCUPATIONAL INJURYMB 60010301 06/01/04 06/01/05 EL DISEASE-EMPLOYEE INDEMNITY AND MEDICAL BENEFIT EL DISEASE-LIMIT $1 MIL COVERAGE EL EACH ACCIDENT TION OCArON9NENICLESIEXCLUSIONIADD�ED�V ENOORESEMENTISPECMIL PROVISIONS Tribal Slatut enn one IF rBm C Is txtyena orded only to the employees peoYided to the stalfmg chiint listed above Waiver Of Srut aeon is applicable to the aDoveHnen6oned wverage. CERTIFICATE HOLDER I X CANCELLATION Dawn M.Schanderl,Deputy City Clerk City of San Juan Capistrano 73"OULD ANY OF THE MOVE DESCRIBED COVERAGE BE CANCELLED BEFORE THE EINIRATION OATC 32400 Paseo Adelando OF,THE IS W ING ENTITY WILL ENDEAVOR TO MAIL]LDAYS WRITTEN NOTICE TO THE FICATE HOLDER NAMED TO THE LEFT,AUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION San Juan Capistrano, CA 92675BILITY OF ANY RIND fir+ X l, AUTHORIZED REPRFEENTgTNE CITY OF SAN JUAN CAPISTRANO INTER-DEPARTMENTAL MEMORANDUM TO: John Shaw,City Attorney FROM: Ott p A 66e�l a_ DEPT: City Attorney DEPT: SUBJECT: Document Review DATE: i PHONE EXT: j NOTE: IF THIS IS A"RUSH" ITEM. PLEASE COMPLETE IN RED INK ATTACHED ARE THE FOLLOWING(please describe document,i.e. agreement,contract,consultant t agr ment, et ) I( /1 ; / -- cy� �Gyl M r ccs pzro o t Ainoer Irem /� u,61 rT_`,'`�/' Cry t cU !-)I- �h U OGc �nl3�C apt k Q (1) For your approval and signature 7 Sjs C�ZLC_ ecc (2) For your review and comment [ ] (3) For your Information [ ] (4)As requested [ ] J " � (5) [ ] iS Ot ti fu A 14 1 PLEASE: b (A) Keep for your files [ ] (A)When completed,return to: � Quin(0. Com • Ext. (o�J O9 LI (C) Datefrime needed: CITY ATTORNEY'S COMMENTS 06/25/2004 FRI 10:00 FAX 31J�,Q2 8325 All City Management Svcs • 4002/002 EVIDENCE OF COVERAGE DATE(OB 11/20W) Master Account THIS EVIDENCE OF COVERAGE AS A MATTER OF INFORMATION ONLY AND M]inEta BUSInlES SOIULIOIIS CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Y DOES NOT AMEND,EMEND OR ALTER THE COVERAGE AFFORDED BY THE P.O.Box 1128 COVERAGE BELOW Blue Lake,CA 95525 EN AFFORO{NG COVERAGE Starring Client INSURER A:Mainstay Employer Oemptlon Indelmlty and Madical Benefits Fund All City Management Services INSURER B: 1749 South La Canoga Blvd, IN Los Angeles,CA 90035 Fax:(710)2024284 INSURER D: rr INSURER E: l COVERAGES - 016 THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE ENTITY NAMED ABOVE FOR THE PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREME , TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE AFFORDED BY THE CERTIFICATE OF COVERAGE DESCRIBED HE REM IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUC COVERAGE.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PALO CLAIMS IeRar TYPES Of COVEMGE POLICY NUMBER POLICY EFFECTIVE POLICY EXPERATION UMTS GATE(MMMONri) PATE IMVCONYI GENERAL LIABILITY EACH OCCURRENCE S coNRLeluAgerreeALLwLIMr FIRE DAMAGE(My one Mel S I:IIaAL MaR OCCW MED EXP(Amy ens puenn) 5 PERSONAL d ADV INJURY S rllx AORIIeuTF Lrrt ' v[R: GENERAL AGGREGATE S roLxr rARcoT LK PRODUCTS-COMPIOP AGG S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S .Nr"TO (EA eccidcrA) uL a AVroe BODILY INJURY $OeUmEPAInea (P«arson) S NMED Aura HONpACRwTos BODILYINJURYS K ((Pr CMBf1I) PROPERTY DAMAGE S Pr mcodere GARAGE UABILITY AUTO ONLY-EA ACCIDENT S OTHER THAN GAACC S AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURANCE S O otcuA curslMM AGGREGATE S 8 K011F1MM �G�'G S M1neNlpw e � S J OCCUPATIONAL INJURY MB 60010301 06/01/04 06)01/05 EL DISEASE-EMPLOYEE 11DEMNITY AND MEDICAL BENEFIT EL DISEASE-LIMIT $1 Mil. COVERAGE EL EACH ACCIDENT TON OCATIONSNENICLES/FJ(CLUSION*-AOD�Y ENOORESEMENTISPECUIL PROVISIONS Tribal Statut em s rom l wvarage d only ID 1M MsnPIOy6es provided to the staffing Clem-listed aW e Waiver of Subrogation is applicable 10!le above-mentioned covgrAO0. CERTIFICATE HOLDER I X CANCELLATION Dawn M.Schanderl,Deputy City Clerk City of San Juan Capistrano SHOULDANY OF THE ABOVE DESCAIBFO COVERAGE BE CANCELLED BEFORE THE ERPIMTION DATE 32400 PaseoAdelando THEROF,THE ISSUe1OENTT'WALENDFAVORTOMML r-DAYSWRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAM:O TO THE LEFT,RUT FA vIte TO DO SO SHALL IMPOSE NO OBUM TION San Juan Capistrano,CA 92675 ORLIABILITYOFANYKJNO AUTHorsrzcD REPRESENTATIVE r pertaiag to general pedestria0safety and school crossing areas. ii . Crossing Guard Services shall be provided by the Contractor at the designated locations and at the designated hours on all days on which the designated schools in the City of San Juan Capistrano, are in session. 12. The Contractor shall provide all Crossing Guards with apparel by which they are readily visible and easily recognized as Crossing Guards. . Such apparel shall be uniform for all persons performing the duties of Crossing Guards and shall be worn at all times while performing said duties. This apparel must be appropriate for weather conditions. The Contractor shall also provide all Crossing Guards with hand held Stop signs and any other safety equipment which may be necessary . Apparel and equipment shall be pre-approved by the City Manager. 13. The Contractor shall at all times provide Worker's Compensation insurance covering its employees, and shall provide and maintain public liability insurance for Crossing Guard activities with the City named as an additional insured. Such insurance shall include, but not be limited to, comprehensive general liability with a combined single limit of not less than $5,000,000.00 per occurrence for property damage and for bodily injury or death of persons. Such insurance shall be primary with respect to any insurance maintained by City and shall not call on City ' s insurance contributions . Such insurance shall be endorsed for contractual liability and personal injury and shall include the City, its officers, agents and interest of City. Such insurance shall not be cancelled, reduced in coverage or limits or non-renewed except after thirty (30) days written notice by Certified Mail, Return Receipt Requested has been given to the City Attorney or City Manager. 14. Contractor agrees to indemnify the City, its Officers, employees and agents against, and will hold and save them and each of them harmless from, any and all actions , claims damages to persons or property, penalties , obligations or liabilities that may be asserted or claimed by any person , firm , entity , corporation , political subdivision or other organization arising out of the negligent acts or intentional tortious acts , errors or omissions of Contractor, its agents, employees, subcontractors, or invitee, provided for herein. a) Contractor will defend any action or actions filed in connection with any of said claims , damages, penalties, obligations or liabilities and will pay all costs and expenses including attorney's fees incurred in connection herewith. City of Sac Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA. 92675 (949) 493-1171 Fax: (949) 493-1053 FAX TRANSMISSION COVER SHEET Date: Fax: C 2 � YO 2- Re: Wk Divi $CJ/Cfil/�C Sender: �_�p /64 YOU SHOULD RECEIVE PAGE(S), INCLUDING THIS COVER SHEET. IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CALL (949) AIS ��2 Oc�lz Coll GC ASO cYc Cu C�r l�ey , uyr �jv� ✓� `Aaiu� - 06/25/2004 FRI 10:00 FAX 31020325 All City Management Svcs 002/002 r .EVIOEAICE OF COVERAGE DATE(01141112004) Master Account THIS EVIDENCE OF COVERAGE AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Mainstay Business Solutions DOES NOT AMEND,EMEND OR ALTER THE COVERAGE AFFORDED BY THE P.O. Box 1128 COVERAGE BELOW Blue Lake,CA 95525 ENTITY AFFORDING COVERAGE Staffing Client INSURER A:Mainstay Employer Occupation Indemnity and Medical Benefits Fund All City Management Services INSURER B: 1749 South La Cienega Blvd. INSURERC, Los Angeles,CA 90035 INSURER D: Fax:(310)202-8284 INSURER E• COVERAGES THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE ENTITY NAMED ABOVE FOR THE 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 COVERAGE AFFORDED BY THE CERTIFICATE OF COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH COVERAGE.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY EFFECTIVE POLICY EEPEPATION I.M., TYTE]OF COVERAGE POLICY NUMBER DATE(MMIDO(VY) DATE IMWDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S <oLmfalCAt cENCR,Auullm FIRE DAMAGE(Any one lire) $ pIX.UR CWM[Mbf a EF' MED EXP(Anyone person) $ PERSONAL&ADV INJURY S OEx'LLOOREC[TELWITNRs YER: GENERAL AGGREGATE $ IMD. POUn ID ECT Loc PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea accident) ALL OrAao AMD& BODILY INJURY SCHEPULCP AUTOS (Pp DOWN $ "NEO[UTOE HONOweePAVTO[ BODILY INJURY $ ((Per accident) PROPERTY DAMAGE $ Per sovdant GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S E ARY Awo OTHEROZAN EA ACC $ AUTO ONLY ACC EXCESS LIABILITY EACH OCCURANCE S OCCUR Q CLAIMS MADE AGGREGATE $ 8 S PEPucTMLE RLTIMTKH f $ A OCCUPATIONAL INJURY MBS060010301 06/01/04 06/01/05 ELDISEASE-EMP LOYEE INDEMNITY AND MEDICAL BENEFIT EL DISEASE-LIMIT $1 MIL COVERAGE EL EACH ACCIDENT DESCRIPTION OF OPERA71ONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENOORESEMENT/SPECIAL PROVISIONS Tribal Statutory Exemptions Apply I Tribal Program This coverage IS afforded only to the employees provided to the staffing client Ilsted above Waiver of Subrogaton is applicable t0 the above-mentioned coverage. CERTIFICATE HOLDER I X CANCELLATION Dawn M.Schande►l,Deputy City Clerk City of San Juan Capistrano SHOULD ANY OF THE ABOVE DESCRIBEO COVERAGE BE CANCELLED BEFORE THE EXPIRATION GATE THEROF,THE ISSUING ENTITY WILL ENDEAVOR TO MAIL 12DAYS WRITTEN NOTICE TO THE 32400 Paseo Adelando CERTIFICATE HOLDER NAMED TO THE LEFT,RUT FAILURE TO 00 SO SHALL IMPOSE NO OaLIG TION San Juan Capistrano,CA 92675 OR LIABILITY OF ANY KIND AUTHORIICO RFPRE$FNTgTIVE 06/25/2004 FRI 9:59 FAX 3102#325 All City Management Svcs • X001/002 ML CM h"AGE1b11INT SFAVICIRS FACSIMILE TRANSMITTAL SHEET TO: FROM: Michael Cantor,Senior Baron Farwell,General Manager Management Analyst COMPANY: DATE: City of San Juan Capistrano 06/25/04 FAX NUMBER TOTAL NO. OF PAGES INCLUDING COVER: (949) 488-3874 2 PHONE NUMBER SENDER'S REFERENCE NUMBER (949) 493-1171 RE: YOUR REFERENCE NUMBER Certificate of Insurance ❑URGENT ❑FORREVIEW ❑PLEASE COMMEN170PLEASE REPLY If you have any questions, please call me at (800) 540-9290. U, Main Office: 1749 S. La Cienega Blvd. -Los Angeles,CA 90035 -310-202-8284 FAX 310-202-8325 Northern California Office: 6500 Dublin Blvd.,Ste. 216- Dublin,CA 94568 - 800-540-9290 FAX 925-803-6992 0 Maria Guevara From: Maria Guevara Sent: Thursday, July 01, 2004 4:47 PM To: jim@cjpia.org' Subject: Insurance question Hi Jim, I work for the City of San Juan Capistrano, I have a question regarding workers comp insurance. We received a certificate covering occupational injury/indemnity and medical benefit coverage. Is this considered workers comp? Maria Guevara, Secretary City of San Juan Capistrano City Clerk Division (949) 443-6309 i Maria Guevara From: Michael Cantor Sent: Wednesday, June 23, 2004 3:33 PM To: Maria Guevara Subject: RE: Workers Comp I'll call themmmmmmmmmmmmmmmmmmmm. -----Original Message----- From: Maria Guevara Sent: Wednesday,June 23,2004 3:21 PM To: Michael Cantor Subject: RE: Workers Comp nooOOOOOOOOOOOO00000O -----Original Message----- From: Michael Cantor Sent: Tuesday,June 22,2004 4:03 PM To: Maria Guevara Subject:Workers Comp Did you get the renewal for All City Management that expired 06/01? Can I see a copy. Thanks. Mike Cantor City of San Juan Capistrano Senior Management Analyst Emergency Services Coordinator CERT Coordinator 949.234.4565 Office 949.246.6375 Cell 949.488.3874 Fax "Thanks for taking the time to be Prepared." 1 32400 PASEO ADELANTO J MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 SAM ALLEVATO (949)4931171 IntaAv0P0.1Eo DIANE L.BATHGATE (949)493-1053 FAX UtuOfem I 1961 WYATT HART www.sanjuancapistrano.org V 1776 JOE SOTO • • DAVID M.SWEROUN May 10, 2004 All City Management Attn: Baron Farwell, General Manager 1749 S. La Cienega Blvd. Los Angeles, CA 90035x RE: Compliance with Insurance Requirements — Crossing Guard Services The following insurance documents is due to expire: J Workers Compensation Certificate 06/01/2004. 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 expir - n date. If you h ve any questions, please contact me at (949) 443-6309. S' ce u a Secretary cc: Michael Cantor, Senior Management Analyst San Juan Capistrano: Preserving the Past to Enhance the Future j�NUZUR PKI ll:u4 PAA 31uzuz1sz4Al1 uty management byes *Juua uuc (CrITY MMMAGEACRNT SERVICES Memorandum November 1, 2002 To: Dawn Schanderl Fr: Baron Farwell Re: Crossing Guards Status I do apologise for not being clear in my last communication regarding the status of our Crossing Guards. Crossing Guards are indeed "our" employees and yet they are "leased" for administrative purposes. This"administrative relationship"in no way, form or fashion compromises our contracted duties and responsibilities or the management of our Crossing Guard Programs. The intent of the wording On Page 1, item number 2 is to affirm the disassociation of Crossing Guards from the employment of the City. In most cases when we assume control of a Crossing Guard program the Guards are typically City employees. This wording was included to clarify the fact that the City has no employer/employee relationship with Crossing Guards beyond the contract date. As we continue to dutifully provide Crossing Guard Services as per our agreement, I would ask that the City release payment for services rendered this school year. Si a ly, B 11, Cc: Lt. J.B. Davis City Attorney Main Office: 1749 S_La Cienega Blvd. -Los Angeles,CA 90035 -310-202-8284 FAX 310-202-8325 Northern California Office: 6500 Dublin Blvd., Ste. 216 -Dublin,CA 94568 -800-540-9290 FAX 925-803-6992 11IV1/ LVVL 1111 11.VV- 1'aA UIVLVL VULU all VIVO Y1u1au0V,w, 1V v,Vv ti--- - -- AILL CX1:4 Y MMAGEbWOff 0 l�ti121U SERVICM It� i �2,ODZ �� IC./r 1 • ��d��L� �{ D �( Memorandum Yew November 1, 2002 To:Dawn Schanderl Fr: Baron Farwell Re: Crossing Guards Status I do apologize for not being clear in my last communication regarding the status of olir Crossing Guards. Crossing Guards are indeed "our" employees and yet they are"leased" for administrative purposes-This"administrative relationship" in no way,form or fashion compromises our contracted duties and responsibilities or the management of our Crossing Guard Programs. The intent of the wording on Page 1, item number 2 is to affirm the disassociation of Crossing Guards from the employment of the City. In most cases when we assume control of a Crossing Guard program the Guards are typically City employees. This wording was included to clarify the fact that the City has no employer/employee relationship with Crossing Guards beyond the contract date. As we continue to dutifully provide Crossing Guard Services as per our agreement, I would ask that the City release payment for services rendered this school year- s' a -ly, Baz � ll, Cc: Lt. J.B.Davis City Attorney Main Office: 1749 S.La Cienega Blvd.-Los Angeles,CA 90035 -310-202-8284 FAX 310-202-8325 Northern California Office: 6500 Dublin Blvd.,Ste. 216-Dublin,CA 94568. 800-540-9290 FAX 925-803-6992 DATE ACORD,N CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 09/06/2002 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis North America, Inc. - Regional Cert Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26 Century'Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. -O. Box 305191 Nashville, TN 372305191 INSURERS AFFORDING COVERAGE INSURED PACA, Inc. INSURERA; American Casualty Company of Reading, Pen 20427-001 PO Box 729 INSURERS: Alexander City, AL 35011 ---- INSURERC: INSURERD: INSURERE: ' 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. INSR POLICYEFFECTIVE POLICYEXPIRATION LTR TYPE OF INSURANCE POLICYNUMBER DATE MMIDDTYY DATE MMIDOM' LIMITS GENERALLu BIUTY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(My we fire) S CLAIMS MADE OCCUR MEDEXP(Myone Perera) $ PERSONALSADVINJURV $ GENERAL AGGREGATE $ GENIE AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY JECOT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea acdtlenQ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) HIREDAUTOS BODILYINJURY $ NON-OWNED AUTOS (Per acm'tlent) PROPERTY DAMAGE S (Per arrident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG S EXCESS LIABILITY r_ _ EACHOCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WC247842430 12/31/2001 12/31/2002 X To�iv LiMrs DER EMPLOYERS'LIABILITY A WC247842444 12/31/2001 12/31/2002 E.L.EACH ACCIDENT s 1 000 000 EL DISEASE-EA EMPLOYEE I$ 1,000 000 EI.OISEASE-POUCYUMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSAOCATIONMEHICLE XCLUSIONSADDED BY ENDORSEMENTISPECIAL PROVISIONS Providing Leased Employees to: All City Management Services, Inc., 1749 South La Cienega Blvd., Los Angeles, CA 90035 Coverage Effective Date: 5/1/02 - PACA #4 CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAR 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Dawn M. Schanderl, Deputy City Clerk City Of B8n Juan Capistrano REPRESENTATIVES. 32400 Pa3e0 Adelando AU ORREDR RES TATIV San Juan Capistrano, CA 92675 ACORD 25-S(7/97) Coll:539483 Tpl:89493 Cert:2163452 ©ACORD CORPORATION 1988 Page 2 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(7l97) Co11:539483 Tp1:89493 Cert:2163152 • ,s, s 32400 PASEO ADELANTO MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 9267$ (949)493-11 �y k SAMALLEVATO 71 (949)493-1171 FAX � }„`" Waeraaalm DIANE L.BATHGATE IS AD ISam 1161 WYATT HART www sanjuancapistran a org 1776 JOE SOTO • DAVID M.SWERDUN NOTIFICATION OF ME E POTENTIAL INTEREST OF THE SAN JUAN CAPISTRANO CITY COUNCIL The City Council of San Juan Capistrano will meet at 7:00 p.m. on July 6, 2004, in the City Council Chamber in City Hall, to consider: "Consideration of Renewal of Agreement for School Crossing Guard Services (All City Management Services, Inc.)" — Item No. D10 If you have specific thoughts or concerns regarding this item, you are encouraged to participate in this decision making process. You can communicate with the City Council through correspondence addressed to the Board and/or by attending the meeting and speaking to the Council during the public meeting. Correspondence related to this item must be received at City Hall by 12:00 p.m. on Tuesday, July 6, 2004 to allow time for the Council to consider its content. If you would like to speak at the meeting, please complete a blue 'Request to Speak" form found inside the entrance to the Council Chamber. This form is turned in at the staff table, just in front of the Council dais. You will be called to speak by the Mayor when the item is considered. You have received this notice at the request of the City staff member Michael Cantor, Senior Management Analyst. You may contact that staff member at (949) 234-4565 with any questions. The Agenda, including agenda reports, is available to you on our web site: www.sanivancaoistrano.org. If you would like to subscribe to receive a notice when agendas are posted to the web site, please make that request by sending an e-mail to: council-aoendasO-sanivancaoistrano.orci. Thank you for your interest, Meg Monahan, CMC City Clerk cc: All City Management Services, Inc.; Capistrano Unified School District; Michael Cantor, Senior Management Analyst " Received staff report San Juan Capistrano: Preserving the Past to Enhance the Future Memorandum: To: Mike Cantor, Senior Management Analyst From: John Shaw, City Attorney Re: All City Worker's Compensation Insurance Issue Date: September 4, 2004 In the light of the circumstances outlined in your memorandum, 1 would recommend the practical solution of accepting the insurance coverage provided. As JPIA has noted, the question of whether to demand a higher standard of insurance is strictly a policy decision for the City. This is not unlike other situations we have seen over the years, for example, the inability of geologists to obtain higher levels of liability coverage. In conclusion, the matter is not legal in nature. It is a policy question of whether to cease providing the crossing guard service due to insurance issues, or accepting a lower form of insurance as noted in the memo. I suggest the latter. MEMORANDUM September 3, 2004 TO: John Shaw, City Attorney FROM: Mike Cantor, Senior Management Analyst lty� SUBJECT: All City Management Services, Inc. (Workers' Compensation rating) The City has contracted with All City Management Services, Inc. (All City)for school crossing guard services since 1993. They have provided excellent service and to the best of my knowledge there have been no unresolved issues with their insurance coverage. There current Workers' Compensation coverage is provided by Reinsurance Company of America, Inc. This company is rated NR-3(Rating Procedure Inapplicable). All City has been notified that the insurance carrier does not have a qualifying rating and that All City is on the non-pay list until this is resolved. All City Management Services, Inc. provides service to around 100 jurisdictions in the area. They appear to have monopolized the industry. I have spoken with the Cities of Dana Point, Mission Viejo and Laguna Niguel regarding the workers'compensation coverage; each of these cities is aware of the insurance rating problem, but is in a holding pattern because there appears to be no other options for crossing guard service due to All City's control of the market. I consulted with JPIA regarding this issue. Although JPIA represents a large number of jurisdictions that also have contracts with All City, JPIA will not offer any direction other than the rating is not acceptable and the decision to accept or not accept the submitted coverage must be made by the City. According to All City Management Services, Inc., they are willing and able to pay for coverage that has an authorized rating approval, but they are unable to find one that will cover their employees. • Their workforce average age is over 60. • Their job is high risk in that they stand in the middle of intersections and ask vehicles to stop for pedestrians. Per information provided by All City, the availability of qualified carriers has diminished over the years, especially in California. California's State Fund was an option, but they no longer have a rating. Their previous carrier (Mainstay Employer Occupation Indemnity and Medical Benefits) is embroiled in lawsuits and appears to be presently unstable;therefore they changed to Reinsurance Company of America, Inc. All City has stated that there is no insurance available that offers a qualifying rating that will insure their employees. Please provide direction regarding this issue? Attachments: 1. Insurance Certificate for Reinsurance Company of America, Inc. 2. JPIA rating guide 3. 1993 Personal Services Agreement (section 13 — Insurance) 0 0 m - CERTWMATE NO.$GATE aggfR !- CEKTIFICATE Qf -LIAWTTiHihC:ZTIFICATE URANCE "`°'-50000 5153 T/,,04-5 902-34 M PRODUCER IS ISSUED AS A MATTER OF INFORMATION Monument Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1310 Utica Street HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OW Oriskany, NY 13424 ALTER THE COVERAGE AFFORDED . Fax: ING COVERAGE INSURED I A; REINSURANCE COMPANY OF AMERICA, INC. CONSOLIDATED EMPLOYER MANAGEMENT SOLUTIONS, INC., PPI URER B: of NY, L/C/F PREFERRED PERSONNEL OF CALIFORNI INS 3552 GREEN AVE SUITE 200 INSURER D: LOS ALAMITOS, CA 90720 INSURERS COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BERN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED-NOTWITHSTANDING ANY REOWREMENT, 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 PADCWMS. TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL.LIABILITY EACH OCCURRENCE S N14.EROAL GENERAL LIABILITY FRE DAMAGE VAYOwflke) S CLAIMS MND; r--1 OCCUR MEDEXP(MY MMPN99R) f . PERSOINLSAP/"JURY S GFRNERALAGGREGATE f GHVL AGGREGATE LNRTAPRLIES PER PROWICTS•COMPIOPAGG S POLICY M MLOG AUTOMOBILE LIABILITY COMBINEDSINGLELYAN S ANY AUTO ') ALL OV0ED AUTOS SOOLY ILNXIY f SCHEDLLEDAUTOS DwP9199A) HRED AUTOS BODILY INUw f HON OWHED AUTOS (Pwamdwd) PROPERTY DAMAGE f PW RCw") GARAGE LIABILITY AUTO ONLY.EA ACCIDENT S ANY AUTO OTHEATWIN EAACC S. AUTO MY. AGC f EXCESS LM9ILRY EACH OCCURRENCE $ OCCUR �CLAIMS MADE AGGREGATE f f DEDUCTIBLE f RETianioN ff WORKERS COMPENSATION AND WC0501040100011 6/1/2004 5/1/2005 A EMPLOYERS'LIABILITY EL EACMACCRDEW f 1000 00 A ELOISEASE•EAFApIDYEE S 10000D0 EL DISEASE-POLICY UMM f SO 0000 OTHER LIMITS S [LIMITS S DESCRIPTION OF OPERATKNISA.OCATN)NSIVEHICLESMXCWSIONS ADOED BY EN NTISPEC4LL PROVISIONS 1. Project Information: . PROVIDING EMPLOYEES CITY MANAGEMENT SERVICES 2. Insured is afforded Workers Compensation and Employers Liability as a co-emP oye —ttTB-'posit or Consolidated Employers Management Solutions, Inc., PPI of NY. CERTIFICATEHOLD R ADanaNALwwRED:INsuREa LEITER: CANCELLATION SHOULDANYOFTHEABOVEGESCWBEOPOUCESBECANC imBEFORETHEEXPMTIDN DATE THEREOF.TH: mSINNG INSURER V11µENDEAVOR TO MNL 30 DAYS W WTTEm CITY OF SAN JUAN CAPISTRANO NOTICE TO THE CERTW"TE VOIDER NAMED TO THE LEFT,BUT FNLUM TO DO$O SHALL 32400 PASEO ADELANTO MP03E NO OBLIGATION OR UABIUTY OF ANY KING UPON nE INSURER ITS AGENTS OR SAN JUAN CAPISTRANO, CA 92675 RE SENTAlNES. AUTI1 =C REPRESENTATNE ACORD 254(7197) C)ACORD CORPORATION 1988 OBTAINING COMPLIANCE 1 ACORD Certificate of Insurance ACORD is an insurance industry trade group that develops standard forms, among other activities.The sample certificate of insurance (ACORD Form 25S) is commonly used to provide evidence of coverage for general liability, auto liability, excess or umbrella liability and workers'compensation. ACORD also publishes other similar certificate forms,as do other organizations, such as COMPASS. Most of these forms will include generally the same information as shown in the example. You should check the certificate for the following items: ❑ Are all names correct? (Insurer,Insured,Additional Insured,etc.) ❑ Are all required coverages indicated?(GL,Auto,WC) ❑ Are all the dates correct?Are policies currents Do policies extend to contract completion? , ❑ Do primary and excess (or umbrella) policies have concurrent dates? C ❑ Is the insurer(s) acceptable? (A.M.Best rating of A--.VII or better,admitted in f/❑-Gfl�Ar^-1Ej2 tCY11 of/— L3 Is General Liability on an"occurrence"basis? ❑ Do policy limits and aggregates meet the minimum requirements in the contract? ❑ Are workers'compensation benefits statutory? ❑ Are any liability self-insured retentions indicated? ❑ Does auto coverage,if required,meet specifications? (I.e.,"any auto') ❑ Is the description of operations,locations,vehicles,etc.,correct? ❑-Is the certificate signed by an appropriate party? ❑ Has the certificate been modified appropriately? Note that the ACORD form is not the only certificate of insurance you may encounter. Some insurers use their own forms. The State Compensation Insurance j Fund(State Fund) also has its own form. 16 CJPIA Contractual Risk Transfer plus to assure reasonable financial stability grid have suf- Sider buying insurance coverage from companies it ficient operating experience to adequately evaluate its they believe have the sufficient financial capacity to pi financial performance, usually two to five years.,General vide the necessary policy limits to insure their risks. exceptions to these requirements include: companies Best's Financial Size Category is based on report that have financial or strategic affiliations with Best's policyholders' surplus plus conditional or technic rated companies; companies that have demonstrated reserve funds, such as the asset valuation reserve, oil long histories of financial performance; companies that investment and operating contingency funds and mise have achieved significant market positions; and newly laneous voluntary reserves reported as liabilities. formed companies with experienced management that The FSC is represented by Roman numerals rangi have acquired seasoned books of business and/or devel- from Class I (the smallest) to Class XV (the largest). T oped credible business plans. distribution by FSC based upon individual compan and rating units is shown below. NR-3(Rating Procedure Inapplicable) Assigned to companies that are not rated by A.M. Best, 2004 FINANCIAL SIZE CATEGORY(PSC) because our normal rating procedures do not apply due BY INDIVIDUAL COMPANIES to a company's unique or unusual. business, features. Adjusted This category includes companies that are in run-off Financial Policyholders' Number with no active business writings, are effectively dormant size Surplus of Distdbuuoti or underwrite financial or mortgage guaranty insurance. category s M'di ons) Companies Percentage Cumulaii Exceptions to the assignment of the NR-3 designation Class I Less than 1 1 0.1% 0.10/ Class II 1 to 2 21 1.0 1.1 include run-off companies that commenced run-off Class III 2 to 5 77 3.5 4.6 i plans in the current year or inactive companies that Class IV 5 to 10 151 7.0 11.6 have been structurally separated from..active affiliates Class V 10 to 25 227 10.4 22.0 within group structures that pose potentia€credit, legal Class VI 25 to 50 182 8.4 30.4 Class VI[ 50 to 100 211 9-7 40.1 or market risks to the group's active companies. Class VIII 106 to 250 250 11.5 51.6 Class IX 250 to 500 241 11-.1 62.7 NR-4(Company Request) • Class X 500to750 102 4.7 67.4 Assigned to companies that are assigned a Best's Rating fol- Class Xi 750 to 1,000 59 2.7 70.1 Class X[I 1,000 to 1,250 83 3.8 739 lowing a review of their financial performance, but request Class XIII 1,250 to 1,500 14 0.6 74.5 that the assigned rating be revised'to-Nit-4-- (Company Class XIV 1,500 to 2,000 94 4.3 78.8 Request).The NR-4 is assigned following the publication of Class XV 2,000 or greater 461 21.2 100.00/ a final letter ratin o inion. Subtotal 2,174 _ g P E &F Rated Companies 37 Grand Total 2�2_ll NR-5 (Not Formally Followed) Assigned to insurers that request not to be formally evaluated for the purposes of assigning a rating NITS opin- ion. It is also assigned retroactively to the rating histo- zoo4 FINANCIAL SIZE BY RATING UUNITSCATEG (FSC) ry of traditional U.S. insurers when they provide prior year(s) financial information to A.M. Best. and receive Adjusted a Best's Rating or another NR designation in more Financial Policyholders' Number recent,years. Finally, it is assigned currently to those size surplus of Distribution Category r1 Millions) Rating Unit utrnit� P rcenta e ti . .;„;y:: companies that historically had been rated, but no Class I Less than 1 1 0.1% 0.1 4 JAI, longer provide financial information to A.M. Best Class lI 1 to 2 21 2.0 2.1 because they have been liquidated, dissolved, or Class HI 2 to 5 76 7-4 9.5 merged out of existence. Class IV 5 to 10 145 14.0 23.5 Class V 10 to 25 206 20.0 43.5 z' -- Class VI 25 to 50 150 14.5 58.0 Class VII 50 to 100 138 13.4 71.4 ; SECTION XII Class VIII loo to 250 117 11.3 82.7 Class IX 250 to 500 74 7.2 89.9 r +� Class X 500 to 750 28 2.7 92.6 FINANCIAL SIZE CATEGORIES (FSC) Class XI 750 to 1,000 9 0.9 93.5 '�- - - Class XII 1,000 to 1,250 13 1.3 94.8 .,"'i• .. Class XIII 1,250 to 1,500 2 0.2 95.0 Class XIV 1,500 to 2,000 9 0.9 959 A.M. Best assigns a Financial Size_ Category (FSC) to Class XV 2,000 or greater 42 4.1 100.0 each letter rated company. The RSC is designed to pro- Subtotal 1,031 - vide the subscriber with a convenient indicator of the E &F Rating Units 37 r u - size of a company in terms of its year-end statutory sur- Grand Total plus and related accounts. Many insurance buyers con- i Ip -!REST'S KEY KEY RATING GUIDE-PROPERTY/CASUALTY -For Current Ratings access www.amhestxom- CITY MANAGEMENT SERVICES Amendment to Agreement between All City Management Services, Inc. and the City of San Juan Capistrano for providing School Crossing Guard Services The.City of San Juan Capistrano hereinafter referred to as the "City", and All City Management.Services, Inc., located at 1749 S. La Cienega Blvd., Los Angeles, CA 90035, hereinafter referred to as the "Contractor", mutually agree6to amend the existing Agreement entered into on September 2, 1993 as follows: 1. Item #1 The City and the Contractor agree to extend the term of this Agreement for the 2003-2004 fiscal year beginning July 1, 2003 - through June 30, 2004. 2. Item #17 The City agrees to pay Contractor for services rendered pursuant to the Agreement the sum of Twelve Dollars and Eighty Cents, ($12.80) per hour of guard service provided. It is understood that the cost of providing three thousand,seven-hundred and eighty,(3,780)hours of service shall not exceed Forty-Eight Thousand, Three-Hundred and Eighty-Four Dollars, ($48,384.00). 3. Except as provided for in Item#1 and Item#17, all other terms and conditions of the original Agreement and Amendments thereto between the City and the Contractor remain in effect. City of San Juan Capistrano All City Management Services, Inc. By By � )4-.e' John S. Gelff, Mayor n eneral Ma ager Date Date March 18, 2003 'TTEST: APP VEDA TO FORM: Margaret R. Monahan, City Clerk John . Shaw, City Attorney San Juan Capistrano City of San Juan Capistrano ATTACHMENT i AGREEMENT BETWEEN THE CITY OF SAN JUAN CAPISTRANO AND ALL CITY MANAGEMENT SERVICES, INC. FOR CROSSING GUARD SERVICES THIS AGREEMENT made and entered into this 2nd day of August, 1993 , by and between the CITY OF SAN JUAN CAPISTRANO , a municipal corporation, hereinafter called the "City" , and ALL CITY MANAGEMENT SERVICES , INC . kereinafter called the "Contractor" ; WITNESSETH The parties hereto have mutually covenanted and agreed as follows: 4 1 . This agreement is for a period of time which commences August, 1993 and ends on June 30, 1994, and for such term thereafter as the parties may agree upon. 2 . The Contractor is an independent contractor and the guards to be furnished by it shall at all times be its employees and not those of the City. 3 . The City ' s representative in dealing with the contractor shall be the City Manager or such person as the City Manager may designate. 4. If , at any time during the contract period , the Contractor questions the meaning of any item of this agreement , the Contractor shall contact the City Manager or his designee for interpretation of that item. 5 . The City shall have the right to determine the hours and locations when and where guards shall be furnished by the Contractor. The Contractor shall notify the ATTACHMENT City in writing of any changes which may need occur in hours of work or locations. The City further has the power to add to, delete from, or revise the work schedule/locations at any time. 6. The Contractor shall provide supervisory personnel to see that guard activities are taking place at the required places and times, and in accordance with all items of this agreement. T . The Contractor shall maintain adequate reserve personnel to be able to furnish alternate guards in the event that any person fails to report4for work at the assigned time and location. 8 . The Contractor shall provide personnel properly trained as herein specified for the performance of duties of Crossing Guards. In the performance of their duties, the Contractor and employees of the Contractor shall conduct themselves in accordance with the conditions of this agreement and the laws and codes of the State of California and the City of San Juan Capistrano. 9. The Contractor shall train, schedule , provide, and supervise personnel in accordance with the contract and the rules and regulations of the City of San Juan Capistrano Crossing guards shall perform their duties as trained and within the City's rules for such guards. 10. Persons provided by the Contractor as Crossing Guards shall be trained by the laws and codes of the State of California and the City of San Juan Capistrano pertaining to general pedestrian safety and school crossing areas. 11. Crossing Guard Services shall be provided by the Contractor at the designated locations and at the designated hours on all days on which the designated schools in the City of San Juan Capistrano, are in session. 12. The Contractor shall provide all Crossing Guards with apparel by which they are readily visible and easily recognized as Crossing Guards. Such apparel shall be uniform for all persons performing the duties of Crossing Guards, and shall be worn at all times while performing said duties. This apparel must be appropriate for weather conditions. The Contractor shall also provide all Crossing Guards with hand held Stop signs and any other safety equipment which may be necessary . Apparel and equipment shall be pre-approved by the City Manager. 13 . The Contractor shall at all times provide Worker's Compensation insurance covering its employees, and shall provide and maintain public liability insurance for Crossing Guard activities with the City named as an additional insured. Such insurance shall include, but not be limited to, comprehensive general liability with a combined single limit of not less than $5,000, 000.00 per occurrence for property damage and for bodily injury or death of persons. Such insurance shall be primary with respect to any insurance maintained by City and shall not call on City' s insurance contributions . Such insurance shall be endorsed for contractual liability and personal injury and shall include the City, its officers, agents and interest of City. Such insurance shall not be cancelled, reduced in coverage or limits or non-renewed except after thirty (30) days written notice by Certified Mail, Return Receipt Requested has been given to the City Attorney or City Manager. 14. Contractor agrees to indemnify the City, its Officers, employees and agents against, and will hold and save them and each of them harmless from, any and all actions , claims damages to persons or property, penalties , obligations or liabilities that may be asserted or claimed by any person , firm , entity, corporation , political subdivision or other organization arising out of the negligent acts or intentional tortious acts , errors or omissions of Contractor, its agents, employees, subcontractors, or invitee, provided for herein. a) Contractor will defend any action or actions filed in connection with any of said claims, damages, penalties, obligations or liabilities and will pay all costs and expenses including attorney's fees incurred in connection herewith. b) Contractor will promptly pay any judgement rendered against City, its officers, agents or employees for any such claims, damages, penalties, obligations or liabilities. c) In the event City , its officers , agents or employees is made a party to any action or proceeding filed or prosecuted against Contractor for such damages or other claims arising out of or in connection with the sole negligence of Contractor hereunder , Contractor agrees to pay City, its officers, agents, or emfiloyees, any and all costs and expenses incurred by City, its officers agents or employees in such action or proceeding , including but not limited to , reasonable attorney's fees. 15. Either party shall have the right to cancel this agreement by giving thirty (30) days written notice to the other . 16. The Contractor shall not have the right to assign this contract to any other person or firm except with the consent of the City. 17. The City agrees to pay the CONTRACTOR for the services rendered pursuant to this Agreement the sum of Thirteen Dollars and Sixty Seven Cents ($13. 67) per hour of guard services provided. It is understood and agreed that the cost for providing one thousand four hundred forty-eight ( 1 ,448) hours of services shall not exceed Nineteen Thousand Seven Hundred Ninety-Four Dollars (19, 794.00) . 18. In the event that this agreement is extended beyond June 30, 1994 , the compensation for services shall be established by mutual consent of the parties. Said payment shall be made upon written statement to the City by the Contractor and approval of the City Manager. IN WITNESS WHEREOF, the parties hereto have executed this agreement the day and year first above written. # CITY OF SAN JUAN C RANO, a municipalratio ATTEST: City Clerk APPROVED AS TO FORM ALL CITY MANAGEMENT SERVICES, INC City Attorney President Maria Guevara From: Michael Cantor Sent: Wednesday, August 18, 2004 2:36 PM To: Meg Monahan Cc: Maria Guevara Subject: All City Management W/C I've spoken to Allen Amico at JPIA regarding the workers'comp problem with All City. I've informed him that All City has contracts with about 100 cities in the area and that they probably have the corner on the market. Besides the rating problem on the w/c, we don't have a"Plan B"to select a different vender. I've touched base with Laguna Niguel, Dana Point and Mission Viejo who all use All City and they, like us, are in a dilemma as to what to do. These cities are more or less in a holding pattern waiting for a "Plan B." Allen said that he would discuss with JPIA staff and get back to us on what to do. I will be out of town until 08/30 so I gave him your name as the contact regarding this issue. I am the project manager, however, this is a risk management issue. Mike Cantor City of San Juan Capistrano Senior Management Analyst / Emergency Services Coordinator s CERT Coordinator n v 949.234.4565 Office 949.246.6375 Cell (\t"n}��—f \l 949.488.3874 Fax Y b "Thanks for taking the time to be Prepared. /,v " 1 �� 32400 PASEO ADEI—ANTOi 4 i A MEMBERS OF THE CITY COUNCIL Li 3 SAN JUAN CAPISTRANO,CA 9267$ i j SAM ALLEVATO (949)493-1171 j/�f+' iuBAPAAwim DIANE L.BATHGATE (949)4931053 FAX ," IIp,tISM[o I (96( WYATT HART www sanjuancapistrano.org VV 1776 JOE SOTO • • DAVID M.SWERDLIN July 7, 2004 Baron Farwell, General Manager All City Management Services, Inc. 1749 S. La Cienega Blvd. Los Angeles, CA 90035 Dear Mr. Farwell: An amendment to agreement between All City Management Services, Inc. and the City for providing school crossing guard services was approved by the City Council at their meeting of July 6, 2004. It is in the process of being executed and will be issued upon receipt of required documentation related to terms of insurance. Specifically, the evidence of insurance for your workers compensation policy does not meet the minimum required standards. Insurance evidence may be faxed to (949) 493-1053 — ATTENTION CITY CLERK -- followed by original signed documents. If you have questions specific to the contact, please contact the project manager, Michael Cantor, Senior Management Analyst (949) 234-4565. Please call Maria Guevara, Secretary, (949) 443-6310 if you have questions regarding the forms of insurance needed. Thank you, Meg Mo aha CMC City Cl rk cc: Michael Cantor, Senior Management Analyst San Juan Capistrano: Preserving the Past to Enhance the Future 32400 PASEO ADELANTO v �% MEMBERS OF THE CITU COUNCIL SAN JUAN CAPISTRANO,CA 92675 j SAM ALLEVATO (949)493'1171 j/9(✓ m[ouonntm DIANE L.BATHGATE (949)4931053 FAX plplpiMtn I )96� WVATT HART www.sanjuancapistrano.org 1776 JOE SOTO •� • DAVID M.SWERDLIN July 7, 2004 Baron Farwell, General Manager All City Management Services, Inc. 1749 S. La Cienega Blvd. Los Angeles, CA 90035 Dear Mr. Farwell: An amendment to agreement between All City Management Services, Inc. and the City for providing school crossing guard services was approved by the City Council at their meeting of July 6, 2004. It is in the process of being executed and will be issued upon receipt of required documentation related to terms of insurance. Specifically, the evidence of insurance for your workers compensation policy does not meet the minimum required standards. Insurance evidence may be faxed to (949) 493-1053 — ATTENTION CITY CLERK -- followed by original signed documents. If you have questions specific to the contact, please contact the project manager, Michael Cantor, Senior Management Analyst (949) 234-4565. Please call Maria Guevara, Secretary, (949) 443-6310 if you have questions regarding the forms of insurance needed. Thank you, Meg Mo aha CMC City Cl rk cc: Michael Cantor, Senior Management Analyst San Juan Capistrano: Preserving the Past to Enhance the Future 32400 PASEO NCAA ADEL-ASTRAN TO SAN JUAN CAPISTRANO,CA 92675IneA1BAR1fR MEMBERS OF THE CRY COUNCIL (949)493-1171 fSRRBOSNER I (961 SAM ALLEVATO (949)493-1053 FAX 1776 DIANE L.BATHGATE www..ranjuancapistrana.org WYATDOES HART JOE SOTO DAVID M.SWERDUN September 8, 2004 Baron Farwell, General Manager All City Management Services, Inc. 1749 S. La Cienega Blvd. Los Angeles, CA 90035 Dear Mr. Farwell: Enclosed is an executed, agreement between All City Management Services, Inc. and the City of San Juan Capistrano for providing school crossing guard services. The agreement was approved on July 6, 2004. We have received documentation confirming current compliance with the terms of insurance under your agreement with the city. Please keep in mind that should this documentation lapse, all work under this agreement must stop and all payments will be withheld until we receive proper evidence of insurance. You may proceed with work under this agreement in coordination with the Project Manager, Michael Cantor, Senior Management Analyst (949) 234-4565. Yours truly, eg ahan, CMC Cit Clerk e closed: greement cc: Michael Cantor, Senior Management Analyst San Juan Capistrano: Preserving the Past to Enhance the Future EVIDENCE OF COVERAGE J DATE(10/20/03) Master Account THIS EVIDENCE OF COVERAGE AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Mainstay Business Solutions DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P.O. Box 112E COVERAGE BELOW. Blue Lake, CA 95525 ENTITY AFFORDING COVERAGE Starting Client INSURER A:Mainstay Employer Occupation Indemnity and Medical Benefits Fund All City Management Services INSURER B: 1749 South La Cienega Blvd. NSURERC: Los Angeles, CA 90035 Fax: (310)202-8284 INSURER D: INSURER E: COVERAGES THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE ENTITY NAMED ABOVE FOR THE 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 COVERAGE AFFORDED BY THE CERTIFICATE OF COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH COVERAGE.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. letter TYPES OF COVERAGE POLICY NUMBER POLICY EFFECTIVE POLICY EXPERATION LIMITS DATE(MMIDD(YY) DATE(MWDD/YY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERICAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE Q OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- Poucr .IECT 100 PRODUCTS—COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS NONaOWNEDAUTOS BODILY INJURY $ ((Per accident) PROPERTY DAMAGE $ Per accident GARAGE LIABILITY AUTO ONLY—EA ACCIDENT $ 8 ANY AUTO OTHER THAN I EA ACC AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURANCE $ 0 OCCUR O CLAIMSMADE AGGREGATE $ F1 DEDUCTIBLE $' RETENTION $ A OCCUPATIONAL INJURY MBS060010301 066/01/03 06/01/04 EL DISEASE-EMPLOYEE INDEMNITY AND MEDICAL BENEFIT EL DISEASE-LIMIT $1 MIL COVERAGE EL EACH ACCIDENT DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORESEMENT/SPECIAL PROVISIONS Tribal Statutory Exemptions Apply/Tribal Program This coverage is afforded only to the employees provided to the staffing client listed above Waiver of Subrogation is applicable to the above-mentioned covers e. CERTIFICATE HOLDER I X CANCELLATION Dawn M. Schanderl, Deputy City Clerk City of San Juan Capistrano SHOULD ANY OF THE ABOVE DESCRIBED COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEROF,THE ISSUING ENTITY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 32400 Paseo Adelando CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION San Juan Capistrano, CA 92675 OR LIABILITY OF ANY KIND. AUTHORIZED REPRESENTATIVE TE(MWDDM) AC RD CERTIFICAW OF LIABILITY INSU NCFXLCIRlG DA07/03/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone: 626-449-3870 Fax:626-449-5268 INSURERS AFFORDING COVERAGE INSURED INSURER A: Admiral Insurance Company INSURER B: Scottsdale Insurance Company All City Management, Inc. Baron Farwell INSURER C: 1749 South La Cienega Blvd. INSURER D: Los Angeles CA 90035 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. INSR rypE OF INSURANCE POLICY NUMBER POLICY ATE MDYY EFFECTIVE DATE I W D/YY LIMITS ON LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY A03AG17604 07/01/03 04/01/04 FIRE DAMAGE(Any one fre) $ 50,000 rlpnc M+ EIE `iII= R MED EXP(Any one person) $excluded X Owner/Cont Prot. PERSONAL B ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 POLICY PRO- RO LOC Em Ben. excluded ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea aadEent) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 4,000,000 B X OCCUR F__] CLAIMS MADE XLS0017813 07/01/03 04/01/04 AGGREGATE s4,000,000 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPEHS.1TIOH.:KD I I WCSIAIU. I TORYLIMITS1 ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.D ASE-EA W1 LOYEE $ E.L.DFSEASE-PO LIMIT OTHER C. L � 1 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS *10 Day Notice of Cancellation for Non-Payment of Premium. Certificatc e ' - Holder is named as Additional Insured, per Endorsement attached to policy. w U CERTIFICATE HOLDER Y ADDITIONAL INSURED;INSURER LETTER: A CANCELLATION CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN City of San Juan Capistrano NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dawn M. Schanderl, IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Deputy City Clerk _ 32400 Paseo Adelando REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE V Michael T. Curry ACORD 25S(7/97) ©ACO D CORPORATION 198 EVIDENCE OF COVERAGE oaza/oDATE(MM/DD/YY)a Master Policyholder THIS EVIDENCE OF COVERAGE AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Northern United Resources DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 302 Main PO Box 518 COVERAGE BELOW. Walt Hill, NE ENTITY AFFORDING COVERAGE Staffing Client INSURER A:Northern United Ca five Company ` INSURER B: All City Management Services INSURER C: INSURER D: rA INSURER E: COVERAGES THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE ENTITY NAMED ABOVE FOR THE PERIOD INDICATED.NOT�TAN" AN1Q'�OUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY Bpl UEDAii MAV TAIN;THE COVERAGE AFFORDED BY THE CERTIFICATE OF COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXC S ANWCON SNS OF SUCH COVERAGE.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM90m letter TYPES OF COVERAGE POLICY NUMBER POLICY EFFECTIVE POLICY EXPERATION ;:0� LIMITS DATE(MINDDIYY) DATE(MWDD/YY) GENERAL LIABILITY EAC46CURR E $ COMMEPoCALGENERALLIABILIIY FIRE SAVAGE( one fire) $ CLAIMS MADE Q OCCUR MED EXP(Any one person) $ PERSONAL B ADV INJURY $ GEN•L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PoucY PRO- ❑ Loc PRODUCTS-COMP/OP AGG $ ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-0WNED AUTOS ((Per accident) $ PROPERTY DAMAGE $ Per accident GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ e ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURANCE $ AGGREGATE $ O OCCUR F-1 CLAIMS MADE $ 8 DEDUCTIBLE $ RETENTION $ A OCCUPATIONAL INJURY OIMB050301 04/15/03 04/15/04 STATUTORY OTH $1 MIL INDEMNITY AND MEDICAL BENEFIT LIMITS -ER COVERAGE EL EACH ACIDENT $1 MIL EL DISEASE-EMPLOYEE $ 1 MIL EL DISEASE-LIMIT $ 1 MIL OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORESEMENTISPECIAL PROVISIONS This coverage is afforded only to the employees provided to the staffing client listed above Waiver of Subrogation is applicable to the above-mentioned coverage. CERTIFICATE HOLDER I X CANCELLATION City of San Juan Capistrano SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE Y P THEROF,THE ISSUING ENTITY WILL ENDEAVOR TO MAIL_30 DAYS WRITTEN NOTICE TO THE Dawn M. Schanderl, Deputy City Clerk CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION 32400 Paseo Adelando OR LIABILITY OF ANY KIND. San Juan Capistrano, CA 92675 AUTHORIZE REPRESL1 EVIDENCE OF COVERAGE DATE(MM/DD/YY) 04/29103 Master Policyholder THIS EVIDENCE OF COVE GE ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Northern United Resources DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 302 Main PO Box 518 COVERAGE BELOW. Walt Hill, NE ENTITY AFFORDING COVERAGE Staffing Client INSURER A:Northern United Captive Company All-City Management Services,Inc. INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE ENTITY NAMED ABOVE FOR THE 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 COVERAGE AFFORDED BY THE CERTIFICATE OF COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH COVERAGE.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. left., TYPES OF COVERAGE POLICY NUMBER POLICY EFFECTIVE POLICY EXPERATION LIMITS DATE(MM,t)D/YY) DATE(MMIDDIYY) GENERAL LIABILITY EACH OCCURRENCE $ coMMERICALGENERALLIABIUTY FIRE DAMAGE(Any one fire) $ C NIS MADE O OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN•L AGGREGATE Beer APPLIES PER: GENERAL AGGREGATE $ ❑ POl1CY JET Loc PRODUCTS-COMP/OPAGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY"TG (Ea accident) $ Au wrNED AUTOS BODILY INJURY SCNEDULEDAurrm (Per person) $ NIRED AUTOS BODILY NDNED AUTOS ((Pe,accident) $ PROPERTY DAMAGE $ Per accident GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ eANr aura OTHER THAN EA ACC AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURANCE $ O OCCUR Q cLAIMSMAOE AGGREGATE $ DEDUCTIBLE $ RETENTION S A OCCUPATIONAL INJURY OIMB050301 04/15/03 04/15/04 STATUTORY OTH $1 MIL INDEMNITY AND MEDICAL BENEFIT LIMITS -ER COVERAGE EL EACH ACIDENT $1 MIL EL DISEASE-EMPLOYEE $1 MIL ELOISEASIE MIT $ 1 MIL OTHER Z u rn DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORESEMENT/SPECIAL PROVISION --t = M This coverage is afforded only to the employees provided to the staffing client listed above Cl)C-) _ Waiver of Subrogation is applicable to the above-mentioned coverage. -pr m In reference to employees of All City Management Services, Inc —"v rn CERTIFICATE HOLDER I X I CAN TN Dawn M. Schanderl, Deputy City Clerk Xe SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CA=ELLED SHIRE THE EXPIRATION DATE City of San Juan Capistrano THEROF,THE ISSUING ENTITY WILL ENDEAVOR TOMAILSWl DAY RNTEN NOTICE TO THE 32400 Paseo Adelando CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION San Juan Capistrano, CA,92675 oRL AeL nvoF D. c^ AUTHORIZED REPRESENTATIVE 32400 PASEO ADELANTO IIG11111111 SAN JUAN CAPISTRANO, CA 92675MEMBERS MEMBERS OF THE CITY COUNCIL (949) 493.1171 DUINELBATHGATE (949y493-1053 (FAX) JOHNS GELFF ivlvly.sanjuancapistrano.org WYATT HART • • JOESOTO DAVID M.SWERDLIN CITYMANAGER GEORGESCARBOROUGH February 19, 2003 Mr. Baron Farwell All City Management, Inc. 1749 South La Cienega Blvd. Los Angeles, California 90035 RE: Compliance with Insurance Reguirements - Crossing Guard Services The following insurance document has expired: VWorkers Compensation Certificate 2/1/2003 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 February 27, 2003. If you have any questions, please contact me at (949) 443-6310. Daw�Sincerely, �9� /� e "-d �-ri Deputy City Clerk cc: Lt. Davis ? ) onus use 1s San Juan Capistrano: Preserving the Past to Enhance the Future This certificate is executed b Liberty Mutual Insurance Gm asuch insurance as is afforded b those co ales. BM0068 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the 2oficies fisted below. This is to certify that(Name and address of Insured) SPECTRUMHMLLC Liberty arty 550 SCEPHENSON HWY.SUITE 203 7L�s�lll� TROY,MI 48093 Mutual,. Mutual,.. is,at the issue date of das certificate,insured by the Company under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and conditions and is not altered by my nophirement term or condition ofanv contract or other document with res ct o which this certificate ma be iasaed. Ex iration Tvve Expiration Date(s) Policy Numbers Limits of Liability Continuous* 02/01/2003 WAI-14D-433107-012 Coverage afforded under WC law of Employers Liability Extended 02/01/2003 WC1-141-433107-072 the following states: Bodily Injury By Accident X Policy Term AL.AR,AZ.CA,DE,FL.GA,IA,IL.IN. $500,000 Each Accident KS.KY.MA,MD.ML MN,MO.Yrs,YIT. Bodily Injury By Disease NC.OK.PA,SC.IN.ll.WI $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate Claims Made Occurrence Bodily Injury and Property Damage Liability Per Occurrence Retro Date Personal and Advertising Injury Per Person/ Organization Other Liability Other Liability Each Accident-Single Limit-B.I.and P.D.Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence C WA POLICY INCLUDES DEDUCTIBLE ENDORSEMENT WITH$250,000 DEDUCTIBLE PER OCCURRENCE/CLAIM(DISEASE)WITH THE PROVISION O THAT LIBERTY MUTUAL MAY(WILL)ADVANCE PAYMENT OF THE DEDUCTIBLE AMOUNT. M **CA EMPLOYERS LIABILITY LIMITS-$1.000,000 EACH ACCIDENT;$1,000,000 POLICY LIMIT;$1,000.000 EACH EMPLOYEE-IN REFERENCE TO M EMPLOYEES OF ALL CITY MANAGEMENT SERVICES.INC. E N T S 'If the certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiration data However,you will not be notified amually ofthe confiscation of coverage. Special Notice-Ohio:Any person who,with intent to defraud or knowing that be/she is facilitating a fraud against an insurer,submits an application or files a claw containing a false or deceptive statement is guilty of insurance fraud. Important information to Florida policyholders and certificate holders:in the event you have my questions orneed information about this certificate for my reason,please contact your local sales producer,whose name and telephone number appears in the lower left comer of this certificate. The appropriate local sales office trading address may also be obtained by calling this number. Notice of cancellation: (not applicable unless a number of days is entered below). Before the stated expiration date the corintrany will nm cartel interface the insurance afforded under the above policies until atleast XXdays notice ofsuch cancellation hasbeenmailedo: fir/' if 9 Office: Farmington Hills,MI Phone: 248-489-2800 �c14,t.G7n=�'t-_'Al'�+"�-�""�{/ / F Certificate Holder: Joanna Saffell DAWN M. SCHANDERL, DEPUTY CITY CLERK Authorized Representative CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANDO SAN JUAN CAPISTRANO, CA 92675 Date Issued: 01/10/03 Prepared By: DZ This certificate is execured b Liberty Mutual Insurance Group as.6.1,insurance as is afforded b those companies. BM0068 Certificate of Insurance This certificate is issued as a maser ofinfomration only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the policies listed below. This is to certify that(Name and address of Insured) SEECTRUMHR LLCRECEIVED Liberty 550 STEPHENSON HWY,SUITE 203 E . TROY,MI 48093 . 2003 JAN I b P 2 D I mutua.l,,. is,at the issue date ofthis certificate,insured by the Company under the policy(ies)listed afforded by the listed poticy(iesl is subject to all theirterms,exclusions and conditiom and is not uttered by env regiourment,term or condition of my contract or otherSAttSUASMate may be issued. Ex iration Type Expiration Dates Policy Numbers Limits of Liability Continuous* 02/01/2003 WAl-14D-433107-012 Coverage afforded under WC law of Employers Liability Extended 02/01/2003 WC1-141-433107-072 the following states: Bodily Injury By Accident X Policy Term AL.AIL AZ,CA.DE.FL,GA,IA.IL,IN. $500,000 Each Accident KS,KY.MA.Mn,ML MN,MO,MS,MT. Bodily Injury By Disease NC.OK.PA.SC.TN.TX,WI $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate Claims Made Occturence Bodily Injury and Property Damage Liability Per Occurrence Retro Date Personal and Advertising Injury Per Person/ Organization Other Liability Other Liability Each Accident-Single Limit-B.I.and P.D.Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence C WA POLICY INCLUDES DEDUCTIBLE ENDORSEMENT WITH$250,000 DEDUCTIBLE PER OCCURRENCE/CLAIM(DISEASE)WITH THE PROVISION O THAT LIBERTY MUTUAL MAY(WILL)ADVANCE PAYMENT OF THE DEDUCTIBLE AMOUNT. M **CA EMPLOYERS LIABILITY LIMITS-$1,000,000 EACH ACCIDENT;$1,000,000 POLICY LIMIT;$1,000.000 EACH EMPLOYEE--IN REFERENCE TO M EMPLOYEES OF ALL CITY MANAGEMENT SERVICES,INC. E N T S .tribe certificate expiration date is continuous or extended term,you will be notified if coverage is terminated Or reduced before the certifimte expiration date. However,you will not be notified amually of the continuation of coverage. Special Notice-Ohio:Any person who,with intent to defraud or snowing that he'she is facilitating a fraud agairet an insurer,submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. important information to Florida poticytrolders and certificate holders:in the event you have any questions or need information about this certificate for my mason,please contact your local sales producer,whose name and telephone number appears in the lower left comer of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number. Notice of cancellation: (not applicable®less a number of days is entered below). Before the stated expiration date the company will not carcel or reduce the insurance afforded under the above policies will at least XX days notice ofswh cancellation has been mailed to: Office: Farmington Hills,Ml Phone: 248-489.2800 ,/�e1.�{y..:-c'a— .�l+b.`- -L=G{may le Certificate Holder: Joanna Saffell DAWN M. SCHANDERL, DEPUTY CITY CLERK Authorized Representative CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANDO SAN JUAN CAPISTRANO, CA 92675 Date Issued: 01/10/03 Prepared By: DZ Dawn Schanderl From: Lt. Davis Sent: Tuesday, March 04, 2003 10:29 AM To: Dawn Schanderl Subject: All City Management Dawn, please make a note that I spoke to Baron Farwell on this date regarding their expired Worker's Compensation insurance certificate. He explained that his company recently changed carriers, going to the State Compensation Insurance Fund. One week ago, the State indicated that it would be a couple of weeks before certificates were issued. Hopefully we will hear from them soon. I explained the"No Pay"list and he understands. JB 1 11/01/2002 FRI 11;04 FAX 310202 8325 All City Management Svcs 002/002 �► ��w U Memorandum November 1,2002 To: Dawn Sebanderl Fr: Baron Farwell Re: Crossing Guards Status I do apologize for not being clear in my last communication regarding the status of our Crossing Guards. Crossing Guards are indeed "our" employees and yet they are "leased" for administrative purposes. This"administrative relationship"in no way, form or fashion compromises our contracted duties and responsibilities or the management of our Crossing Guard Programs. The intent of the wording on Page 1, item number 2 is to affirm the disassociation of Crossing Guards from the employment of the City. In most cases when we assume control of a Crossing Guard program the Guards are typically City employees. This wording was included to clarify the fact that the City has no employer/employee relationship with Crossing Guards beyond the contract date. As we continue to dutifully provide Crossing Guard Services as per our agreement, I would ask that the City release payment for services rendered this school year. Sit a ly, Bar i 11, Cc: Lt. J.B. Davis City Attorney Main Office: 1749 S_ La Cienega Blvd. -Los Angeles, CA 90035 -310-202-8284 FAX 310-202-8325 Northern California Office: 6500 Dublin Blvd., Ste. 216 - Dublin, CA 94568 - 800-540-9290 FAX 925-803-6992 ll/V1/GVVG Cal 11.VV CRA VIVGVL UVGV all V1Fjy VIUILUt) lUIW1G UIUV v--- •- All, CXL] :S LVL1611LVduGEv!:1E6V 11 SEIYUVfLUdL S Memorandum November 1, 2002 To:Dawn Schanderl Fr: Baron Farwell Re:Crossing Guards Status I do apologize for not being clear in my last communication regarding the status of otir Crossing Guards. Crossing Guards are indeed `bur" employees and yet they are "leased" for administrative purposes. This"administrative relationship"in no way,form or fashion compromises our contracted duties and responsibilities or the management of our Crossing Guard Programs. The intent of the wording on Page 1, item number 2 is to affirm the.disassociation of Crossing Guards from the employment of the City. In most cases when we assume control of a Crossing Guard program the Guards are typically City employees. This wording was included to clarify the fact that the City has no employer/employee relationship with Crossing Guards beyond the contract date. As we continue to dutifully provide Crossing Guard Services as per our agreement, I would ask that the City release payment for services rendered this school year. S, a `ly, U1 Cc: Lt J.B. Davis City Attorney Main Office: 1749 S. La Cienega Blvd.-Los Angeles, CA 90035 -310-202-8284 FAX 310-202-8325 Northern California Off-ice: 6500 Dublin Blvd.,Ste.216 -Dublin,CA 94568.800-540-9290 FAX 925-803-6992 DATE ACORDTN CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 09/06/2002 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willie North America, Inc. - Regional cert center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26 centyry'Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 'O. Box 305191 Nashville, TN 372305191 INSURERS AFFORDING COVERAGE INSURED PACA, Inc. INSURERA: American Casualtycompany of Reading, Pen 20_4_27-_001 PO Box 729 INSURER B: Alexander City, AL 35011 -- -- -- - INSURERC. _INSURER D' NSURERE' 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. INSR POLICYEFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICYNUMBER DATE(MMIDDY'D DATEIMMIDDNYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ MMERCIAL GENERAL LIABILITY FIRE DAMAGE(Am mefire) $ CLAIMS MADE .00CUR MEDEXP(Any.re,Weon) $ P_ERSONALBADV INJURY $ GENERALAGGREGATE E GEN'L AGGRE_GA_TE LIMIT APPLIESPER: IPRODUCTS-COMPIOPAGG $ POLICY JR LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea acdden0 ALL OWNED AUTOS BODILY INJURY $ _ SCHE DU LED AUTOS (Per person) HIREDAUTOS —_ BODILY INJURY $ NONOWNEDAUTOS (Per acdtlenq PROPERTY DAMAGE $ (Pe,amitlen) GARAGE LIABILITY (AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EAACC $ I 'AUTO ONLY: AGG $ EXCESSLIABILITY EACH OCCURRENCE $ OCCUR ' CLAIMS MADE 'AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- A WC247842430 12/31/2001 12/31/2002X_.TO LIMITS ER EMPLOYERS'LIABILITY A WC247842444 12/31/2001 12/31/2002 E.L.EACH ACCIDENT $ 1 000,-000__ I E L DISEASE-EA EMPLOYEE y 1 OQO 000 EL.DISEASE-POLICY LIMIT $ 11000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Providing Leased Employees to: All City Management Services, Inc., 1749 South La Cienega Blvd. , Los Angeles, CA 90035 Coverage Effective Date: 5/1/02 - PACA #4 CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TOM SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Dawn M. Schanderl, Deputy City Clerk Cit} O£ San Juan Capistrano REPRESENTATIVES. 32400 Paseo Adelando AU RIZEDR RES TATIV San Juan Capistrano, CA 92675 ACORD 25-S(7197) Coll:539483 Tpl:89493 Cert:216 52 ©ACORD CORPORATION 1988 Page 2 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(7/97) Co11:539483 Tp1:89493 Cert:2163152 ACORD CERTIFICA OF LIABILITY INSUFONCIERL CSR AG DATE(MWDD/YY) LCI-1 09/30/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 B. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone: 626-449-3870 Fax:626-449-5268 INSURERS AFFORDING COVERAGE INSURED INSURER A: Admiral Insurance Company INSURER B: Scottsdale Insurance Company All City Management, Inc. INSURER C: Baron Farwell 1749 South La Ciene a Blvd. INSURER D: Los Angeles CA 90035 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, ILTR TYPE OF INSURANCE POLICY NUMBER POLICY ATE MWD�IYY E DATE YMM/PUDNY N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY A02AG149292 09/27/02 07/01/03 FIRE DAMAGE(Any one fire) $ 501000 CLAIMS MADE T OCCUR MED EXP(Any one Person) $exclu.ded X Owner/Cont Prot. PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 17 POLICY F7 PRO- LOC JECT Emp Ben. excluded AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS LIABILITY EACH OCCURRENCE $4,000,000 B X OCCUR F7CLAIMSMADE XLS0014948 09/27/02 07/01/03 AGGREGATE s4,000,000 $ DEDUCTIBLE $ X RETENTION $ 10,000 $ WG STA WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILRY E.L.EACH ACCIDENT $ E.L.DIS SE-EA EMPLOYEE $ E.L.DISFCSE-POLI IMIT L O rn C_ n n DESCRIPTION OF OPERATIONS/LOCATIONSNENICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS n *10 Day Notice of Cancellation for Non-Payment of Premium. Certificate Holder is named as Additional Insured, per attached Endorsement CG2010 10i. 'D M w v CERTIFICATE HOLDER Y I ADDITIONAL INSURED;INSURER LETTER: A CANCELLATION L.I. SJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN City of San Juan Capistrano NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dawn M. ScherIMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Deputy Cityity Clerk 32400 Paseo Adelando REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE Michael T. Cur ACORD 25.S(7/97) ©ACORD CORPORATION' 11/01/2002 FRI 11:06 FAX 310202 8325 All City Management Svcs ?002/002 Memorandum November 1, 2002 To: Dawn Schanderl Fr: Baron Farwell Re: Crossing Guards Status I do apologize for not being clear in my last communication regarding the status of our Crossing Guards. Crossing Guards are indeed "our" employees and yet they are "leased" for administrative purposes. This "administrative relationship" in no way,form or fashion compromises our contracted duties and responsibilities or the management of our Crossing Guard Programs. The intent of the wording on Page 1, item number 2 is to affirm the disassociation of Crossing Guards from the employment of the City. In most cases when we assume control of a Crossing Guard program the Guards are typically City employees. This wording was included to clarify the fact that the City has no employer/employee relationship with Crossing Guards beyond the contract date. As we continue to dutifully provide Crossing Guard Services as per our agreement, I would ask that the City release payment for services rendered this school year. Si Ily, Barzf 11, Cc: Lt. J.B. Davis City Attorney Main Office: 1749 S. La Cienega Blvd. -Los Angeles, CA 90035 - 310-202-8284 FAX 310-202-8325 Northern California Office, 6500 Dublin Blvd.,Ste. 216 - Dublin, CA 94568 -800-540-9290 FAX 925-803-6992 11/01/2002 FRI 11,06 FAX 310202 8325 All City Management Svcs Z001/002 ALL CTJrY BLAANAGEbIENT SERVICES FACSIMILE TRANSMITTAL SHEET TO: FROM: Dawn Schanderl, City Clerk Baron Farwell, General Manager COMPANY: DATE: City of San Juan Capistrano 11/1/02 FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: (949) 493-1053 1 PHONE NUMBER: SENDER'S P14ONF NUMBER: (949) 770-6011 (800) 540-9290 RE: FAX NUMBER: Crossing Guard Status (310) 202-8325 ❑ URGENT 0 FOR REVIEW ❑PLEASE. COMMENT 13PLEASE REPLY Original to follow my mail. if you have any questions, please feel free to contact me. Main Office: 1749 S. La Cienega Blvd.•Los Angeles, CA 90035 • 310-202-8284 FAX 310-202-8325 Northern California Office: 6500 Dublin Blvd., Ste. 216-Dublin,CA 94568• 800-540-9290 FAX 925-803-6992 MEMORANDUM TO: Baron Farwell, General Manager All City Management FROM: Dawn Schanderl, Deputy City Clerk DATE: October 31, 2002 SUBJECT: Agreement - Crossing Guard Services I received your letter dated October 9, 2002 and have reviewed it with the City Attorney. As previously stated in my memo dated September 27, 2002, 1 am requesting an explanation to the following concern: The PACA workers' compensation certificate I received references under description: "providing leased employees to All City Management Services. Are the guards leased? The agreement, page 1, item number 2 states "The contractor is an independent contractor and the guards to be furnished by it shall at all times be its employees and not those of the City. Are the crossing guards leased or your employees? Sincerely, Dawn Schanderl cc: Lt. J.B. Davis City Attorney Attached: PACA certificate Front page of Agreement with City ACORD. CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 F09100612002 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis North America, Inc. - Regional cert Center HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Boz 305191 Nashville, TN 372305191 INSURERS AFFORDING COVERAGE INS PACA, Inc. INSURERA:American Casualty Company of Reading, Pen 20427-001 PO Bos 729 INSURER B. Alexander City, AL 35011 INSURERC: INSURERD: INSURERE: 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. INSR POUCYEFFECTNE LITN)N TR TYPE OFINSURANCE POLICY NUMBER DATE MIDD DATEPOCY EXPIRA LMMANI LIMITS GENERALLIABILITY EACH OCCURRENCE $ CO MMERCIALGENERALUFBIUTY FIRE DAMAGE AA amfire f CLAIMS MADE ❑OCCUR MEDEXP(AI ompMson) S PERSONALSADVINJURY f GENERAL AGGREGATE f GEN'L AGGREGATE LIMITAPPUES PER PROD1JCTS-COMP/0PAGG $ POLICV JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f ANY AUTO (Ea amitlen) ALLOWNEDAUTOS BODILYINJURY SCHEDULEDAUTOS (PeIPLY%m) S HIREDAUTOS BODILY f NONaWNED AUTOS (��IM`I)) PROPERTY DAMAGE S (Per ecdaen0 GARAGE LIABILITY AUTOONLY.EAACGDENT $ ANY AUTO OTHERTHAN EAACC $ AUTOOWY: AGO f EXCESSLIABILITY_ EACH OCCURRENCE f OCCUR CLAIMSMAOE AGGREGATE f _._ f DEDUCTIBLE f RETENTION f f A WORNERSCOMPENSATIONAND WC247842430 12/31/2001 12/31/2002 X T�Tcru TAN s EMPLOYERS'LIABILITY A WC247842444 12/31/2001 12/31/2002 E.L.EACH ACCIDENr f 11000,000 EL.DISEASE-EAEMPLOVEE S 11000,000 E.L.DISEASE-POLICY UMIT $ _.1,000,000 OTHER DESCRATNNI ERATroNSAOCATNHiSNENN;L,ESiEXCLVSKNIS ADDED BY ENDORSEMENTISPECIALPROVISYONS Provid ees to: All City Management Services, Inc , 1749 South La Cienega Blvd., e es, CA 9003 Coverage Effective Date: 5/1/02 - PACA #4 CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WN-L ENDEAVOR TO MAR 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY NINO WON THE INSURER ITS AGENTS OR Dawn M. Schanderl, Deputy City Clerk City of Sart Juan Capistrano REPRESENTATNES. 32400 PaseO Adeland0 AUT RIZEDR REB TATN San Juan Capistrano, CA 92675 ACORD25-S(7197) Coll:539483 Tpl:89493 CeIt:2163452 ©ACORD CORPORATION 1988 AGREEMENT BETWEEN THE CITX OF SAN ,IU pIS O AND ALL CITY MANAGEMENT:SERVIC89, Txd '01C, { ' * CROSS N6 THIS AGREEMENT made and entered into this 2nd day of August, 1993 , by and between the CITY OF SAN JUAN CAPISTRANO , a municipal corporation, hereinafter called the "City" , and ALL CITY MANAGEMENT SERVICES , INC . , -kereinafter called the "Contractor" ; WITNESSETH The parties hereto have mutually covenanted and agreed as follows: 1 . This agreement is for a period of time which commences August, 1993 and ends on June 30, 1994, and for such term thereafter as the parties may agree upon. The Contractor is an independent contractor and the guards to be furnished by it shall at all times be its employees and not those of the City. 3 . The City ' s representative in dealing with the contractor shall be the City Manager or such person as the City Manager may designate. 4. If , at any time during the contract period, the Contractor questions the meaning of any item of this agrooment , the Contractor shall contact the City Manager or his designee for interpretation of that item. 5. The City shall have the right to determine the hours and locations when and where guards shall be furnished by the Contractor . The Contractor shall notify the AGREEMENT BETWEEN THE CITY OF SAN ,JUAN CAPIST�iO N,,M AND ALL CITY MANAGEMENT;3$RVIC� , INC ' CROSSING GUAM'^'SERVICE ' THIS AGREEMENT made and entered into this 2nd day of August, 1993 , by and between the CITY OF SAN JUAN CAPISTRANO , a municipal corporation, hereinafter called the "City" , and ALL CITY MANAGEMENT SERVICES , INC . , --hereinafter called the "Contractor" ; WITNESSETH The parties hereto have mutually covenanted and agreed as follows: 1 . This agreement is for a period of time which commences August, 1993 and ends on June 30, 1994, and for such term thereafter as the parties may agree upon. NO2 . The Contractor is an inde endent contractor and the guards to be furnished by it shall at all times be its employees and not those of the City. 3 . The City ' s representative in dealing with the contractor shall be the City Manager or such person as the City Manager may designate. 4. If , at any time during the contract period, the Contractor questions the meaning of any item of this agreement , the Contractor shall contact the City Manager or his designee for interpretation of that item. 5 . The City shall have the right to determine the hours and locations when and where guards shall be furnished by tlhe Contractor . The Contractor shall notify the City in writing of any changes which may. need, .oc _ . .in hours of work or locatS "it oni•. The Clty utkl power to add to, delete from, or revise the works schedule/locations at any time. 6 . The Contractor shall provide supervisory personnel to see that guard activities are taking place at the required places and times, and in accordance with all Items of this agreement. 7 . The Contractor shall maintain adequate reserve personnel to be able to furnish alternate guards in the event that any person fails to report for work at the assigned time and location. 8 . The Contractor shall provide personnel properly trained as herein specified for the performance of duties of Crossing Guards. In the performance of their duties, the Contractor and employees of the Contractor shall conduct themselves in accordance with the conditions of this agreement and the laws and codes of the State of California and the City of San Juan Capistrano. 9 . The Contractor shall train, schedule , provide, and supervise personnel in accordance with the contract and the rules and regulations of the City of San Juan Capistrano Crossing guards shall perform their duties as trained and within the City's rules for such guards. 10 . Persons provided by the Contractor as Crossing Guards shall be trained by the laws and codes of the State of California and the City of San Juan Capistrano pertaining to general pedestrian safety and school crossing areas. - 11 . Crossing Guard Services shall be provided by the Contractor at the designated locations and at the designated hours on all days on which the designated schools in the City of San Juan Capistrano, are in session. 12 . The Contractor shall provide all Crossing Guards with apparel by which they are readily visible and easily recognized as Crossing Guards. Such apparel shall be uniform for all persons performing the duties of Crossing Guards and shall be worn at all times while performing said duties. This apparel must be appropriate for weather conditions. The Contractor shall also provide all Crossing Guards with hand held Stop signs and any other safety equipment which may be necessary . Apparel and equipment shall be pre-approved by the City Manager. 13 . The Contractor shall at all times provide Worker 's Compensation insurance covering its employees, and shall provide and maintain public liability insurance for Crossing Guard activities with the City named as an additional insured. Such insurance shall include, but not be limited to, comprehensive general liability with a combined single limit of not less than $5,000, 000.00 per occurrence for property damage and for bodily injury or death of 1 I persons. Such insurance shall be primary witty r pact ,J to any insurance maintained by Cit-jz and I'shall not 4a on City ' s insurance contributions . Such insurance shall be endorsed for contractual liability and personal injury and shall include the City, its officers, agents and interest of City. Such insurance shall not be cancelled, reduced in coverage or limits or non-renewed except after thirty ( 30) days written notice by Certified Mail , Return Receipt Requested has been given to the City Attorney or City Manager. 14 . Contractor agrees to indemnify the City, its Officers, employees and agents against, and will hold and save them and each of them harmless from, any and all actions , claims damages to persons or property, penalties , obligations or liabilities that may be asserted or claimed by any person , firm , entity , corporation , political subdivision or other organization arising out of the negligent acts or intentional tortious acts , errors or omissions of Contractor, its agents, employees, subcontractors, or invitee, provided for herein. a) Contractor will defend any action or actions filed in connection with any of said claims, damages, penalties, obligations or liabilities and will pay all costs and expenses including attorney's fees incurred in connection herewith. b) Contractor will promptly pay any judgement rendered against City, its officers, agents or employees for any such claims, damages, penalties, obligations or liabilities. C) In the event City , its officers , agents or employees is made a party to any action or proceeding filed or prosecuted against Contractor for such damages or other claims arising out of or in connection with the sole negligence of Contractor hereunder , Contractor agrees to pay City, its officers, agents, or employees, any and all costs and expenses incurred by City, its officers agents or employees in such action or proceeding , including but not limited to , reasonable attorney's fees. 15 . Either party shall have the right to cancel this agreement by giving thirty (30) days written notice to the other . 16. The Contractor shall not have the right to assign this contract to any other person or firm except with the consent of the City. 17 . The City agrees to pay the CONTRACTOR for the services rendered pursuant to this Agreement the sum of Thirteen Dollars and sixty Seven Cents ( $13 . 67) per hour of guard services provided. It is understood and agreed that the cost for providing one thousand four . hundred forty-eight ( 1 , 448) hours of services shall not exceed Nineteen Thousand Seven Hundred Ninety-Four Dollars (19,794.00) . 18. In the event that this agreement is extended beyond June 30, 1994, the compensation for services shall be established by mutual consent of the parties. Said payment shall be made upon written statement to the City by the Contractor and approval of the City Manager. IN WITNESS WHEREOF, the parties hereto have executed this agreement the day and year first above written. CITY OF SAN JUAN C RANO, a municipal Orati ,a- ATTEST: � City Clerk APPROVED AS TO FORM ALL CITY MANAGEMENT SERVICES, INC City Attorney l By President AILCTrYMANAGEMIENT SERVICES Dawn Schanderl, Deputy City Clerk October 9, 2002 City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 v Dear Ms. Schanderl: c CM Fn 0 I received your memo dated September 27,2002 regarding the relationship betwek�PACS McMtaff and All City Management Services Inc.(ACMS). Please allow me to clarify these relatipnsh�s and w, u explain how these arrangements came to be. - - (n C7 When our Worker's Compensation Insurance expired in April of 2001 we wereZaced fth a thirty to forty percent increase in our insurance premium. To maintain our cost we decided to enter into a partnership with a Professional Employee Organization(PEO),T and T Staff Management Services. This partnership allowed us to acquire Worker's Compensation Insurance coverage with only a ten percent(10%) increase in our premium. Under this type of co-management partnership the PEO handles some administrative functions including payroll and provides Worker's Compensation Insurance. ACMS handles all other employee functions including hiring, training, scheduling and supervision. This relationship came to an abrupt end when CNA Insurance decided to terminate the Worker's Compensation Insurance it provided to T & T Staff and thereby ACMS. Fortunately, we located a new partner MesaStaff. MesaStaff provides the same functions as T&T Staff Management did, mainly payroll processing and Worker's Compensation coverage. MesaStaff is a subsidiary of PACA, both of which are insured by American Casualty Company of Reading. With regard to our day to day operations and our contract with the City of San Juan Capistrano, nothing has changed nor will it as a result of our partnership with MesaStaff. As you may know, Worker's Compensation Insurance rates in California are currently in a state of flux. I suspect that in the coming years we will see significant changes in the industry and the companies that provide this insurance. Until then or such time that we can obtain direct insurance at a reasonable cost we will most likely continue to work through PEO companies. I hope this helps to clarify the issues you raised. We appreciate your patronage and look forward to another safe school year. Sincer r ar n F e neral Manager "The Crossin Guard Company" cc: Lt. J.B. Davis Main Office: 1749 S. La Cienega Blvd. •Los Angeles, CA 90035 •310-202-8284 FAX 310-202-8325 Northern California Office: 6500 Dublin Blvd., Ste. 216 • Dublin, CA 94568 • 800-540-9290 FAX 925-803-6992 MEMORY TRANSMISSION REPORT TIME : SEP 27 10210:57 TEL NUMBER : 949-493-1053 NAME : CITY SJC FILE DATE TIME DURATION PGS TO DEPT NBR MODE STATUS 754 46 SEP. 27 14:57 00/29 1 310202 8325 EC M OK MEMORANDUM TO: Sharon Farwell, office Manager All City Management FROM: Dawn Schanded, Deputy City Clerk DATE: September 27, 2002 SUBJECT: Agreement - Crossing Guard Services Thank you for the copy of the letter. The letter explains the relationship between PACA and MesaStaff. What is the relationship between PACA and All City Management.? If one is the parent company and one the subsidiary please provide us with a copy of the documentation. Our concern is the agreement is between the City of San Juan Capistrano and All City Management not PACA. Znd ACA workers' compensation certificate I received references under description: ing leased employees to All City Management Services. Are the guards leased?ition, the and general liability endorser n fort naming the City as additional insured will expire today. Ra-eAA_k,e d Eth reement, page 1,item number 2 states"The contractor is an independent contractor guards to be furnished by it shall at all times be its emalovees and not those of y. Please provide me with an explanation in writing to the above questions so I may review With the City Attorney. I appreciate your time. Sincerely, 0 /IDawn derl cc: Lt. J.B. Davis 6 AM CfrY MANAGEMENT SERWCES SW4, 0,000 Dawn Schanderl, Deputy City Clerk October 9, 2002 City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 "' Dear Ms. Schanderl: c r n I received your memo dated September 27,2002 regarding the relationship betwe*PACg MciMtaff and All City Management Services Inc.(ACMS). Please allow me to clarify these relatipnsb�s and explain how these arrangements came to be. _Uu m - Q When our Worker's Compensation Insurance expired in April of 2001 we wereZfaced kth a thirty to forty percent increase in our insurance premium. To maintain our cost we decided to enter into a partnership with a Professional Employee Organization(PEO), T and T Staff Management Services. This partnership allowed us to acquire Worker's Compensation Insurance coverage with only a ten percent(10%) increase in our premium. Under this type of co-management partnership the PEO handles some administrative functions including payroll and provides Worker's Compensation Insurance. ACMS handles all other employee functions including hiring, training, scheduling and supervision. This relationship came to an abrupt end when CNA Insurance decided to terminate the Worker's Compensation Insurance it provided to T & T Staff and thereby ACMS. Fortunately, we located a new partner MesaStaff. MesaStaff provides the same functions as T&T Staff Management did, mainly payroll processing and Worker's Compensation coverage. MesaStaff is a subsidiary of PACA, both of which are insured by American Casualty Company of Reading. With regard to our day to day operations and our contract with the City of San Juan Capistrano, nothing has changed nor will it as a result of our partnership with MesaStaff. As you may know, Worker's Compensation Insurance rates in California are currently in a state of flux. I suspect that in the coming years we will see significant changes in the industry and the companies that provide this insurance. Until then or such time that we can obtain direct insurance at a reasonable cost we will most likely continue to work through PEO companies. I hope this helps to clarify the issues you raised. We appreciate your patronage and look forward to another safe school year. Sincer at n F e neral Manager "The Crossin Guard Company" cc: Lt. J.B. Davis Main Office: 1749 S. La Cienega Blvd. •Los Angeles, CA 90035 • 310-202-8284 FAX 310-202-8325 Northern California Office: 6500 Dublin Blvd., Ste. 216 • Dublin, CA 94568 • 800-540-9290 FAX 925-803-6992 MEMORANDUM TO: John Shaw, City Attorney FROM: Dawn Schanderl, Deputy City Clerk DATE: October 11, 2002 SUBJECT: All City Management - Crossing Guard Agreement All City Management provided a workers compensation certificate of insurance to us naming PACA as named insured instead of All City. Under description it states"providing leased employees to: All City Management Services. We spoke about my concerns and I was to contact All City to see what their intent was. I received a letter from Baron Farwell in response to my memo and I don't know if the "PACK certificate is acceptable especially regarding the reference to leased employees. I need your advice. I have highlighted the portion of the agreement I have concerns with (page 1, number 2). 1 have attached copies of: Insurance certificate from PACA for All City Management Copy of Agreement Copy of my Memo to All City All City response Appreciate your help, Tha s, a MEMORY TRANSMISSION REPORT . TIME SEP 27 '02 �:57 TEL NUMBER 949-493-105 NAME CITY SSC NBRFILE DATE TIME DURATION PGS TO DEPT NBR MODE STATUS E 754 46 SEP. 27 14:57 00/29 1 310202 8325 EC M OK MEMORANDUM TO: Sharon Farwell, Office Manager All City Management FROM: Dawn Schanderl, Deputy City Clerk DATE: September 27, 2002 SUBJECT: Agreement - Crossing Guard Services Thank you for the copy of the letter. The letter explains the relationship between PACA and MesaStaff. What is the relationship between PACA and All City Management.? If one is the parent company and one the subsidiary please provide us with a copy of the documentation. Our concern is the agreement is between the City of San Juan Capistrano and All City Management not PACA. The PACA workers' compensation certificate I received references under description: " roviding leased employees to All City Management Services. Are the guards leased? n dition, the and general liability endorsem n form naming the City as additional insured will expire today. The agreement, page 1,item number2 states"The contractor is an independent contractor and the guards to be furnished by it shall at all times be its employees and not those of the City. Please provide me with an explanation in writing to the above questions so I may review with the City Attorney. I appreciate your time. Sincerely,j /U 'I Dawn Schanderl cc: Lt. J.B. Davis 09/27/2002 FRI 12:26 FAX 310202 8325 All City Management Secs ?901/002 0 0 ALL CG= AG3EhT1= SERVICES FACSIMILE TRANSMITTAL SHEET TO: FROM: Dawn Schanderl, Dep_City Clerk Sharon Farwell,Office Manager COMPANY: DATE: City of San Juan Capistrano 9/27/2002 FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: (949) 493-1053 Two PHONE NUMBER: SENDER'S PHONE NUMBER: (949 443-6310 (800) 540-9290 RE: MY FAX NUMBER: ACMS W/C Insurance (310) 202-8325 Q URGENT El FOR REVIEW ❑PLEASE COMMENT ❑PLEASE REPLY Hi Dawn, Per our phone conversation, the following is a letter to our Insurance Broker . (Wescott) explaining why"PACA" is on the insurance certificate. Let me know if you have any other questions or concerns. Main Office: 1749 S. La Cienega Blvd. • Los Angeles, CA 90035 • 310-202-8284 FAX 310-202-8325 Northern Califomia office: 6500 Dublin Blvd., Ste. 216 • Dublin, CA 94568 •800-540-9290 FAX 92.5-803-6992 09/27/2002 FRI 12:26 FAX 310202 8325 All City Management Svcs ?002/002 • The Highest Standard in Staffing and PEO September 6, 2002 Wescott 5142 Clareton Drive Suite 270 Agoura Hills, CA 91301 To Whom It May Concern: I understand that there has been great concern expressed concerning the appearance of the name•`PACA"on the workers compensation certificates being issued by MesaStaff to your clients. Therefore,please accept this letter as a brief explanation of the relationship that exists between PACA and MesaStaff. MesaStaff is a subsidiary of PACA, a payroll and compensation administration company, affording worker's compensation insurance to MesaStaff and its subsidiaries. We have been under the umbrella of PACA's coverage since May 2002. I hope this letter clarifies this relationship to you. Sincerely, Brian L. Hall President 2521 Hillcrest Road Mobile. AL 36695 - Toll Free- 1.800.964.1714 • T- 334.661.6077 • F: 334.661.8303 www.mesastal`Ec m i • MEMORANDUM .J TO: John Shaw, City Attorney FROM: Dawn Schanderl, Deputy City Clerk DATE: September 19, 2002 SUBJECT: Insurance Question The City has an agreement for Crossing Guard Services with All City Management. They have always provided as required per agreement a workers compensation certificate of insurance where All City Management is named as named insured Question: I just received a certificate of workers comp naming PACA, Inc. as named insured providing leased employees to All City Management for crossing guard services. Is this acceptable OR must All City Management provide a certificate where they(All City) are name as named insureds as they have previously done? Thank you! i �VAW 32400 PAS50 NCA ADELAISTRANNTO SAN JUAN CAPISTRANO, CA 9267$ L%/ I ppppO10 MEMBERB OF THE CITY COUNCIL (949) 493-1171 DNIUfIl1 1961 DIANE L BATHGATE CAMPBELL (949) 493-10$3 (FAX) 1776 COU-ENEJOHN S.GELFF 1V1V1V.SNNj N(IpCQp15(IQRO.OI'g • HART DAVID DAVID M.BWERDLIN CITYMANAGER GEORGESCARBOROUGH August 26, 2002 Mr. Baron Farwell, General Manager All City Management 1749 S. La Cienega Blvd. Los Angeles, California 90035 RE: Compliance with Insurance Requirements - Crossing Guard Service The following insurance document is due to expire: V Workers Compensation Certificate 9/1/2002 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, eawn M. Schanderl Deputy City Clerk cc: Lt. J. B. Davis onuo use rs San Juan Capistrano: Preserving the Past to Enhance the Future facsimile TRANSMITTAL to: Baron Farwell, General Manager All City Management fax #: 310-202-8325 re: General Liability Endorsement Form date: January 15, 2002 pages: 2 including cover sheet. If your insurance company has any questions please have them contact me at(949- 443-6310). The City Hall fax number is (949) 493-1053. Thank you From the desk of... Dawn M. Schanderl Deputy City Clerk City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (949) 443-6310 Fax: (949) 493-1053 Saml doh I �. POLIC f ABE COMMERCIAL GENERAL LIABILITY Ei' !.-I_NT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) Thi: ; e !il isurance provided under the following: X141 =NERAL LIABILITY COVERAGE PART. SCHEDULE Name : 1 �r :1s, eVloyees and agents (If no p oration required to complete this endorsement will be shown in the Declarations as app o t it.) WHO 'J 1 II) is amended to include as an insured the person or organization shown in the Schad . I o liability arising out of"your work"for that insured by or for you. CG 20 Copyright, Insurance Services Office, Inc. 1984 CERTI CATE ACORD. CERTIFICATE OF LIABILITY INSURANCE 9/241 001211 O./DATE VC2-53533-z 2427'1 pe/z4/zopT 1i:ps:Le AN PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hanafin Bates & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8144 Walnut Hill Lane #1081 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Dallas, TX 75231 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 214-346-1501 fax: 425-671-4667 INSURERS AFFORDING COVERAGE INSURED MSURERA: National Fire Insurance company of Hartford ALL CITY MANAGEMENT SERVICES, INC. / T & T STAFF 1749 S. LA CIENEGA INSURER B: LOS ANGELES, CA 90035 INSURER C: 310-202-8284 fax: 310-202-8325 INSURER D: 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. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM DD Y DATE MM D LIMBS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL UABILITY FIRE DAMAGE(My one fire) $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PELT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accdent) PROPERTY DAMAGE $ (Per accdent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANVAUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR ❑CL/UMS MADE AGGREGATE $ § DEDUCTIBLE $ RETENTION $ SP § WORKERS COMPENSATION AND WC249189627 09/01/2001 09/01/2002 X I TORYL MITI ER 31� EMPLOYERS'LIABILITY E.L.EACH ACCIDE T $ G7 1 A E.L.DISEASE-EA QPLOAE $ �� 1 E.L.DISEASE-POLF-r)j1 OTHER O UMIT ""'T1'''r UMIT --i V,f11 CO m DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMEWISPECIAL PROVISIONS 1. Certificate holder is provided with a waiver of Subrogation for Workers Compensation 2. P,yject S Information 3. Said policy shall not be cancelled, nonrenewed or materially change without 30 days advaliag written notice being gived to the owner [city] except when the policy is being cancelled for nonpayment o emium in which case 10 days advanced written notice is required. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of San Juan Cpaistrano DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Cheryl Johnson, City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 32400 Paseo Adelando San Juan Capistrano, CA 92675 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25-S(7/97) O ACORD CORPORATION 1988 dNar 32400 PASEO ADELANTO �� MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 1 R(InuBb q I-EATHGATE JOHN S.GEU (949)493-1171 ItR (96) JOHN GREINER 'n6 (949)493-1053 (FAX) WAr HART www.sanjuancapistrano.org DAVID M. SWERDUN CITY MANAGER GEORGE SCARBOROUGH August 14, 2001 All City Management Attention: Baron Farwell, General Manager 1749 S. La Cienega Blvd. Los Angeles, California 90035 RE: Compliance with Insurance Requirements - Crossing Guard Service The following insurance documents are due to expire: Y Workers Compensation Certificate 9/1/01 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, M� . Dawn M. Schan erl Deputy City Clerk cc: Lt. Rick Stahr use �s San Juan Capistrano: Preserving the Past to Enhance the Future 0 ACORD CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NO.I DATE VC2-53523-190167 s/30/01 3:30:50 PH PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hanafin sates & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8144 Walnut Hill Lane 41081 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Dallas, TX 75231 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 214-346-1501 fax: 425-671-4667 INSURERS AFFORDING COVERAGE INSURED INSURER A: American Casualty Co.of Reading Pennsylvania ALL CITY MANAGEMENT SERVICES, INC. / T & T STAFF 1749 S. LA CIENEGA INSURERS: LOS ANGELES, CA 90035 INSURER C: 310-202-8284 fax: 310-202-8325 NSURER O: 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. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTRGATE MMIDDfIY DATE MMIDDIYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(My one fire) $ CLAIMSMADE [::] OCCUR MED EXP(Any one Person) $ PERSONAL B ADV INJURY $ GENERA-AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PEo- LOC AUTOMOBILE LIABILITY COMBINED SINGLE OMIT ANY AUTO (Eaaccitlenl) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Peon) $ Person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accitlent) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC249859437 5/1/01 9/1/01 X TORYLIMITS Eft EMPLOYERS'LIABILITY A E.L.EACH ACCIDENT $ 1,000,000 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER LIMIT $ LIMIT $ DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENIISPECIAL PROVISIONS 1. Certificate holder is provided with a Waiver of Subrogation for Workers Compensation 2. Project Information 3. Said policy shall not be cancelled, nonrenewed or materially change without 30 days advanced written notice being gived to the owner [city) except when the policy is being cancelled for nonpayment of premium in which case 10 days advanced written notice is required. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of San Juan Cpaistrano DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Cheryl Johnson, City Clerk NOTICE TOTHE CERTIFICATE HOLDER NAMEDTO THE LEFT,BUT FAILURE TO DO$0 SHALL 32400 Paseo Adelando San Juan Capistrano, CA 92675 IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25-S(7/97) a ACORD CORPORATION 1988 AC0RD CERTIFICA-0 OF LIABILITY INSUWC�m OP ID A DATE IMM/DDl0 LCI-1 01/16/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone: 626-449-3870 Fax:626-449-5268 INSURERS AFFORDING COVERAGE INSURED INSURER A: Admiral Insurance Company All City Management, Inc. INSURER B: General Security Ins. Co. Baron Farwell INSURER C: _ 1749 South La Cienega Blvd. INSURER D: Los Angeles CA 90035 Li 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. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICYNUMBER DATE MNVDD DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GEN X OCCUR A01AG11534 09/27/01 09/27 02 FIRE DAMAGE one fire) $ 100,000 CLAIMS IX ' Owner Cont Prot. / / MED EXP(Any one person) $Excluded A X�COMMERCIAL GENERAL LIABILITY ' — 1 PERSONAL BADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER:, PRODUCTS-COMP/OP AGG $ 1,000,000 _.. POLICYPRO LOC JEGT 4AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO f (Ea accitlent) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS _ ', BODILY INJURY $ NON-OWNED AUTOS (Per accident) j PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ! AUTO ONLY-EA ACCIDENT S I ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 4,000,000 B Xl OCCUR CLAIMS MADE I CE9001223 09/27/01 09/27/02 1 AGGREGATE $4,000,000 $ DEDUCTIBLE '. $ X 'I RETENTION $ 10,000 $ WORKERS COMPENSATION AND TORY LIMITS ER L— EMPLOYERS'LIABILITY i EL EACH A061DENT EL OISEAS BAP YE E.L.DISEASES LIQF+1M1T $ T rn OTHER rn q _ z z r f✓ v DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS z *10 Day Notice of Cancellation for Non-Payment of Premium. Certificate Holder is named as Additional Insured, per attached Endorsement CG2010 1093. N SUPERCEDES CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED. CERTIFICATE HOLDER N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN City of San Juan Capistrano NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dawn M. Schanderl, IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Deputy City Clerk 32400 Paseo Adelando REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE Michael T. ACORD 25-3(7197) ®AC RD CORPORATI N 988 w •DMIRAL INSURANCE COMPAR Named Insured: ALL CITY MANAGEMENT,INC. No: 04 Policy: AOIAG11534 Effective Date: 9/27/200 COMMERCIAL GENERAL LIABILITY CG 20 10 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: AS REQUIRED BY WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED(Section 11) 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 ongoing operations performed for that insured. CG 20 10 10 93 Copyright, Insurance Services Office, Inc.,1992 Page 1 of 1 Original Copy aIP OMP. CERTIFICAI0017 LIABILITY INSUR C& DATE(MM/DDNY) ALLCICI 04/05/01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICAT7frp0ES11DT AMEND, EXTEND OR 489 E. Colorado ALTER THE COVERAGE A THE POLICIES BELOW. Pasadena CA 91101 -CCAWNFS A ORDI G COVERAGE Michael T. Curry COMPANY FIN -ol Phone No. 626-449-3870 Fax No. 626-449-5268 A Hartford Casualty Ins. Co. INSURED COMPANY DFPARTHENT B C)iY T&T Staff Management, Inc. COMPANY API;IPANi; All City Management Services 406 Chelsea Street COMPANY E1 Paso TX 79905 D COVERAGES THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDM') DATE(MM/DDNY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGS $ CLAIMS MADE [:]OCCUR PERSONAL 8 ADV INJURY $ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED EXP(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 8 ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) LIR=IIERDAMAIE� $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY. EACH ACCIDENT 8 AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND X WC STATU- OTHEMPLO - WORKE S C LIABILITY _TORY LIMITS _ ER EL EACH ACCIDENT $ 1000000 A THEPROPRIETORI INCL 46 WN J74940 06/01/00 06/01/01 EL DISEASE-POLICY LIMIT $ 1000000 PARTNERS/EXECUTIVE OFFICERS ARE EXCL EL DISEASE-EA EMPLOYEE $ 1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPEOIAL ITEMS Cove age is provided for only, those employees of T&T STAFF MANAGEMENT, INC. Ail City Management Services, Inc. 10 days notice of cancellation shal be given for non-payment of premium & non-submission of payroll insureds as their interests may appear. Per project aggregate limits apply. CERTIFICATE HOLDER CANCELLATION CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of San Juan Capistrano BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Cheryl Johnson, City Clerk 32400 Paseo Adelando OF ANY KIND UPON THE COMPANY,ITS AGENTS aRREPRES TA S. San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE Michael T. Curry ACORD 25-S(1/95) ON 1988 32400 PASEO ADELANTO �� f� MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO, CA 92675 ROIIfI1RI DIANE L.BATIIGATE JOHN S.GEU=F (949) 493-1171 BIIBIIfIB 1961 JOHN GREINER (949) 493-1 OS3 (FAX) 1776 MATT HART www.sanjuancapistrano.org DAVID M. SWERDUN CITY MANAGER GEORGE SCARBOROUGH March 25, 2001 All City Management 1749 S. La Cienega Blvd. Los Angeles, CA 90035 RE: Compliance with Insurance Requirements - Crossing Guard Service The following insurance document is due to expire: IWorkers Compensation 4/1/01 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 Paseo Adelanto, San Juan Capistfano, CA 92675 by the above expiration date. If you have any questions, please contact me at (949) 443-6308. Sincerely, Dawn M. Schanderl Acting City Clerk cc: Lt. Rick Stahr, Police Services DRUG USE IS San Juan Capistrano: Preserving the Past to Enhance the Future 32400 FASEO ADELANTO i�� MEMBERS OF THE CITY COUNCIL SAN .JUAN CAPISTRANO, CA 92675 � I 0nnnlpl JOHN S.GELFF DIME L.SATHGAIE (J49) 493-1171 If111113111 1961 JOHN GREINER (949) 493-1053 (FAX) 1776 MATT HART www.sanjuancapistrano.org •� • CAME M. SwEMLIN CITY MANAGER GEORGE SCARBOROUGH September 21, 2001 All City Management Attention: Baron Farwell, General Manager 1749 S. La Cienega Blvd. Los Angeles, California 90035 RE: Compliance with Insurance Requirements - Crossing Guard Service The following insurance documents are due to expire: General Liability Certificate 9/27/01 �i V General Liability Endorsement CG 20 10 1185 naming the City of San Juan Capistrano as additional insured. 1oj: }0 4L,-U_ 4^srrj Automobile Liability Certificate 9/27/01 rv©� nc ('c "'-d Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 Paseo Adelanto, San Juan CapistFano, CA 92675 by the above expiration dates. If you have any questions, please contact me at (949) 443-6310. Sincerely, A LS�-� Dawn M. Scha der Deputy City Clerk cc: Lt. Rick Stahr DflUO USE IS San Juan Capistrano: Presen�ing the Past to Et)hance the Future ACORDCERTIFICA OF LIABILITY INSUFONCI�LCOP I-CI_ S DATE /1 09/27/27/00 1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone: 626-449-3870 Fax:626-449-5268 INSURERS AFFORDING COVERAGE INSURED ' INSURER A. Admiral Insurance Company All City Management, Inc. INSURER B: General Secuity Ins. Co. Baron Farwell INSURER c. 1749 South La Ciene a Blvd. INSURERD. Los Angeles CA 9003 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. SR V OL CY PIRATIC# LTR TYPE OFINSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY A01AG11534 09/27/01 09/27/02 FIRE DAMAGE(Any one fire) $ 10 0,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $Excluded X Owner/Cont Prot. PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 1,000,000 JECT POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGO $ EXCESS LIABILITY EACH OCCURRENCE $ 4,OOO,OOO B X OCCUR ❑CLAIMS MADE CE9001223 09/27/01 09/27/02 AGGREGATE $ 4,000,000 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND TORYTATU LIMITS ER EMPLOYERS'LIABILITY -- E.L.EACH ACCIDENT E.L.DISEASE+ EMPLOYE S E.L.DISEASE JPW= IT F-- OTHER a+ rn DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ... O *10 Day Notice of Cancellation for Non-Payment of Premium. s C7 insureds as their interests may appear. Per project aggregate limits apply. CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER: CANCELLATION CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL City of San Juan Capistrano IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Cheryl Johnson, City Clerk 32400 Paseo Adelando REPRESENTATIVES, San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE A Michael T. Cur ACORD 26S(7197) CACORD CORPORATION 1988 awn Schanderl To: Rick Stahr Subject: All City Management I still need general liabioity endorsment form CG 20 10 11 85 naming City as an additional insured per agreement. Expired 9/27/01 . FYI Thank you Sir. Oct 02 01 02: 42p R11 City Management Svcs 310 202-8284 p. 3 ACORD CERTIFICA OF LIABILITY INSUR C� OPID $ DATE DAMiDO"Y' LLCI-1 I 09/27/0.1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Colorado ALTER_ THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone': 626-449-3870 rax: 626-449-5268 I INSURERS AFFORDING COVERAGE INSURED INSURERA Admiral Insurance Company . INSURERS General Secuity Ins_Co. All City Management, Inc. ---- - - — ---- - -- Baron Farwell INSURER C. 1749 South La Cienega Blvd, NSIJRVR Los Angeles CA 90035 ------ ---- -- -- -- -- --- -- - - INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PCI ICY PERIOD INDICATED.NOTWITHSTAND.NO 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 INSR ---- - - ---- - POLICY FrEC POL CY E%PIRA ION LIMITS LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MWDDIYY' GENERAL LIABILITY EACH VR NCE $ 1,000,000 A X �COMMERCIAL GENERAL LIABILITY AOIAG11534 09/27/01 09/27/02 FIRE 7AM1IAG'(Any one lire; $ 100,000 CLAIMSMAOE OCCUR MED CXP(Any ons FVI_q $Excluded X Owner/Cont Prot. �PLRSCNALa AUV IIJJl1RY ($ 1,000,000 ~GENERAL AGGRLGATF I$ 2,000,000 _ GEN'LAGGREGATE LIMIT APPLIES PER. IPRODLQS_COMPICO A_G s10 , 00,000 POLICY I JEC LOO I— AUTOMOBILE LIABILITY _ COMBIN'�J SINGLE LIMI f 1 ANY AUTO IFS acvidert) �$ ALL OWNED A'JTOS ypp y wdJRV L SCHEDULED A,TDS (Per Fersan) AIRED AUTOS SODIL'WJURI NON-OWNED AUTOS III fIL,dent) FFOPLRT(DAMAGE $ IPS-acnexnc) GARAG E LIABILITY I AU-0 ONLY,FA ACCIDENT ANY AUTO OTTER THAN FA ACG {$ - _- dUT_ON[Y AGG $ EXCESS LIABILITY EACH OCGJRRENCE $_4,00(),000 B X occuR CLAIMS MADE CE9001223 09/27/01 ! 09/27/02 ' AGGREGAIE _ s4,000 ,000 s DEDUCTIBLE S X RETENTION s 10,000 —$ WORKERS COMPENSATION AND li �TORY_LIMI'S� j�FR EMPLOYERS'LIABILITY _ F EACF.ACQDENT SJ E L ODFASE_EP FMPLOYL $ CL JISt ASF POLCYLIMT $ OTHER � 7� DESCRIPTION OF OPERATIONSILCCATIONS EHIOLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS *10 Day Notice of Cancellation for Non-Payment of Premium. insureds as their interests may appear. Per project aggregate limits apply. CERTIFICATE HOLDER N I ADDITIONAL INSURED{INSURER LETTER', CANCELLATION CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POI IMES BE CANCELLED BEFORE THE ::N DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DA1'SWRIT TEN NOTICE TO THE CERTIFICATE HOI DER NAMED TO THE LEFT,BUT FAILURE TO DO SO:MALI City of San Juan Capistrano Cheryl Johnson, City Clerk IMPOSE NO OBLIGATION OR LIADIUTY Or ANY KIND UPON THE INSURER.ITS ADEN' .A 32400 Paseo Adelando REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATih-E I Michael T. Curr /' /r AGnRD 99-q 17/071 Ak 1. All City Management Crossing Guard Service-endorsement CG 20 10 11 85 and aute-ecpt�d972 1. Letter sent 9/21 with follow up fax dated 10/4/01. L�-Ujd J-D /tip► a,� u cew d 6 Jold ti,Wt,, /2Z/ , a� �vrr�c� rte_ Dec 26 01 11 : 14a All City Management Svcs 310 202-8284 p. 1 ALSd'Sa C SV1Sd11NAG11o6V1lLt N J1 oyER\' CES FACSIMILE TRANSMITTAL SHEET TO FROM Dawn M. Schanderl Baron Farwell Deputy City Clerk COMPANY DATE City of Sari Juan Capistrano 10/02/01 PAX NUMBER- TOTAL NO OF PAGES INCLUDING rOVER (949) 493- 1053 PHONE NUMBER SENI)i.E'>EFFERENI:n NUMBER (949) 493-1171 310 202-8281 RE YOUR.LIEN RBNCP.NUMBER liability Certificate ❑ URGENT X FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE Rlt:'LY ❑ PLI,AMb RF, 1 I goo, CLICK HERF, AND TYPF RE-TURN ADDRFSSj Dec 26 01 11 : 14a R11 City Management Svcs 310 202-8284 p. 2 Alk ACORD CERTIFICA OF LIABILITY INSU �IC�LLOIID S DA09�271/01 PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Colorado ALTER THE COVERAGE AFFORDED BY THE_POLICIES BELOW._ Pasadena CA 91101 Phone: 626-449-3870 Fax:626-449-5268 INSURERS AFFORDING COVERAGE INSURED INSURER:. Admiral Insurance Company INS.IRERL General Secuity _Ins.- Co. All City Management, Inc. ----- —- — ---- _ -_--- Baron Farwell °suRER: 1749 South La Cienega Blvd. �sGRER Los Angeles CA 90035 -- J NSURER COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD,INDICATED.NOTWITHSTA NOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIROATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 3 SUB„ECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SI,CH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 3Y PAID CLAIMS. I _ PCUCV EFFECTIVE r'OLICV EXPIRATION - -- LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIOOIYY DATE yMWOPYyL LIMITS GENERAL LIABILITY EACH OCCI,RRi,NCE S 1,000,000 A X1 COMMERCIAL GENERAI LIABILITY A01AG11534 09/27/01 09/27/02 FIRE DAMAGE,Any one've) ' i 100 ,000 CLAIMS MADE LJ OCCIIR i \1V(1 l"XP(Anynvr pei.onl SF.XO�lldaCj Owner/Cont-Pro t PERSONAL.B A JV INJJkY �S 1,0001000 _ENERA_AGGREGATE ;s 2,000,000 DEVIL AGGREGATE LIMIT AP-LIES PFk PROIIIrTN C�,MPIUR AOC 11 ,000, 000 POLICY PRO- ECT _ AUTOMOBILE LIAB.LITY ( COMBINED SI NGi FMIT ANY AUTO Ce aradenfj $ ALL OWNED AUTOS ROLA Y IND.,`Y SCHEDULED AUTOS IF"person! S HIRED AUTOS ` - - 60p V INJVI<� S NON-OWNED AUTO_ (Pei L.,dnr': PROPERTY DAMAGE $ (Pea®Wen, GARAGE LIABILITY A,TO ONLY-PA AC.IDFnT OT--R AN S ANY AUTC EA A::.. 5 n - AU-C OND' _ _. A.:G q EXCESS LIABILITY � � 64c4 oCLUkRCNCE 84,000,000 B X occuR CLAWS CE9001223 09/27/01 09/27/021r A3GRC,AT7 Is 4,COO ,C00 DEDUCTIBLE --�-- ][ I RETENTION S 10,000 WORKERS COMPENSATION AND I TORY ITORY I INI Is J Ell - EMPLOYERS'LIABILITY F I FAGA ACC )ENT F 1 DIS-ASC LA EMPLOYFa > L.D,SEASE POLIG_IMIi' S - OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMEN'TISPEOIAL PROVISIONS x10 Day Notice of Cancellation for Non-Payment of Premium. insureds as their interests may appear. Per project aggregate limits apply. CERTIFICATE HOLDER N I ADDITIONAL INSURED:INSURER LETTER _ CANCELLATION CTTysic SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED PFFCRE TIrc-ea(•IFP• � DATE TL THE ISSU NG INSJRER WI_ENDER>OR TO MAIL -aQDA,IN.- NOTICE TO THE CERTIFICATE HOI CER NAMED TO THE LEFT,BUT FAILURE_-,DO 10`nA City of San Juan Capistrano IMPOSE NO OHI IG4TION OR LIABILITY OF ANY KIND UPON THE INSURER IIe ADEN 1' S Cheryl Johnson, City Clerk 32400 Paseo Adelando REPRESENTADVES. San Juan Capistrano CA 92675 AUTHDRIZZDREPRESeNTAT1v E ',Michael T. Curr ............ .. ....... n.-..on r-noono nrin oco Dec 26 01 11 : 14a R11 City Management Svcs 310 202-8284 p. 3 • � Jean � 32400 PASEO AOELAN i0 J � MEM6NS OF-PE Ciiv COCrvC'_ SAN JUAN CAPI9TRAN0, CA 92675 �OIIYI4�p IIANI fl Ill I I ✓ iOHNs (,n•� (949) 4931171 wuwn, 1961 �JiN 1W IN ' (949) 493-1053 (FAX) 1776 11Ai 'm, Iht 0lti )AVID V WI ' September 21, 2001 All City Management Attention: Baron Farwell, General Manager 1749 S. La Cienega Blvd. Los Angeles, California 90035 RE: Compliance with Insurance Requirements - Crossing Guard Service The following insurance documents are due to expire: General Liability Certificate 9/27/01. V General Liability Endorsement CG 20 10 11 85 naming the City of San Juan Capistrano as additional insured. V Automobile Liability Certificate 9/27/01 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 dates. If you have any questions, please contact me at (949) 443-6310. Sincerely, (� Z �C ci15—i Dawn M. Sch11a derl ' Deputy City Clerk cc: Lt. Rick Stahr DO USE Q.,.. T,.,.., �.,nrcrrn nn• �w< On 1•tnlo f�L' �� IPt fil �1.�)Nll i'P f�'iP f"I/71/f'P 1S Oct 02 01 02: 42p 811 City Management Svcs 310 202-8284 p. l 0 j FACSIMILE TRANSMITTAL SHEET F M. Om D'aN" A Schanderl 70 Baron Fanvell IQ Deputy City Clerk COMPANY DATE — City of San Juan Capistrano 10/02/01 MX NUMBER TOTAL NO OF PACES IN- LUDINC COYER (949) 493- 1053 3 St- X t'HONE I"UMSER SENF"R'F R-.FERE11 F NUMBER (949) 493-1171 310 202-8284 Ri: YOUR REFERENCE NI�MB_'.R Liabilinr Certihcatc ❑ URGI?NT XF,,P RFVIN,IX ❑ PL :ASL- COMP:EN7- ❑ 'LEA'.,H RI=.'IS ❑ FLF:ASF RHLi LI 1 o Woi mr, Farweu , NeaSe See cL JCLICIC HERS AND TYPP RF.,IIRN ACDRE.SSj Oct 02 01 02: 42p R11 City Management Svcs 310 202-8284 p. 2 JOWWO 32400 PASEO ADELAN'tO .-:!1 MEMRFES OF THF C.TY COU' . SAN JOAN CAPISTRANO, CA 92675Ia m;;no.wuc DiANEL.PA`C( TC L- iOHN s-GEt R (949) 493-1171 Inmuwm 1961 .inHN -,Ruv,u (949) 493-1053 (FAX) 1776 WrAii Hai org f)WN l M nWFR7,N ❑wx. anju.Incn�)i,c)ram.. �� GlY MANAGER CFi1RGF CARB^RiIU+ September 21, 2001 All City Management Attention: Baron Farwell, General Manager 1749 S. La Cienega Blvd. Los Angeles, California 90035 RE: Compliance with Insurance Requirements - Crossing Guard Service The following insurance documents are due to expire: V General Liability Certificate 9/27/01 VAAJII� L)-ka—kAn"Y' V General Liability Endorsement CG 20 10 1185 naming the City of San Juan Capistrano as additional insured. 9+0t need V "ocumentation Please submit updated /th Cty of San Juan Capistrano, attention City Clerk's office, 32400 Paseo Adelanto, San Juan Capistrano, CA 92675 by the above expiration dates. If you have any questions, please contact me at (949) 443-6310 Sincerely, Ajl� 1Ot -X Dawn M. Scha dh erl Deputy City Clerk cc: Lt. Rick Stahr DPIUA USE IS Snn .Marr ('nnkrrapwr PrPc"rI ino rho PncT r., F„7,. 7,o F,.r... .ate., 3.2400 PASEO AOELANTO �$/ MEMBERS OF THE CITY COUNCIL 'SAN JUAN CAPISTRANO, CA 92675 13' 'ia o,voveru owNE L.BATMGATE .'OHN S.GELFP (949) 493-1171 aranmu 1961 COLLEGE OAMPEELL (949) 493-1053 (FAX) 1776 wYATT HART R'h'IP.SC!/1f GLlnCnp(.SlralII).org • CAVO M.SWERULIN ♦ ♦ CITY MANAGER GEORGE SCARBOROUGH December 21, 2001 Camp Dresser & McKee 1925 Palomar Oaks Way, Suite 300 Carlsbad, California 92000008 RE: Comoliance with Insurance Requirements - Design Well Site No. 5 The following insurance documents are due to expire: Vr General Liability Certificate 1/1/02 V General Liability Endorsement CG 20 10 11 85 naming the City of San Juan Capistrano as additional insured. V Automobile Liability Certificate 1/2/02 Workers Compensation Certificate '/2/02 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 dates. If you have any questions, please contact me at (949) 443-6310. Sincerely, �] Dawn M. Schanderl Deputy City Clerk cc: Eric Bauman, Senior Engineer DRUG USE IS San Juan Capistrano: Preserving the Past to Enhance the Future .. .._. ............ .._. ......_. _ . ...._ ... "AccND CERTIRC E OF LIABILITY INS NCE LL I D09/29 Y) ALLCI-1 09/29/00 PDODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry fnaurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Coldrado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 COMPANIES AFFORDING COVERAGE Michael T. Curry COMPANY Phone No. 626-449-3870 Fu No. 626-449-5268 A United National Insurance Co. INSURED COMPANY B Zenith Insurance Company All City Management, Inc. COMPANY Baron Farwell C Diamond State Insurance Co. 1749 South La Cienega Blvd. COMPANY Los Angeles CA 90035 D COVERAGES -: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE Or INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 A X COMMERCIAL GENERAL LIABILITY L7145845 09/27/00 09/27/01 PRODUCTS-COMPIOPASS $1,000,000 CLAIMS MADE IX OCCUR PERSONAL B ADV INJURY $1,000,000 X OWNERS&CONTRACTOR'SPROT EACH OCCURRENCE $1,000,000 FIRE DAMAGE(Any one fire) $100,000 MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILITY A ANY AUTO L7145845 09/27/00 09/27/01 COMBINED SINGLE LIMIT $1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIREDAUTOS BODILY INJURY X NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ................. ... ............ ...... .. ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $4,000,000 C X UMBRELLA FORM CU0063581 09/27/00 09/27/01 AGGREGATE $4,000,000 OTHER THAN(UMBRELLA FORM $ WORKERS COMPENSATION AND X IWC STATU. OTH TORY LIMITS ER EMPLOYERS LIABILITY EL EACH ACCIDENT $ 1000000 B THE PROPRIETOR/ INCL 2046175201 04/01/00 04/01/01 EL DISEASE-POLICY LIMIT $ 1000000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 1000000 OTHER t H C DESCRIPTION OF OPERATION&LOCATIONS/VEHICLES/SPECIAL ITEMS f! A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. rn Names The City and the Community Redevelopment Agency, its elected gr appointed officers, officials, employees and volunteers an as additional -itir„ _$ m insureds as their interests may appear. Per project aggregate limits apply v CERTIFICATE HOCtlER CANCELLATION.: CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLECSORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of San Juan Capistrano BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Cheryl Johnson, City Clerk 32400 Paseo Adelando OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE Michael T. CurryCr" �L ACORD:25-S :A CO, N 1988:,:;: (rhe attaching clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective September 27,2000 at 12:01 a.m. standard time, forms a part of Policy #: L145845 Issued to: All City Management, Inc. By: United National Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (SECTION II) is amended to Include the person or organization shown in the Schedule below, but only as respects liability imposed or sought to be imposed on such additional insured because of an alleged act or omission of the named insured. 1. If liability for injury or damage is imposed or sought to be imposed on the additional insured because of: a. Its own acts or omissions,this insurance does not apply; b. Its acts or omissions and those of the named insured, as to defense of the additional insured, this Insurance will act as coinsurance with any other insurance available to the additional insured, in proportion to the limits of liability of all involved policies, and the Other Insurance provisions of this policy (SECTION IV - CONDITIONS) are amended accordingly. However, this insurance does not apply to indemnity of the additional insured for its own acts or omissions. 2. If an agreement between the named insured and the additional insured providing Indemnity or contribution in favor of the additional Insured exists or is alleged to exist, the extent and scope of coverage under this insurance for the additional insured will be no greater than the extent and scope of indemnification of the additional insured which was agreed to by the named Insured. 3. The naming of an additional insured will not increase our limit of liability. SCHEDULE Name of Person or Organization (Additional Insured) Premium Blanket Additional Insureds $ ountersignature SL-12(2/97) Oct 19 00 06: 31a R11 City Management Svcs 310 202-8284 p. 2 32400 FASEO ACIELANTO �y MEMBERS OF THE CITY SA COUNCIL TMGATE SAN JUAN CAPISTRANO,CA 92575 1i nuunnu COOLDIML.EAMPBEL 1961 COLLEGE CAMPBELL (949) 493-1171 n1776 WONT+ HART R (949) 493-1053 (FAX) 1776 - DAVID MART DAVID M.SWEROLIN CITY MANAGER IjYr.�J_/ GEORGE SCARBOROUGH October 3, 2000 Mr. Baron Farwell All City Management 1749 South La Cienega Blvd. Los Angeles, California 90035 — Re: General Liability Endorsement Form (Crossing Guard Service) Dear Mr. Farwell: Thank you for the certificate of insurance and endorsement that was received by the City of San Juan Capistrano on October 2, 2000. The endorsement did not list the City of San Juan Capistrano as an additional insured nor was it signed. Please send an updated endorsement form to the City, attention City Clerk's office, by October 11, 2000. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. Very truly yours, u lj 9 1 —� / Dawn M. Schanderl o Deputy City Clerk cc: Cheryl Johnson, City Clerk Lt. Rick Stahr, Police Services =103u 'C" E R T I F I C A T E • O L D E R L I .S T • Date 10/19/AO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 4 Customer,:ALLCI -1 Range :All Dates : All A1l ' City Management, Inc . Code Name Street City ST Zip Code Iss Date Queued Day ....... .......................... .......................... ...................... .. ......... ....... ...... ... CITYOFA City of Agoura Hills 30101 W. Agoura Road #102 Agoura Hills CA 91301-4335 09/29/AO No 30 Carol Tubelis City Manager's Office Description of Operations A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. Names certificate holder as additional insureds as their interests may appear. 818-597-7332 CITYCFB City of Bellflower 16600 Civic Center Drive Bellflower CA 90706-5494 10/12/AO No 30 Debbie Pons, City Clerk 562-925-8660 Description of Operations A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. Names certificate holder as additional insureds as their interests may appear. CITYCFL City of Lake Forest 23161 Lake Center Drive, #100 Lake Forest CA 92630 09/29/AO No 30 Attn: Mr. David A. Bass Director of Finance/Risk Mgr. Description of Operations A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. CITYPAL City of Palo Alto 250 Hamilton Avenue, 1st Floor Palo Alto CA 94301 09/29/AO No 30 B.T. Purchasing 6 Contractors Administration Description of Operations A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. Names certificate holder as additional insureds as their interests may appear. CITYPAR City of Paramount 16400 Colorado Blvd. Paramount CA 90723 09/29/AO No 30 Mary Wilsor, Personnel Mgr. Description of Operations A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. Names certificate holder as additional insureds as their interests may appear. CITYRAN City of Rancho Palos Verdes 30940 Hawthorne Blvd. Rancho Palos Verdes CA 90274-5391 09/29/AO No 30 Jo Purcell-Admin.Serv.Dir. Description of Operations A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. Names certificate holder as additional insureds as their interests may appear. CITYRED City of Redwood City 1017 Middlefield Road Redwood City CA 94563 09/29/AO No 30 Office of the City Clerk Silvia Ponte,Sr.Dep.City Clerk Description of Operations A 10 Day Notice of Cancellation will be given fox Non-Payment of Premium. Names certificate holder as additional insureds as their interests may appear. CITYROL City of Rolling Hills Estates 40450 Palos Verdes Drive North Rolling Hills Estates CA 90274 09/29/AO No 30 Ellen Shinkai Description of Operations A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. Names certificate holder as additional insureds as their interests may appear. CITYSJC City of San Juan Capistrano 32400 Paseo Adelando San Juan Capistrano CA 92675 09/29/AO No 30 Cheryl Johnson, City Clerk Description of Operations A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. Names The City and the Community Redevelopment Agency, its elected or appointed officers, officials, employees and volunteers an as additional insureds as their interests may appear. Per project aggregate limits apply. r g clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) orsement, effective September 27,2000 at 12:01 a.m. standard time, forms a part of L145845 Issued to: All City Management, Inc. By: United National Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (SECTION II) is amended to Include the person or organization shown in the Schedule below, but only as respects liability imposed or sought to be imposed on such additional insured because of an alleged act or omission of the named insured. 1. If liability for injury or damage is imposed or sought to be imposed on the additional insured because of: a. Its own acts or omissions,this insurance does not apply; b. Its acts or omissions and those of the named insured, as to defense of the additional insured, this insurance will act as coinsurance with any other insurance available to the additional insured, in proportion to the limits of liability of all involved policies, and the Other Insurance provisions of this policy (SECTION IV - CONDITIONS) are amended accordingly. However, this insurance does not apply to Indemnity of the additional insured for its own acts or omissions. 2. If an agreement between the named insured and the additional insured providing indemnity or contribution in favor of the additional insured exists or is alleged to exist, the extent and scope of coverage under this insurance for the additional insured will be no greater than the extent and scope of indemnification of the additional insured which was agreed to by the named insured. 3. The naming of an additional insured will not increase our limit of liability. SCHEDULE Name of Person or Organization (Additional Insured) Premium Blanket Additional Insureds $ Countersignature SL-12 (2/97) 32400 PASEO ADELANTO LJ '� MEMBERS OF THE CRY COUNCIL SAN JUAN CAPISTRANO, CA 92675 uneruno DIANE L.BATHGATE (948) 493-1171 CO JOHN GR B[ArtlflG 1961 NE CAMPBELL CCAMAM (949) 493-1053 (FAX) 1776 VNATT HART DAVID M.SWERDLIN CITU MANAGER GEORGE SCARBOROUGH September 26, 2000 Mr. Baron Farwell All City Management 1749 South La Cienega Blvd. Los Angeles, California 90035 Re: Renewal of General Liability Certificates of Insurance and Endorsement Form (Crossing Guard Service) Dear Mr. Farwell: The General Liability Certificate of Insurance, regarding the above-referenced service, expired on September 14, 2000. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. The agreement requires a general liability endorsement form naming the City of San Juan Capistrano as an additional insured. Please forward the updated certificate and endorsement to the City, attention City Clerk's office, by October 9, 2000. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Lt. Rick Stahr, Police Services DRUG USE IS San Juan Capistrano: Preserving the Past to Enhance the Future AC RD CERTIFICME OF LIABILITY INSU NCEcSR SM DATE(MWDD/VY) ALLCI-1 04/04/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 489 E. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 COMPANIES AFFORDING COVERAGE Michael T. Curry COMPANY PKone No. 626-449-3870 Fa.N.. 626-449-5268 A United National Insurance Co. INSURED COMPANY B Diamond State Insurance Co. All City Management, Inc. COMPANY Baron Farwell C Zenith Insurance Company 1749 South La Cienega Blvd. COMPANY Los Angeles CA 90035 D COVERAGES THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 00 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS LTR DATE(MM/DD/YY) DATE(MMIDDNY) GENERAL LIABILITY GENERAL AGGREGATE s2,000,000 A X COMMERCIAL GENERAL LIABILITY L7134251 09/14/99 09/14/00 PRODUCTS-COMP/OP AGG $ 1,000,000 CLAIMS MADE OCCUR PERSONAL&ADV INJURY $ 1,000,000 X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000_,000 F FIRE DAMAGE(Anyone fire) $ 100,000 MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILffY COMBINED SINGLE LIMIT $ 1,000,000 A ANY AUTO L7134251 09/14/99 09/14/00 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Penton) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (PerawideM) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE s4,000,000 IS X UMBRELLA FORM CU0053876 09/14/99 09/14/00 AGGREGATE $ 4,000,000 OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS UABILIFY TORY LIMITS ER EL EACH ACCIDENT 81000000 L. THE PROPRIETOR/ INCL 2046175201 04/01/00 04/01/01 EL DISEASE-POLICY LIMITS 1000000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE 000000 OTHER C O7 ><n< n vT�n �1 m DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. nzy� o Names The Cit and the Community Redevelopment Agency, its elected or = appointed officers, officials, employees and volunteers an as additional o insureds as their interests may appear. Per project aggregate limits apply. • CERTIFICATE HOLDER CANCELLATION CITYHJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of San Juan Capistrano BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Cheryl Johnson, City Clerk 32400 Paseo Adelando OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE Michael T. Curr3 U_ LL-�, ACORD 25-S(1/95) .. ACORD CORPORATION 1988 Jtww I 32400,PASEO ADELANTO WYATT HART HARTMEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO, CA92675 3O N GR R CAMPBELL (049) 493-1 171 ' unnmm JOHN (949) 493-1053 (FAX) _ mumnu IB61 GIL JONES 1776 DAVID M.SWERDLIN w CITY MANAGER GEORGE SCARBOROUGH March 27, 2000 Mr. Baron Farwell, Manager All City Management 1749 S. La Cienega Blvd. Los Angeles, CA 90035 Re: Renewal of Workers' Compensation Certificate of Insurance (Crossing Guard Services Dear Mr. Farwell: The Workers' Compensation Certificate of Insurance, regarding the above-referenced service, is due to expire on April 1, 2000. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. Please forward an updated certificate to the City of San Juan Capistrano, attention City Clerk's office, by April 10, 2000. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Lt. Rick Stahr p1U0 USE IS San Juan Capistrano: Preserving the Part to Enhance the Future SUNDE A N I N S U R A N CSERVICES, INC November 5, 1999 Cheryl Johnson, City Clerk City of San Juan Capistrano 32400 Paseo Adlando San Juan Capistrano, CA 92675 Re: All City Management, Inc. Policy No. L7134251 09-14-99 TO 09-14-00 Dear Cheryl: Please be advised that the Certificate of Insurance that was issued to you by All City Management is incorrect. The City of San Juan Capistrano is an Additional Insured, however at this time there is no per project aggregate. If there are any questions, please do not hesitate to contact me. Sincer y, A Holly A. l Extens Lk 02 Ltrld 30744/ i19624/d21943 j ff CD VT=� CA) � m N < �y'T�31 J RJ v o g 3021 Citrus Circle, Ste #220 Phone (925)942-4020 Walnut Creek, CA 94598-2691 Fax (925)942-4021 f�G�RD_ CERTIFI . TE OF LIABILITY INS ANCE ^i ..'. .. 10/13/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lie #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. f:olorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 COMPANIES AFFORDING COVERAGE Michael T. Curry COMPANY Phrn.Nn. 626-449-3870 FUNu. 626-449-5268 A United National Insurance Co. INSURED COMPANY B Diamond State Insurance Co. All City Management, Inc. COMPANY $aron Farrell C Zurich Compensation Insurance 1749 South La Cienega Blvd. COMPANY Los Angeles CA 90035 D COVERAGES d THIS IS TO CERTIFY THAT 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PND CLAMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MWDDIYI) DATE(MMID YM GENERAL LIABILITY GENERAL AGGREGATE $2,00-0,00-0 A X COMMERCIAL GENERAL LIABILITY L7134251 09/14/99 09/14/00 PRODUCTS-COMPIOPAGG $ 1,000,000 CLAIMS MADE OCCUR PERSONAL I ADV INJURY $ 1,000,000 X OWNERS$CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any a Ns) $ 100,000 MED EXP(Any o P«wn) $5 000 AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Pr,P�) $ HIRED AUTOS BODILY INJURY NOWOWNED AUTOS (PA, dent) $ PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE s 4 000 000 $ X UMBRELLA FORM CUOOS3076 09/14/99 09/14/00 AGGREGATE s4,000,000 OTHER THAN UMBRELLA FORM Is WORKERS COMPENSATION AND I WC STATUER - EMPLOYERS LIABILITY 'RY IM ITS EL EACH ACCIDENT $ 1000000 C THE PROPRIETOR/ INCL WBN687SOA 04/01/99 04/01/00 EL DISEASE-POLICY LIMIT $ 1000000 PARTNERSIEXECUTIVE OFFICERS ARE EXCL EL DISEASE-EA EMPLOYEE I S 1000000 OTHER C=) n —y L DESCRIPTION OF OPERATIONSILOCATIONSIVEHIQESISPEOAL ITEMS A 10 Day Notice of Cancellation will be given for Non-Pacent of Premium. Names a Ci and the Community ymen - m tv ty Bedevelopment Agency, iEa Bleated or — appointed of Mears, officials, employees anfld volunteers an as additional insureds as their interests may appear. Per project aggregate limits apply.' ., 0 CERTIFICATE HOLDER CANCELLATION .. CITYSJC ...'SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA�BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of San Juan Capistrano Cheryl Johnson, City Clerk BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 32400 Paseo Adelando OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPRE A Michael T. ACORD 2SS(1195):: " ACORQ'GORPO DN 198E is (The attaching douse need be(mpMW only when rrda twonemenn la issued ubmquwn to preparatlon of the poky,) This endorsement, effe CIW 09/14/190 at 12:01 a.m. standard time, forms a part of POIICy 4t: L7134M o Issued to: Ali city wagiamant,Inc. m n -- rn By: United National Insurutce Campany � < a THIS ENDORSEMENT CHANGES THE POLICY, PLEASE REAP?IT CARHFULL.Y ADDITIONAL INSURED- ENDORSEMENT This endorsement modit Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVEMGE PART WHO IS AN INSURED(SECTION II) Is amended to Muds the person or orgarkstlon shown In the Schedule below,but only as respecta kablity Imposed or sough to be imposed on atilt additional insured because of an alleged act or omtsdon of the named lnumW. 1. ff liability for In)ury or damage Is Imposed or sought to be Imposed on the additional insured because of: a. Its own acts or omissions,this insurance does riot apply: b. Its ads or omitsiom and those of the named Insured, as to defataa of the addhlonat insured, ibis insurance Will act as coinsurance with arty other Insurance avallable to #w addltloml Insured. in proportion to the Ihnits of liability of all Involved policies,and the Other insurance provisions of this policy (SECTION IV - CONDITIONS) are emended accordingly. However, this Insurance does not apply to Indemnity of the additornal insured for its own acts or omissions. 2 It an agreement between rhe named Insured and the addtdonal insured prwlding Indemnity or contribution In favor of the addiuorW Itntured eodats or to alleged to exist, the extent and scope of coverage under this Insurance for the additlorel Insured wilt be no greater than the ®mann and Scope of indemnifewon of the addit tW Insured which Mas agreed to by the named Insured. 3. The naming of an additional Insured will not increase our)itnt of Ilabllty., SCHEDULE Name of Parson or OraaD=,n(Addeional Insured) Premium CITY OF SAN JUAN CAPISTRANO, ITS OFFICIALS, EMPLOYEES & AGENTS CHERYL JOHNSON, CITY CLERK S 32400 PASEO ADELANTO SAN JUAN CAPISTRANO CA 92675 ntastgnaturs SL-12(2/en � 1 t 1 OCT-12-99 16 = 54 FROM=CURRY INS.629-449-5266 ID- PAGE 2/2 (Theatbdit CkLft nerdbsa=piphado*rdfanvfitendorsern8abrIrauearawgtnrNtopnrpmHonarhMAOo�Y•1 Thief wxkvsaMal%etfEebq 00/14/1999 at 12,01 a.m. Startdard thee,form a part of PONCY#.- L7134251 Issued ta: AA c Inv MeriigolneM inc, By: united 6latlaW 4taaarrce Car ;mlf THIS EN00RSEMENT CHANM THrPOLICY. PLEASE HEAD IT CAREFULLY ADDIrONAL INSURED- EMDORSEMEN'T Tres enaOMMant modleg kesfua0ce p uMW under fie b w kV GO W BUAL GENERAL LIARUTY c OVMkW PART WHD iS AN INSURED (SECTION IQ Is W=Wgd tc tifclede the person or 010N ration clown Ih the Schedule hdow,hs only as tra)eets FabsKy Inpowd or sought to be bTmed on arch addoonal Insured because d an aAeged as oronucdon of fie named kaunxi. 1. tf INNIty torinflty or dan age lakhppsad ar soLtoht to be I nlposed an rtha eddttmal irfafiad t)aCAt1Se t1f. A h6 O m Ocb Or Umla err,,this bfsuranm does rlotap* b. Its " or amitalan: and those of ft rlamed buured, as to detonw d the addhiafal wewea, aft I� " act as cotrse nce .vn cry other inswance &Aftble to tiw additional insured. in PlOWIan 10 Ile lk is 1Y kbW d al kwoFM poWeN and the:Odw insurance MvWons of ads pd-ny (SECTION N- CO rATIC" erg artwndgd tndarnTAroftheadOitonalWuredForitsherrnacesorourifsslone � However, the insexance does not appy to 2 It an*{Tasman between the named hrehxed and dle add-Jorml kmved provkAng tndamr>ny or contrlbotion In lawn tit the&Mftnal haaued eiders or Is a%iged nd to edst the WWI ascope of coverage under t11k Insurance for the eddldoral Inured wI be M greater rlmlr the wftt and Wope d iWarrolloglon d the addtticrud Ir su rad wMch%as agreed to by the named bmured. 3. Tha rmning d an sddf mW Insured wt not Ifcreetse ourima of uabiRty.. SCHEDULE Kim af Person or Orgflnt4R(Additional I P CITY OF SAN JUAN CAPISTRANO, ITS OFFICIALS, EMPLOYEES & AGENTS CHERYL JOHNSON, CITY CLERK s 32400 PASEO ADELANTO SAN JUAN CAPISTRANO CA 92675 uftarergnahss SL-12 0!/e7} Fax Name: Irma Organization: All City Management Fax: 310-202-8325 From: Cheryl Johnson Date: 10/12/99 Subject: General Liability Endorsement Pages: 2 Comments: The City needs a General Liability Endorsement Form naming the City as an additional insured. A sample General Liability Endorsement Form is attached. A faxed copy will suffice to show the coverage and release your check, but we do require receipt of the original certificate. From the Desk of Cheryl Johnson,City Clerk City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano,CA 92675 (949)443-6308; fax(949)493-1053 Sample Endorsement 4 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY ITHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE IName of Person or Organization: 1 0 v of XYZ, its officials, employees and agents (if no entry appears above information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) 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. I CG 20 10 11 85 Copyright, Insurance Services Office, Inc. 1984 CSR say DATE(MM DOY� AcORD CERTIFIC TE QF LIABILITY INS _ ANGE ALLCI-1 09/16/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic #0588757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 COMPANIES AFFORDING COVERAGE Michael T. Curry COMPANY Phone No. 626-449-3870 Fw No. 626-449-5268 A United National Insurance Co. INSURED COMPANY B Zurich Compensation Insurance All City Management, Inc. COMPANY Baron Farwell C Diamond State Insurance Co. 1749 South La Cienega Blvd. COMPANY Los Angeles CA 90035 D COVEFtAGE6 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REOUIREMENT,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 E SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY EFFECTIVEMILIMITS GENERAL LIABILITY GENERAL AGGREGATE s2,000,000 A X COMMERCIAL GENERAL LIABILITY L7134251 09/14/99 09/14/00 PRODUCTS-comp/op AGG $ 1,000,000 CLAIMS MADE OCCUR PERSONAL B ADV INJURY 51,000,000 X OWNER'S 6 CONTRACTORS PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one Sre) $ 100,000 MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE UMIT s ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY s NON-OWNED AUTOS Per so"Iwo PROPERTY DAMAGE s GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT s AGGREGATE s EXCESS LIABILITY EACH OCCURRENCE s4,000,000 C X UMBRELLA FORM CU0053876 09/14/99 09/14/00 AGGREGATE s4,000,000 OTHER THAN UMBRELLA FORM s WORKERS COMPENSATION AND WCA EMPLOYERS'LIABILITY TORY OMITS I I ER EL EACH ACCIDENT $ 1000000 B THE PROPRIETOR/ INcL NW68750A 04/01/99 04/01/00 ELDISEASE-Poucy 1000000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL I EL DISEASE=EA EMPLOYEE 11000000 OTHER rn -T I rn ro rn DESCRIPTION OF OPERAnONS/LOCATKNISNEHICLESWECUL ITEMS A 30 Day Notice of Cancellation will be given for Non-Pa nt of Premium. Names The City and the Community Redevelopment Agency, its elected or -- appointed officers, officials, employees and volunteers an asdditional LO insureds as their interests may appear. Per project aggregate limits apply. CERTIFICATE HOLOER CANCELLATION CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MNL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Dawn Schanderl Dof San Juan Capistrano BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Dawn 32400 Paseo Adelando OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE Michael T. Curry ACORp 25.8(7/9S) ACOAD Go POitATfoN 49!! • �Sa„ 32400 PASEO ADELANTO MEMBERS OF THE CITY COUNCIL SAN .JUAN CAPIST RANO, CA 92675 ? COLLENE CAMPBELL mta�nmo JOHN GREINER (949) 493-1171 WYATT HART (949) 493-1053 (FAX) Inuusm 1961 GIL JONES 1776 DAVID M.SWERDUN September 7, 1999 •� • CITY MANAGER SCARBOROUGH Mr. Baron Falwell, Manager All City Management 1749 S. La Cienega Blvd. Los Angeles, California 90035 Re: Renewal of General Liability Certificate of Insurance and Endorsement Form (Crossing Guard Service) Dear Mr. Farwell: The General Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on September 14, 1999. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. The agreement requires a general liability endorsement form naming the City of San Juan Capistrano as an additional insured. I have included the City approved endorsement form to submit to your insurance company; however, your insurance company may provide their own endorsement form. Please note that the comprehensive general liability with a combined single-limit should not be less the $5,000,000 per occurrence for property damage and for bodily injury as per requirements of the original agreement signed August 2, 1993. Please forward the updated certificate and the endorsement form to the City, attention City Clerk's office, by the above due date. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. �V�eryry�trruu�llyy��yyoours Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Lt. Rick Stahr DRUG USE IS San Juan Capistrano: Pre serving the Past to Enhance the Future acoRv_ ICE-kTIFIC QF LIABILITY �NSUFONGEC$R 9M-i °"'x03 31/9""31/9' . . ... ALLCI9 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISUCurry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lia #0598757 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 489 E. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 COMPANIES AFFORDING COVERAGE Michael T. Curry COMPANY Phw No. 626-449-3870 F.No. 626-449-5268 A Zurich Compensation Insurance INSURED COMPANY � B a _ N All City Management, Inc. COMPANY - ]Baron rarwell C _ ... 1749 South La Cienega ]Blvd. COMPANY — Los Angeles CA 90035 D w COVERAGES a THIS IS TO CERTIFY THAT 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 TOOA6MCH TENS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE-RRMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAR)CLAMS. CO TYPE OF INSURANCE POLICY NUMBER POUCYEFFECTIVE POLICY EXPIRATION UMIB LTR DATE(MMIDDAY) DATE(MMA)ONY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGG f CLAIMS MADE OCCUR PERSONAL b ADV INJURY S OWNER'S 6 CONTRACTORS PROT EACH OCCURRENCE $ FETE DAMAGE(My aM fn) $ MED EXP(Any oeu psnon) f AUTOMOBILE UABILITY ANY AUTO COMBINED SINGLE LIMB f ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (PK Psncn) HIRED AUTOS BODILY INJURY NON-0WNED AUTOS (P«k veno S PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT f ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE f EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM f WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS UABILITY TORY LIMB PER EL EACH ACCIDENT f 5000000 A THE PROPRIETOR/ INCL NW-68750–A 04/01/99 04/01/00 EL DISEASE-POLICY LIMIT s1000000 PARTNERSOEXECUIIVE OFFICERS ARE EXCL I EL DISEASE-EA EMPLOYEE $ 1000000 OTHER DESCRIPTION OF OPERATIONSILOCATONSNEHrLESSPECUIL ITEMS A 10 Day Notice of Cancellation will be given for Non-Payment of Premium. CERTIFICATE MQ ©ER CANCELLATION COFSANJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of San Juan Capistrano Lieutenant Paul Sullivan BUT FAILURE TO MNL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 32400 Paseo Adelantoo OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. IVE San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE Michael T. Cur / ACOttb 2$.S(1/96)'. OQR[t�£17itpORAt988 '-. / MEMBERS OF THE CITY COUNCIL 32400 PASEO ADELANTO IIL�\ I7J SAN JUAN CAPISTRANO,CA 92675 LJ L/ JOLLENECAMPBELL OHNR (949)493-I 171 �j iuuvruno WYATT HART HART (949)493-1053 (FAX) annuw 1961 GILJONES 1776 DAVID M.SWERDLIN �w CITY MANAGER GEORGE SCARBOROUGH March 22, 1999 Mr. Baron Farwell, Manager All City Management 1749 S. La Cienega Blvd. Los Angeles, CA 90035 Re: Renewal of Workers' Compensation Certificate of Insurance (Crossing Guard Services) Dear Mr. Farwell: The Workers'Compensation Certificate of Insurance,regarding the above-referenced service, is due to expire on April 1, 1999. In accordance with your agreement,the insurance certificate needs to be renewed for an additional period of one year. Please forward an updated certificate to the City of San Juan Capistrano, attention City Clerk's office, by April 1, 1999. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Lt. Rick Stahr, Police Services opuo uaE n San Juan Capistrano: Preserving the Past to Enhance the Future ................ th[SIUTAN ..... ..... ........ ................ NRIUE DATE (MMIDDNY) ......... .... IF a 0 RT CA �O F: 10/2 /199 0 0� ..............-2 �x PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE LFC Insurance DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 113 N. San Vicente Blvd. , #301 POLICIES BELOW.........................-.................. Beverly Hills, CA 90211 COMPANIES AFFORDING COVERAGE (213) 655-9999 Fax(213) 655-0578 C= .......... ........................... COMPANY A Scottsdale InsuranceComp LETTER "y ................... - — ...... COMPANY B INSURED LETTER IV fTl ........................... All City Management, Inc. COMPANY LETTER C Qj 1749 S. La Cienega. Blvd. . ................-_.-....... ....................................... .................... Los Angeles, CA 90035 CO"'A"Y D LETTER ca .........................—- .......... .................... ......... COMPANY E LETTER �777FF I.T 7 'W 01 M. THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ........................................... ......................................----...........................----..........-....---......I.....I................ . ................. LTR DO TYPE OF INN)RANCE POLICY NULLBER POLICY EFFECTIVE POLICDATY EXPIRATION LNM DATE (MU?DDNY) E(MMA)DA-Y) .................................................. ............ .. ... ...... GENERAL LIABILITY GENERAL AGGREGATE s 200000000 x COMMERCIAL GENERAL LIABILITY CLS0559832 PRODUCTS-COMPrOP ADD. ................. CLAIMS MADE X OCCUR . INJURY 09/14/98 09 14 9 9,"E""M&ADV- 1"0000000 OWNUM&CONTRACTOR'S PROT. EACH OCCURRENCE 1,0000 000 FIRE DAMAGE(Any me) $ 100,000 MED.EXPENSE(My oria par,im).11 ............................................................ ............. ............. AUTOMOBILE UAIIHUITF COMBINED SINGLE LIMIT 1,000,000 A ANY AUTO CLS0559832 ALL OWNED AUTOS 09/14/98 : 09/ 14/99 GODLY INJURY SCHEDULED AUTOS (Pei person) ............ X :HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per acedwo ................ ....... GARAGE LIABILITY PROPERTY DAMAGE S .............. ................. EXCESS LIABILITY EACH OCCURRENCE i.UMBRELLA FORM AGGREGATE ......... ... ........... ........ ................. OTHER THAN UMBRELLA FORM WORKER'S COMPENSATOR STATUTORY LIMITS AND EACH ACCIDENT DISEASE-POLICY LIMIT UWWVERS'LMUNUTY DISEASE $ OTHER DOCRIPTION OF OPIERAYNNNSLOCATION&NIENICLEGROPECIAL DEW The City and the Community Redevelopment Agency its elected or appointed officers, officials, employees and volunteers are Additional Insureds. General Liabili a re ate a lies " er location F t74 1.77.F77r7 .. .7 �M. .. ..... ... ........... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE City of San Juan Capistrano LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO 013UGATION OR Attn: Dawn Schanderl LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 32400 Paseo Adelando —AUTHORGED REPRESENTATIVE San Juan Capistrano CA 92675 AGGRO 2 OCT 28 '9B 09:54 FR LFC INS LIC 40608239 V3 655 0578 TO 19494931053 P.02/02 ✓'^AT: M 4 ib G,G &�/1/'IQI'OSS I R ,{ - rN {N rY ♦ 1 ypriral �1Yr Lb't 4YA+v ':. NfuE MTE MMNOT') Y4%t T YiP'Fr I p1' �.+,^. it1.�:4Q Ywf.I��T 1�.: .:t .,r Gn 3�1!p-e.GYiGQ�� .l�i)i�ir.. �l�r. ��.,ILrYt PSPY.JY:VMd1atiL,C: 10/28/1998 PI)BDLTca THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION ONLYCONFERS NO RIGAND IS CERTIFICATE LFC Insurance DOES NOT &MEND.EXTTEENC OREALTER THECA TCERTIFICOVERAOE HOLDER. AFAFFORDED BY THE 113 N. San Vicente Blvd_, #301 POLICIES RFLOW. Beverly Hills, CA 90211 COMPANIES AFFORDING COVERAGE (213) 655-9999 Faz(213)655-0578 A Scottsdale Insurance Company _ _ coNPANr 9 N911Am LtT101 All City Management, Inc_ COMPANYC LIS 1749 S. LCienega Blvd_ LETTER Los Angeles, CA 90035 CO~ D I.EnER COMPAM' E r1.v JG YS'. Y{Y�t1AY'ii L4A'J�uu�.Y'�.�..{f'T iwTt l�iAAiYf'Y,. .�.R.�.tTI.Y�H.I IX�in is C�� rn_I.vt�„*iM�,y"�Z',�I.f'f rx%m.riA444G 9'!v�4(KG!l .l: x vYTJ�Yit�1M% THIS IS TO CERTIFY THAT THE POLICIES OF INSUlUIVCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ALTOVE FOR THE POLICY FLROD~ INDICATED, NOTWITHSTANDING ANY REOUIREMEWT, 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 SUBIECT TO ALI THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PND CLAIMS. 00 TY![OF R]MCY MIINFly P Y�Mr.^�TMWIE� 'POMCT p ATIOW IJLIMITSLMI. AMIIRIAIICt DATE 0"V O YI MTC(MAMCP”) .......... _. ............. ........ A apwRAL UA.anr OLWRAx AWRFQATE s 2, 000,000 z `cDAPIA rcw GE.ProA UAWNY CLS86506A PMOOUCTSCOMPATP AOO s 14,900#000 -- CLAW MADE % OCCUR. 09/14/98 09/ 14/99 puma"." A°9�"'xm : 1,000,000 ORT1 ACONTRACTORS PROT. - u,pIOCCUMVIAW :i 1,e.QOO,DOO FTE DAAANk Pvp'>.6.) A 106,000 -..... MED.DVTMW (A^I W P..).3 AMTOINOI�TOPIBY cLSOSBB632 LCO NED SWILL A 's 1,000,000 ---- ALL ONNMAUTOS .09/14/96 09j14/99wniLy T SCHEOULM AUTOS (PW p.rAn) i ,..X "MED AUTOS - KO LY Aum i NONOWNLO AUTOS lPa Mr�oMN nAKAGE LVELRY P%PFRTT DAMAGE 'i ....... ......... .._... .........._.. ... -i=En LIABETTY EACH OCwf� ! uNBiELLA FOTM AOOTEOATE i OTIEA THAN UMOFALLA FORM WOATODPA COMPU MTom - STATUTORY LAA7S .EACH ACCIUUW AND ITIiFA�F POLICY LMO j EIROYNAI'LAMIR Y ............ ......... DISEASE-FACH DIPLOVM 'A ....,01101 PEfol/INN OF OTN1A1110100CJJ7101gRY A9l> CIAO ffeN The City and the Community Redevelopment Agency its elected or Ippointed officers, officials, employees and volunteers are Additional nsureds. General Liabill a re ate a lies "Bar location ro 'aot•'_ Aa— M, SHOULD ANY OF THE AEIOVE DESCRIBED POLICIES OF CANCELLED BEFOR THE ' "PIRIAIION DATE THEREOF. THE ISSUING COMPANY WIO ENDEAVOR TO MAIL 30 DAYS WRITTEN NODCL TO THE CERTIFICATE HOLDER NAMFD TO THE City of San Juan Capistrano LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Attn: Dawn Schanderl : LIABILITY OF ANY KIND UPON ME COMPANY, ITS AGENTS OR REPIIESENTAMWES. 32400 Paseo Adelando ';'luIT11011®BE,11E6ElMTATIK San Juan Capistrano CA 92675 -10W ,... ** TOTRt PRIiI .0J ** LIABILITY ENDORSEMENT l CITY OF SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Juan Capistrano,California 92675 ATTN: A. POLICY INFORMATION Fndas®cart# 1. Insurance Comp Scottsdale Ins. Co. ;Policy Number CLS0559832 2. Policy Teem(From) 9/14/18 (fo) 9/1 4 /99 ;Endorsement Effective Date 9/14/98' 3. Named Insured ALL CITY MANACEPIENT,_ INC. 4. Address of Named Insured 1749 S Ta Ci an an? L AngalPc , CA 90035 5. Limit of Liability Any One Occurrence/Aggregate$ 1 n n n n n 0 / 2 ,n n , 0 n n General Liability Aggregate(Check one:) Applies"per location/project" X Is twice the occurrence limit 6. Deductible or Self-Insured Retention(Nil unless otherwise specified): S2 , 500 De d. 7. Coverage is equivalent to: Comprehensive General Liability form GL0002(Ed 1/73) X Commercial General Liability"claims-made"form CG0002 8. Bodily Injury and Property Damage Coverage is: "claims-made" "occurrence" If claims-made,the retroactive date is B. POLICY AMENDMENTS This endorsement is issued in consideration of the policy premium- Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto,it is agreed as follows: 1. INSURED. The City and the Community Redevelopment Agency,its elected or appointed officers,officials,employees and volunteers are included as insureds with regard to damages and defense of claims arising from;(a)activities performed by or on behalf of the Named Insured,(b)projects and completed operations of the Named Insured,or(c)premises owned, leased or used by the Named Insured. 2. CONTRIBUTION NOT REQUIRED. As respects:(a)work performed by the Named Insured for or on behalf of the City,or(b)projects sold by the Named Insured to the City,or(c)premises leased by the Named Insured from the City,the insurance afforded by this policy shall be primary insurance as respects the City,its elected or appointed officers,officials, employees or volunteers;or stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. In either event,any other insurance maintained by the City,its elected or appointed officers,officials, employees or volunteers shall be in excess of this insurance and shall not contribute with it. "3. SCOPE OF COVERAGE. This policy,if primary,affords coverage at least as broad as: (1) Insurance Services Office form number GL0002 (Ed. 1/73), Comprehensive General Liability Insurance and Insurance Services Office form number GL0404 Broad Form Comprehensive General Liability endorsement;or, (2) Insurance Services Office Commercial General Liability Coverage,"occurrence"form CG0001 or"claims-made" form CG0002;or, SEP 2 3 1998 (3) If excess,of ^ s coverage which is at least as broad as the pri f insurance forms referenced in the preceding sections(1)wid(2). 4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to each insured who is seeking coverage or against whom a claim is made or a suit is brought,except with respect to the Company's limit of liability. 5. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the City and the Community Redevelopment Agency,its elected or appointed officers,officials,employees or volunteers. 6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspended,voided,cancelled,reduced in coverage or limits except after thirty(30)days'prior written notice by certified mail return receipt requested has been given to the City. Such notice shall be addressed as shown in the heading of this endorsement C. INCIDENT AND CLAIM REPORTING PROCEDURE Incidents and claims are to be reported to the insurer at: ATTN: Sharon Hayden Claims Dent. (Title) (Department) LPC Insurance (Company) 113 N . San Vicente Blvd. (Street Address) Beverly Hills, CA 90211 (City) (State) (Zip code) (213) 655-9999 (Telephone) D. SIGN•TURE OF INSURER OR AUTHORMD REPRESENTATIVE OF THE INSURER L Terry T uman g (pnndtype name),wasant that I have authority to bind the below listed insurance company and by my signature hereon do so bind this company. SIGNATURE OF KUTHORIZED SENTATIVE (Original signature required on endo ent fiunished to the City) ORGANIZATION: LFC Insurance TITLE ADDRESS: 113 N San Vicente B1 Beverly Hills , CA TELEPHONE: 213-655-9999 AUG 07 '98 14: 16 FR LFC INS LIC U0608239 323 655 057H in 19494931053 1,.01/W) LF �ee BROKERS bAGENTS/113 NO SAN VICENTE BOULEVARD,SUITE 301/BEVERLY HILLS,CA 90211 (213)655-QM 1 FAX(213)8550578 M E M O R A N D U M DATE: August 7 , 1998 TO: Dawn M. Schanderi, Deputy City Clerk CITY of SAN JUAN CAPISTRANO Community Redevelopment Agency 949-493-1053 FROM: Michael P. Checca / 213-951-4711 vvtq-=� RE: Crossing Guard Services/ ALL CITY MANAGEMENT (ACM) As you know, ACM's commercial liability policy is coming up for renewal on 9/14/98. Wanted to inform you that the current insurer, GENERAL AGENTS wants to attach GL 102 (05/92) (see attached) to clarify its coverage provided under the City's LIABILITY ENDORSEMENT. Considering the nature of the scope of operations for the crossing guard services, the GL 102 (05/92) is not injurious to the City. Also, the City of Laguna Hills has agreed to the attachment of the GL 102 (05/92) . Will call you to discuss. Thanks! ! cc Baron Farwell/ ACM 4 pages to follow doc acmB.7 tL AS Aat4 AUG 07 '98 14: 16 FR LFC INS LIC 906OB239 323 655 057B TO 19494931053 P.02i0S • 0 Cr L. 102_ (D5 /a-,- ) POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT RESTRICTS THE POLICY. PLEASE READ IT CAREFULLY. CHANGES IN COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement modifies insurance provided under the following.- COMMERCIAL ollowing:COMMERCIAL GENERAL LIANLITV COVERAGE PART DEDUCTIBLE LIABILITY INSURANCE A $250 per claim dedi critib will apply under the Pfaperty Danns" Liability Coverage to all damages because of "propaRY damage sustained by any one person or organitation as the result of any ort oCczrranim. Our ebftmn Wider Property Damage liability Coverage to pay damages an your behalf applies only to the ave ouniz of damages in excess of the deductbld amount. and the limit of innrence applicable to each occurrence will be reduced by the aaht of the deductible. To settle any claim or 'suit' we My pay a0 or any part of the deductible and upon notification of the action taken you shall promptly reimburse us for such part of the deductible as has been paid by us. no terms of this insurance apply irrespective of the application of the deductible. including those with respect to our rioht and duty to defend any -suits' seeking those damages and your duties in the event of an 'oecuffericir .. claim or 'auk'. EXPECTED OR INTENDED INJURY EXCLUSION This insurance does not apply to and no duty to defend is provided by us Mr 'bodily injury' or 'property damage' ruing from an intentional act whether or not the resultant 'bodily injury' or 'property damage' was; intended or xpeCted from the standpoint of the ipsured. This exclusion does not apply to 'bodily injury' n isiuI&g Rom the use if reasonable force to protect persons or property. LIQUOR LIABILITY EXCLUSION This insurance does not apply to and no duty to defend is provided by us for'bodily brjury' or'property damage' for which any insured may be held liable by reason of_ 1. Causing or eantnibudi to the intobdcadon otany person: 2.The furnishing of alcoholic beverages to a person under the legal drinking age at under the itRuenoe of alcohol: or 3. Any statute. ordinance or regulation relating to the sales. gHt, disvibution or use of alcoholic beverages. This exclusion applies only if you: I- Manufectuns. seg at distnUm alcoholic beverages: 2. Save or famish alcoholic bewrpea far a charge whether or rot such actin w: las Repuires a license; Ibl Is for do purpose of feunafal pain or ivelilmod:or 3. Serve or furnish alcoholic beverages without a charge. if a license is requi for such activity. CLASSIFICATION NOT SCHEDULED EXCLUSION This insurance does not apply to and no duty to defend is provided for 'bodily injury'.-prom"damage'. 'perw-Wo injury'mr'advartiaim inlury' arising out of any classircii6onlsl —hick is carol not sci+.duled in die Commercial General utility Coverage Part Dedaradons egd for which you have not paid a premium. NEW ENTITIES EXCLUSION Pert a_ of SECTION II-WHO IS AN INSURED does not apply. General Agents Insurance Company of Armies, Inc. M tnlrncinll MGA lnrumnoe Comoa , Ine- Pape 1 of 4 900/C00® NONIZM • 69I'I11 SSZ9 OTC OTC& LT!OT WLT/OO RUG 07 190 14:17 FR LFC INS LIC U06OB239 323 655 0570 TO 19494931053 P.03i0`� TOTAL POLLUTION EXCLUSION This insurance does not apply to and no duty to defend is provided by us for: 1. 'Bodily injury' ne 'Property damage' which would not have occurred in whole or part but for the actual, alleged or threatened discharge, dispersal, seepage, migration. or release or escape of pollutants at any time. 2. Any loss, cost or expense arising out of any: " (al Request,demand Or order that any insured or others test for,moni00r,clean up. remove, Contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of pollutants: or Ibl Claim or 'suit" by or on behalf of a governmental authority for damages because of testing for. monitoring, Meaning up,removing, conUining, treating,detoxifying or nevtralizing,or in any way responding to.or aaemssing the effects of posutants, Pollutants means any solid. liquid, gaseous, bacterial, of r"rrmal Irritant Or contaminant including smote, vapor.&oat, fumes, acids, alkalis, chemicals and waste. Waste includes material to be recycled, recondidoned or rodalmod. PUNITIVE, EXEMPLARY, AND STATUTORY MULTIPLE DAMAGES EXCLUSION This insurance does not apply to a claim of or indemnification for any lass. cost or expertft for punitive or exemplary damages which are imposed by a court of law to punish a wrongdoer WWw to deter odtI from amnilar conduct. If a 'suit' is brought against any Insured for a claim falling within the coverages provided in this pokgy, smoking both compensatory enrol punitive or exemplary damages, then we will afford a defense to such action. We shall not have any obligation to pay for any cost, interest, supplementary payments. or damages attributable to punitive at exemplary damages. Further, if State Law provides for statutory multiple damage awards, we will pay only the amount of the award before the multiplier is applied For example, if a stag allows ttebte damages: If the basic award is 51.000, the Court may then multiply that amount by three, finaliizing the award at $3,000. We wilf pay tsubject to the Limit of Insurancel only the $1,000. You must pay the $2,000 award plus you will reimburse us for VOW deductible. EMPLOYMENT RELATED PRACTICES EXCLUSION This inayra ice does not apply to and no duty to defend is provided by us for claims, 'suits', accusations or charges or any loss, cost or expense for 'bodily injury'. 'personal injury', 'advertising injury' or 'property damage' arising out of any: 1. Refusal to employ: 2. Termination of employment, 3. Coercion, !emotion. evaluation, reassignment. discipline, defamation. harassment, humiliation, dscrim4metion or odrer employment related prectiems, policies, acts or omissions. or 4. Consequential 'bodily injury-. "property damage. 'personal injury" or advertising inryry' as d result of t through 3. Thus exclusion applies whether tete insured may be held lisble as an employer or in any other capacity and to ami obligation to share damages with or to repay someone at" who must pay damages because of the iniury- COMMUNICABLE DISEASE EXCLUSION This insurance does not apply to and no duty to defend is provided by us for deems, 'writs', amrsatiats or charges or any loss.Cost or expense arising out of"badly injury',"personal injury',•advarosirg Wary' or'peopwty damage" arising Out of the: I_ Transmission of a communicable disease by an insured or any employee of an insured: or 2. Failure to perform services which were either intended t0 or assumed to prevent communicable diseases or their transmission to others. PROFESSIONAL SERVICES EXCLUSION 'his insurance does not apply to "bodily Injury "Property damage, "personal Injury" or 'advertising injury' dun r•^ the rendering or failure to render any professional service. General Agents Insurance Company of America, Inc. GL102(051921 MGA Insurance Company, Inc_ Page 2 of 4 900/►0018 Noxbmm 7 SSI-Iff SSS! OTC OTCQ OUST 4e/LT/e0 AUG 07 '9e 14: 17 FR LFC INS LIC #0608239 323 655 0578 10 19494'731053 P.04/05 ABUSE OR MOLESTATION EXCLUSION This insurance does not apply to and no duty t0 defend is provided by us for claims. 'suits, acawtims or deegea Of arta 1093. Cost or expense for 'bodily injury'. 'personal injury-, -advertising iniury- or 'property damage- arising out of: 1. The actual or threatened abuse or molestation of any persons, or 2_ The negligent hiring.employment,placement. training,supervision,investigation,reporting to the proper sudnorides. or failure to report to the proper authorities, retention of a person for whom any insured is or ever was bgagy, responsible and whose conduct would be excluded by 1. above. Abuse and molestation includes but is not limited to any verbal or nonverbal communication, behavior,or conduct with Sexual connotations. infliction of physical,emotional, or psychological injury or harm whathw for sexual Gratification, discrimination,intimidation. Coercion,or Other purpose. regardless of whether such action or resulfkg ir*"is alleged to be intentionally er negligently unused. SUBSIDENCE EXCLUSION This insurance does not apply to and no duty to defend b provided by us for -bodily, k*xy'. 'property damage', 'personal iniwv' or"advan ising initW caused by, resulting from, attributable or contributed m,or aggravated by the subsidence of lanel as a result of landslide,mudhow, earth sinking or shifting, resulting from operations Of any unwed or any subcontractor of any insured. LEAD CONTAMINATION EXCLUSION This endorsement excludes occurrences at the insured promises which result in: I- -tiodily injury- arising out of the Ingestion, inhalation or absorption of lead in any form; 2. 'Property damage- arising from any farm of lead; 3. 'Personal injury- ansing from any form of kid; 4. 'Advertising "ury' arising from any form of lead; S. -Medical Payments' arising from any form of lead; 6- Any loss, cost or expanse arising out of any request, demand or order that any insured or others test for, monitor, dean up, remove. contain- treat, detexrfy or neutralize or In any way resoorld m, or assess the affects of lead. or 7. Any loss, cost or expense arising out of any claim or suit by or on behalf of a governav rital audtority for damages Wouse of testing for, removing, cleaning up. monitoring, containing. treating, detox hVing or neutralizing, or in any way responding to, or assessing the effects Of lead. ASBESTOS EXCLUSION This Insurance does not apply to and no duty to defend is provided by us for 'bodily lniury-. 'personal niury-. 'advertising iniury- or 'Property damage or any loss. cost at expense arising out of- t- Inhaling, ingesting or prolonged physical exposure to asbestos or goods or products containing asbestos; or 2. The use of asbestos in constructing or msnufecur ing any good. product or structure;or 3. The removal of asbestos from any good, product or stiuchwe; or 4. The manufacture. trans" omit n. storage, service. installation. use. sale. mining. Nstl6lRion. or disposal n' asbestos or goods or products containing aabantos. AMENDATORY ENDORSEMENT - CONTRACTORS - SUBCONTRACTED WORK I- you must keep Certifcates of Insurance on as for sly contractors or subcontractors perfomniiq work or operations for my 'nsund show ng that Commercial Gerwal Liabfidv insurance is in effect with rn9 nimum coverage and Smits epusl to the coverage and limits carried by you under this policy. 2. Audit premiums for your contractors and subcontractors for which you do not have Gadfleaas of Insurance will be developed by taking the cost of contracts against the appropriate PremiseslOpwatiao dasslffcstiwh and an sdditlonal premium will be charged. General Agents Insurance Company of America, Inc. 000/C000 '- Nt1NiiI9 3 SSI-Ig ^ ifZll OTC OTCQ et;S,1 I.0/LT/11 AUG 07 '90 14:17 FR IFC INS LIC U060M39 323 655 0570 Tn 19494931M° P.P"/0" BLANKET INTERMEDIATE CONTRACTUAL LIABILITY The definition of 'insured contras' in the DEFINITIONS Section is replaced by the followag unless the Contractual Liability Limitation Endorsement CG 1139 is made a part of this policy: -Insured Contract- means any written: 1. Lease of premises: 2. Easement agreement, except in connection with construction or demolition operations on or within 50 feet of a raur, 3_ Indemnification of a municipality as required by ordinance. except in connection with work for a municipality. 4_ Sidetrack agreement or any easement or license agreement in connection with vehicle or pedestrian private railroad Crossings at grade: or S. GMvator maintenance agreement. or S. That pan of any other written contract or agreement pertaining to Vow business under which yoe assume the tort liability of another to pay damages because of'bodily injury' or'property damage- to a third person or organization. N the contract or agreement Is made prior to the 'bodily injury- or -property damage-. However. tfih Insurance does net apply to that part of any contract or agreement that indemnifies my persan or OWAftellon for the .derrethee's soh tort liability. Tort liability means a liability that would be imposed by law in the absence of any other contract or aoreemem. An -insured contract' does not include that part of any contract or agreement. 1. That indemnifies an architect, engineer or surveyor for injury or damage arising out of: a. Preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys. changes, orders, designs or specifications; or b. Giving directions or inavuction, or failing to give them, if that is the primary ease of the injury or damage, 2_ Under which the insured- if an architect, engineer or surveyor, assumes liability for injury or demo"arising nun of the insured's rendering or failing to render professional services, including those listed in t. above and supervisory. inspection or engineering services: or 3. That indemnifies any person or organization for damage by fire to premises rented or loaned to you: or C That indemnifies any person or organization for injury or damage arising our of the ownership. maintanance, use er entrustment to others of any aircraft,•auto' or watercraft owned or operated by or rented or loaned to any insured or subconvactor of any insured- Use includes 'loading or unloading'. AMENDMENT OF SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS Part 9- When We Do Not Renew of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted OTHER INSURANCE (EXCESS COVERAGE) If other valid and collectible insurance is available to the insured for a loss we cover under Coveragss A or B of the Commercial General Liability Coverage Part, our obligations are limited as follows: s. primary Insurance This insurance is primary except when b. below applies. b. Excess Insurance This insurance is excess over any other insurance, whether primary, excess, contingent or an any oder basis. When this insurance is excess, we will have no duty under Coverage A or B to defend any claim or -ailit' diet any other insurer has a duty to defend. If no other insurer defends, we will undertake to an to. but we will he entitled to the insured's rights against all those other insurers. AMENDATORY ENDORSEMENT - PREMIUM AUDIT SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is charged as follows: 1. Part 5 paragraph b. of Pre"um Audit is replaced by the following: b. Premium shown on the Commercial General Liability Coverage Part Declarations as advance premium is a deposn premium Only. At the close of each audit period we will compute the earned premium for that period. Audit premiums ara due and payable on notice to the first Named Insured. 2. Paragraph d, is added to Part S. Premium Audit. d. The advance premium shown on the Commercial General Liability Coverage Part Declarations shall be the rninin.. . Premium for the policy period and is nonrefundable. General Agents Insurance Company of America, Inc. GL102I051921 MGA Insurance Company. Inc- Pape 4 of 4 gDo/g00I� NONIICTI9 y SS17e ssza sit pita WST La/LT/Bo Ah / P . STATE P.O. BOX 420807,SAN FRANCISCO, CA 94142-0807 COMPENSATION I N S U R A N C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE MARCH 31 , 1998 POLICYNUMBER: 1501059 - 98 CERTIFICATE EXPIRES: 4-1-99 F CITY OF SAN JUAN CAPRISTRANO DEPT OF BUILDING AND SAFETY/ATTN: ED GREEN 32400 PASEO ADELANTO SAN JUAN CAPRISTRANO CA 92675 JOB: INCEPTION DATE 4/1/98 L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. _ This policy is not subjecttocancellation by the Fund except upon tef lays'advance written notice to the employer. We will also give you TEEVdays'advance notice should this policy be cancelled prior to its normal expiration. XX This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER 'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1 ,000,000 PER OCCURRENC ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03/31/98 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. a .e t � c „1 EMPLOYER m I-� m ALL CITY MANAGEMENT INC m 1749 S LA CIENEGA BL LOS ANGELES CA 90035 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND STATE- COMPENSATIONHOLDERS ' NOTICF RTIFICATE I frV S U RpA�N O 81 r U 1 V ❑ ENDORSEMENT AGREEMENT - HOME OFFICE SAN FRANCISCO ALL EF°ECTIVE DATES ARE AT 12:01 AM PACIFIC - ---- -- STANDARD TIME OR THE ' TIME INDICATF2 AT PACIFIC STANDARD TIME ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THIS POLICY SH L.L NOT DL CANC:7- ,ED UNTIL: 30 DAYS AFTER WRITTEN NOTICE OF SUCH CANCELLATION HAS BEEN PLACED iN THE MAIL BY STATE FUND TO CURRENT HOLDERS OF CER'_'IrICAL_ Or WORKERS ' CO`:PENSATION INSURANCE. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EX _ NY C 1 ONIGR e I 0 Lc TA a F THIS POLIC 0 ,c T �,4 A FST' 1 OT c IN :S PO IC S r^ LLHELD T YA T VA R L d THES. I NS. EE!v S R LU.1L TATlO S HIS ORS'c 'T. 2065 =OUNTERSIGNEC AND ISSUED AT SAN FRANCISCO: P (Re AUTHORI7_D REPRESENTATIVE PRESIDENT pLp FORM S:E - NOV 25 '97 10: 10 FR LF[ [N5 LIC #0608239 213 655 0578 TO 17144931053 P.02/02 NOU 21 197 13:41 FR LFC INS LIC 220609239 213 655 0570 TO 17144931053 P.02103 LIABUXM ENDOR91SM6M CITY OF SAN JUAN CAPIS UANO COMMUNITY RXI)XVILOPM814T AGENCY 32400 Pasco Adedann San Juan Capistmao,California 92675 ATTN: sawn M_ SChanderi. A. POLICY INFORMATION Fndnsemomil 1. tinsurm=Compaoy General Agents Ins.Co. ;PolicyNumber GPP643132 2. PolicyTerm(Ftom) 9/14/97 (Co) 9/14/98 :E odmxmentEffectveDece 911 3- Named[nsmed Ar.T. rTTv MANAGEMENT ING_ 4. i.a tivnPy� T.na Angg� P9r CA_9Q035 S. Limit of Liability Any One OriwrcncdAgnyogste General Lability Aggregate(Check one:) Applies-per location*oject" is twice the occurrence limit 6. Deductible or W-Insured Retention(Nil unless otherwise specified): S _2 5 0 . 7. COQ is equival at to: Comprehensive General Liability form GL0002(Ed IM) X Commercial General Liability"claims-made"form C00002 a. Bodily Injury and Property Damage Coverage is: "claims-made" . Y "occurrence" If claims-made,the retroactive date is N/A B. This endorsement is issued in consideration of the policy premium. Notwith ending any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows: 1. INSURED. The City and the Community Redevelopment Agency,its elected or appointed officer;officials,employees and volunteers ate included as insureds with regard to damages and defense of claims arising tion; (a)activities performed by or on behalf of the Named Insured,(b)projects and compkeed operations of the Named Inured.or(c) premiss owned,leased or used by the Named Insured. 2. CONTRMEMON NOT REQUIRED. As respetn:(a)wort performed by the Named lmmmil fur or on behalf of the City;or(b)projects said by the Named limited to the City;or(c)promises]wed by the Named Innaed fine the City. the instance afforded by this policy shatI be primary insurance as respects the City.its elected or appointed officers. officink employers or volmetecrs;or shod in an unbroken chain of coverage excess of the Named Insumdrs scheduled underlying primary coverage. In either event any other insurance maintained by tie City.its elected or appointed offucm.officials,employees or volunteers shall be in excess of this inso canoe and shall not co m'buoe with it 3. SCOPE OF COVERAGE. This policy,if primary,affords coverage at least as broad as: (1) himirance Services Office fettm number GLOM(Ed. IM).Cwprebeni ive General Liability In7msmce and Insurance Services Office foam number GLO404 Broad Form Compmherts(ve General Liability Wdmsoment; or. (2) Insurance Services Office Commetcial General Liability Coverage.'oceurreow form CG0001 or"claims- made"form CG0002;or, NOV 21 '97 13:41 FR LFC INS LIC #0608239 213 655 0570 TO 17144931053 P.03103 (3) If ewesa,affords coverr p which is akkavt as broad as the primary instaa ice fotms referenced in the ptecediog sections(1)and(2). 4_ SEVERABII "OF MTERM 71e m mum afforded bydmply*Phm mp$nO ►y to each towed whoa salting coverage or against whom a claim is made or a suit is brought.except with respect to the Coropauv's limit of liability. 5. PROVDIONS REGARDING THE INSURED'S DUTIES AFTER ACCHIENT OR IHSS. Arty failure to comply with reporting provisions of the policy shall not affect oovaage provided to the City and the Comm"Redevelopment Agency-its elected or appointed Officers,officials,employees or volunteer]. 6. CA,NCUJ-.AXON MOTICE. The ntsumace aft"by this policy shall not he=Wmded voided,cancelled reducad in coverage of limits except after thirty(30)dayd prior wriam notice by certified mail.cram receipt req tried has baa given to the City. Such mace shall be addressed as shown in the heading of this mdmyaaant. C. INCID];,H't"An CIIAIM RRrORMG PROCIADUIt y Incidents and claims ate to be reported to eat issuer at: ATTN: Sharon Hayden Claims Dept. (Tick) (Department) L-PC Insurance (Company) 113 N _ San Vicente Blvd. , #301 (Street Address) Beverly Hills, CR 90211 (City) (State) (Zip code) (213) 655-9999 (Telephone) D. SIGNATURE OF RMURRR OR AUTRORiM RFJNMENTATIVF Og THK R1 gr(rtz t3 L Michael 0. Ch e c c a (pamAype name),want that I have araheaily to bind the below lisfed iaoce company and by my sigoturc hereon do so bind this company. SIONA OF OWIIDREPRESENTATIVE (Original signanae an codoratmeot famished in the City) ORGANIZATION: L"C 7nsurancP TITLE ADDRESS- 113 N_San 17ir`Pnt0, RaUP,r1y 9llgtr TELEPHONE; (2 13) 655-9999 NOU 25 197 10: 10 FR LFC INS LIC 9060P239 213 655 0578 TO 17144931053 P.01102 `` • 10 LF �ce BROKERS d AGENTS 1113 NO.SAN VICENTE BOULEVARD,SUITL301 I BEVERLY HILLS,CA 90211 (213)65&9999/FAX(213)955-0578 / FACSIMILE COVER SHEET TO FAX NO DATE: � / Pages attached: TO: al FROM: Terry Tumang Dir /Line 21 ) 951-4 RE: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - Cat CONPIDENf1AIlrY AGREE.NENr 7Tia fstatmile tranamseion and any iw wmpaayiag domments contain infotmatim betonyng to the condor whin+may be CONFIDI PMKL AND LEGALLY PRIVILEGED. Tlm mkwmatton a tnteaded ot[ly for the uae of the individual or entity to whom this famimilc naromio inn was sent m indimted above. If yon a.e not the intended recipient,any d"Imum.copying distribution,or action taken to teliaecc on the contents of the iofotnNtion contained in this romimile tnnsmiasion a Lrictly pmhtbited. If you have received this tmmmimion in error,please m6 rs m arrange for the mum of the documents. NOV 21 197 13:40 FR LFC INS LIC 90608239 213 655 0578 TO 17144931053 P.01/03 • -L/JF nOKEReee BROKERS b AGENTS f 113 NO.SAN VICENTE BOULEVARD,SUITE 3011 BEVERLY HILLS,CA 90217 (213)6555-9009 1 FAX(213)655-0578 FACSIMILE COVER SHEET TO FAX NO (1/4 Y73 , D F3 / DATE: �f' v— v Pages attached: TO: < Jan FROM: Terry Tumang Direct line (2 3) 951-4720 �— RE: 4Z#�rr �Am lwt p Al - - - - - - - - -� - - 1i/a1/g7 - - ce CONDI ENITAUTY AGREEMENT Ibis facumde ttansmisam and my accompanying documents contain inrotmation beloagm to the ander whirh may be CONFIDE'N77AL AND 1 E AI I Y PRIVILEGED- This udrimratioe is intended only for the t of the individual or entity to Mom this f mivaile tnnamman ass sent as indicated above. R you toe not the intended recipient.my disclosure,copying,distribution,or action token in telimee on the contents of the in1brmation contoined in this faccimile transmission is strictly pmbNted. If you have rel=ived this tranun moon us crtw,please call us to amnge for the return of the doev ncnts- Oil 9/16/19.9.6 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE LFC Insurance DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 113 N. San Vicente Blvd. , #301 POLICIES BELOW. ................................................................................................................................................................. Beverly Hills, CA 90211 COMPANIES AFFORDING COVERAGE (213) 655-9999 Fa8(213) 655-0578 .................................................................................................................................................................. COMPANY LETTER A Northfield Insurance Co. :....................................................................................................................................................................... COMPANY nplREo LEITEFI B Commer,gial Undervriters ...................................................... All City management, Inc. COWN^' C 1749 S. La Cienega Blvd. LETTER �a :....................................................................................................................................................................... Los Angeles, CA 90035 D i....................................................................................................................................................................... CCMPANY E LETTER �� ) Avo .111. c,>..>.o;C N>' THIS IS TO CERTIFY THAT 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 DCGUMENT 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, E)(CWSIONS AND CONDITIONS OF SUCH POLICIES. LIMITSSHOWN MAY HAVE BEEN REDUCED BY.PAIC CLAIMS. ......................................................................................................................................................................................................................................................................................................... POLIC LTTR: TYPE OF NByRANCE POLICY NUMBER DATEY(WWDD//M POLICY RAMIDYJ O � LW~ ...........................................................................................................................................:...........................................................................----............................:....................................... A,;,GENERAL LJABEJR' GENERAL AGGREGATE :s 1.1.000,.0.0,0 $ COMMERCIAL GENERAL LIABILITY CP311467 PRODUCTS40MPMP AGO. i Incl. .................. -._....! CLAMS MAGE S .;OCCUR. ., ......._. ... ... ....................................... 09/14/96 : 09/14/97 P"3ONN 61° Mur+r_. 1,000,000 OWNERS sCONTRACTORS PROT. EACH OCCURRENCE + 1.,.000,_000 FIRE DAMAGE(Airy ens r... s 25,000 MED.E)PENSE(Arry w Porn l_3 1,000 ............................................................................................................................................::.......................................................................................................................................................... AUTOMOBEL LIABLITY CCMBkIEO SINGLE $ ._...:ANY WTO ;LMR L....._.' ........._._................_................. ALL OWNED AUTOS GODLY HAM i3 i SCHEDULED AUTOS (Per T»fCR) _...................................................... ........i HIRED AUTOS GODLY HAIRY 3 i NON-OVA ED AUTOS (Par=k Wo :........y GARAGE LIABLRY PROPEITTY DAMAGE i3 .....::........i............................................................................._._.................................._.....;.................._._.......... ....................................................................................................................... ExcELs LIABILITY EACH OCCURRENCE 000,000 j UMBRELLA FORM CEL013925 !09/14/96 09/ 14/97 AGGREGATE >s, 4t000�00.0 OTHER THAN UMBREDA FORM .._..... WORLFAYI COIiENGTDM.... .._.. .... _....... ....... STATUTORY LMfTS . ....... . . .... . . ................. .. AND : EACH ACCIDENT __.... 3 DISEASE-POLICY LMT :3 O/LOVENO'LIABILITY DISEASE-EACH EMPLOYEE 3 OTNm M m c OESC CertiOF ficateAholdderr is an "Additional Insured" as their interpgW rn may appear. = {, N M xr m Am SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED�E THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENOEAVOWTO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE City Of San Juan Capistrano :? LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Attn: Cheryl Johnson LIABILITY OF ANY IOND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 32400 Paseo A ela o d nd �:�:::AUTN111�D REPRESENTATIVE San Juan Capistrano CA 92675 > LIABILITY ENDORSEMENT CITY OF SANJUAN CAPISTRANO RECEIVED COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto OCT 25 07 PM 196 San Juan Capistrano,California 92675 II U ATTN: na".,n M SnhAndert %T'r' CI IRK OkN�i:1N[.4'7 A. POLICY INFORMATION J io,H, 1. Insurance Company Northfield Ins . Co. Pogc,Number CP311467 2. Policy Term(From) (To) ;Endorsement Effective Date 9/14/T6-- 3. /14/96 - 3. Named Insured -7M L— SfiY MANA ME T, INC. 4. Address ofNsmed Insured S. La Cienega Blvd. , Los Angeles, CA 900 5 5. Limit of Liability Any One Occurrence/Aggregate$ 1, 0 0 0, 0 0 0 / 1, 000 , 000 General Liability Aggregate(Check one:) Applies"per location/project" X Is twice the occurrence limit 6. Deductible or Self-Insured Retention(Nil unless otherwise specified): $ 1, 500 , 7. Coverage is equivalent to: Comprehensive General Liability form GL0002(Ed 1173) X Commercial General Liability"claims-made"form CG0002 8. Bodily Injury and Property Damage Coverage is: "claims-made" $1, 000 , 000 "occurrence" If claims-made,the retroactive date is B. POLICY AMENDMENTS This endorsement is issued in consideration of the policy premium Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto,it is agreed as follows: 1. INSURED. The City and the Community Redevelopment Agency,its elected or appointed officers,officials,employees and volunteers are included as insureds with regard to damages and defense of claims arising from;(a)activities performed by or on behalf of the Named Insured,(b)projects and completed operations of the Named Insured,or(c)premises owned, leased or used by the Named Insured. 2. CONTRIBUTION NOT REQUIRED. As respects: (a)work performed by the Named Insured for or on behalf of the City;or(b)projects sold by the Named Insured to the City,or(c)premises leased by the Named Insured from the City,the insurance afforded by this policy shall be primary insurance as respects the City,its elected or appointed officers,officials, employees or volunteers;or stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. In either event,any other insurance maintained by the City,its elected or appointed officers,officials, employees or volunteers shall be in excess of this insurance and shall not contribute with it. 3. SCOPE OF COVERAGE. This policy,if primary,affords coverage at least as broad as: (1) Insurance Services Office form number GL0002 (Ed. im), Comprehensive General Liability Insurance and Insurance Services Office form number GL0404 Broad Form Comprehensive General Liability endorsement;or, (2) Insurance Services Office Commercial General Liability Coverage,"occurrence"form CG0001 or"claims-made" form CG0002;or, (3) If excess, affords coverage which is at least as broad as the primary insurance forms referenced in the preceding sections(1)and(2). 4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to each insured who is seeking coverage or against whom a claim is made or a suit is brought,except with respect to the Company's limit of liability. 5. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the City and the Community Redevelopment Agency,its elected or appointed officers,officials,employees or volunteers. 6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspended,voided,cancelled,reduced in coverage or limits except after thirty(30)days'prior written notice by certified mail return receipt requested has been given to the City. Such notice shall be addressed as shown in the heading of this endorsement. C. INCIDENT AND CLAIM REPORTING PROCEDURE Incidents and claims are to be reported to the insurer at: ATTN: Sharon Hayden, Claims Mgr. (Title) (Department) LFC Insurance Brokers & Agents (Company) 113 N. San Vicente B1, #301 (Street Address) Beverly Hills, CA 90211 (City) (State) (Zip code) (2-3) 655-9999 (Telephone) D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER I Terry T umang (prinUtype name),warrant that I have authority to bind the below listed insurance company and by my signature hereon do so bind this company. SIGNATURE OF UTTIMIZED REP SENTATIVE (Original sigriaturd required on endo ent furnished to the City) ORGANIZATION: LFC Ins. TITLE Acct Rep ADDRESS: 113 N. San JZJnente B1 , BeVPrIV Hi 11 a,_ A TELEPHONE: ( 13) 655-9q" 4r �y MEMBERS OF THE CITY COUNCIL COLLENE CAMPBELL GIL JO HART NES imlorro�rnn CAROLYN u1776 1961 DAVID SWEASH 1776 DAVID SWERCLIN CITU MANAGER • GEORGESCARBOROUGH September 17, 1996 All City Management, Inc. 5839 Green Valley Circle, #201 Culver City, California 90230 Re: General Liability Endorsement Form (Crossing Guard Service) Gentlemen: Thank you for the General Liability Certificate of Insurance, which was received by the City of San Juan Capistrano on September 17, 1996. In accordance with your agreement, please be advised of the following: (1) The City must have on file a general liability endorsement form naming the City of San Juan Capistrano as an additional insured. Attached is a duplicate of the form previously sent to you. Please forward the endorsement form to the City, attention City Clerk's office, by September 29, 1996. If you have any questions, please contact me at (714) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Lt. Paul Sullivan 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO. CALIFORNIA 92675 • (714) 493.1171 MEMBERS OF TUE CITU COUNCIL COLU:NE CAMPBELL HART OIL JONES mmuewlo CAROLYN NADH f1r7XI0 1961 S 1776 DAVID SVlERDLIN CRV MANAGER GEORGE SCARBOROUGH September 10, 1996 All City Management, Inc. 5839 Green Valley Circle, #201 Culver City, California 90230 Re: Renewal of General Liability Certificate of Insurance (Crossing Guard Service) Gentlemen: The General Liability Certificate of Insurance, regarding the above-referenced project, is due to expire on September 14, 1996. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. The agreement requires a general liability endorsement form naming the City of San Juan Capistrano as an additional insured. I have included a City approved endorsement form to submit to your insurance company; however, your insurance company may provide their own endorsement form. Please forward the updated certificates and the endorsement form to the City, attention City Clerk's office, by September 24, 1996. If you have any questions, please contact me at (714) 443-6310. Thank you for your cooperation. Very truly yours, `(Uu}n)� . ,�►l&mad Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Lt. Paul Sullivan 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493.1171 STATE F!O. BOX 420007,SAN FRANCISCO, CA94142'V807 comPsmaArIow oNSURAINICIE FUND��N�� CERTUFICATE OF WORKERS' COMPENSATKONUNSURANCE SEPTEMBER 11 " 1017 POLICY NUMBER: 1501059 ~ 97 oenTinoxrssxp|nse: 4-1-98 F CITY DF SAN JUAN CAP9ISTRANO DEPT OF BUILDING AND SAFETY/ATTN: ED GREEN ]2400 BASED ADELANTO SAN JUAN CAPRISTRANO CA 92675 JOB: INCEPTION DATE 8/1/97 [ This is to certify that we have issued a mad Wakers' ComperIsation Inswarme polly in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. _ 3 This policy is not subject to cancellation by the Fund except upon teR-Oays'advance written notice to the employer. ' VVowiUclongkmyovTl�N,Uuys'uclvnnoonobnooUou\dthi^po\ioybonunce\\odphortohnno,malaxp)n&ion. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded Vythe policies described herein is subject to all the terms, exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVE pnswosmr EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: S1000,000 PER OCCURREN[ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08/01/97 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. � .n c� anrn owpux'sn F- w� ALL CITY MANAGEMENT 1749 S. LA CTENEGA PL LOS ANGELES CA 90005 S T ATS ------ . - CC:MPENSAITION I NSU RAA,NCL` F U 1 �8 D ENDORSEMENT AGREEMENT HOME OFFICE SAN FRANCISCO ALL EFF-cCTIVE DATES ARE AT 1::07 AM PACIFIC --- STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME _CT` :1?'i Ci _ S �CC,_ ^Q -_ V :,C�.r_ � -.7 ' _a: _- A.G = S 7 `;0= C C_'dC-7=ED u: --- 30 DAYS AP LR TNOTG. uCCA - i =T_ � -CS — _ i _ _ t_ L : _D NLS!7 b" STA!_ D TO CU-PURENT :OLDERS 07 Com_ _ _ C_-- 0- NOR-K _RS C0y? _\S. 0 ; VSUt�\C t NOTHING IN THIS ENDORSEMENT CONTAINED SHALL SE HELD TO VARY, ALTER, YJAIVE OR EX _. NY F T F E=` C I ION GR t ° I O u: 7A I J F THIS POUCI' O T �:. a = ST' OT I E r IN I$ PO IC S :AIL EE HELD T Y, a T wA R L d THE I S, I NS. c❑ S R LI:.L TAT 10 S HIS ORSE 2065 =OUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENTATIVE PRESIDENT � N� �U��o �� P.O. BOX 420007,SAN FRANCISCO, [A84142'0807 oouxPsma».rvom oNSLJRAN«�r= FUND�� CERTUFKCATE OF WORKERS' COMPENSATUONUNSURANCE AiY2]��T� 7, 1997 p»unvw»wREn� 1501059 - 97 CERTIFICATE EXPIRES: 4-1-98 CITY OF SAN JUAN CAPRISTRANO DEP7 OF BUILDING AND SAFETY/ATTN' B} GREEN 32400 PASEO A[}ELANl'O SAN JUAN CAPRISTRANO CA 92675 JOB: INCEPTION DATE: 08`01-97 L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California __- Insurance Commissioner to the employer named below forthe policy period indicated. _ This policy is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer. We will also give you TEN days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein issubject toall the terms,exclusions and conditions vf such policies. xoroon/zsunspnsaswrxr/vc pneumswr EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1 , 000 , 000 PER OCCURREN{ � � C� : ~~~ rn swpunEn LID� F- ALL CITY MANAGEMENT, INC, 1749 S. LA CIENEGA BLVD" LOq ANGELES CA 9OO�5 due* MEMBERS OF THE CITY COUNCIL COLLENE CAMPBELL JOHN GREINER mmxvxxxux WYATT HART munlxm 1961 GIL JONES 1776 DAVID M.SWERDLIN CITY MANAGER GEORGE SCARBOROUGH July 22, 1997 All City Management 5839 Green Valley Circle, #201 Culver City, CA 90230 Re: Renewal of Workers Compensation Certificate of Insurance (School Crossing Guard Service) Gentlemen: The Workers' Compensation Certificate of Insurance, regarding the above-referenced service, is due to expire on August 1, 1997. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. Please forward an updated certificate to the City of San Juan Capistrano, attention City Clerk's office, by August 8, 1997. If you have any questions, please contact me at(714) 443-6310. Thank you for your cooperation. Very truly yours, �Q� Q AWL" aml�^'_ .— Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 0 (714) 493-1171 STATE P.O. BOX 420807,SAN FRANCISCO,CA 94142-0807 COMPENSATION 1 NSU R^N G E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AUGUST 12, 1996 POLICY NUMBER: 1435245 - 96 CERTIFICATE EXPIRES: 8-1-97 F- CITY OF SAN JUAN CAPRISTRANO DEPT OF' BUILDING AND SAFETY/ATTN: ED GREEN 32400 PASEO ADELANTO SAN JUAN CAPRISTRANO CA 92675 JOB: VERIFICATION OF COVERAGE B-1-96 TO 8-1-97 L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. 30 This policy is not subject to cancellation by the Fund except upon tRxdays'advance written notice to the employer. 30 We will also give you TMJ days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1 ,000,000 PER OCCURRENCI ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE OB/12/96 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. SPECIMEN ENDORSEMENT #2065 ATTACHED. EMPLOYER ) . ALL CITY MANAGEMENT, INC 1749 S. LA CIENEGA BL LOS ANGELES CA 90035 L THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND STATE . COI..t►ENSLTION C7-3T177-CA.--- HOLDERS ' NOTICE I N 6 UR ANCZ P V NN D ENDORSEMENT AGREEMENT HOME OFFICE. ' SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME A-NY _NG IN THIS ?OLICY TO Tr CONT?L?Y NOT•;77 ST r DING , -- IS AGRE ::AT_ _ IS POLICY SHALL NOT 5E CANCUNTIL. 30 DAYS pr ER -W-RITTEN NOTICE 0= SuC CPKCELI.AT_ION r?S BEEN ?LACED IN -_ ' ?LTL =`' STAB :-INM TD Cb R_N7. riOLDE?5 O. C= :CAi: 0. wOPK 3S ' CO*?ENSA=ION _'NSUz?�? CE. NOTH I::G IN 7 I ENOOFSc N.ENT CONTAINED S=:ALL °c . .E LO O VARY, AL . TRI `;.AIV_ OF. Ek�,'Y _ _ _ _ ,� r 10;:{ uP.c'' .:�7 pLi:�T TA T=:!S ?OLIC .�O�� i . ' 9�S`:. 57' i IGTFJIIt ^circa -^7clh�-'rCpp�IC15�..�L _c F:ELO Y, :. T :'..)t•!T-1R L ll�I(-- E= Et'rZS F Llf.� :.ilOi-!:5 NDORSEY�J U ..y �� —11 LJ COON7ERS1GNcD AND ISSUED AT SAN =RANC'S'CG' ........................ ...................... YyL ... SEEMS DATE (Wkowy) Af M. 9/ 9/1995 ......... . ....... -:'.7a.i. ... . ...... .. IYRoouDeR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE (213) 655-9999 Fax(213) 655-0578 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE LBC Insurance POLICIES BELOW. 113 N. San Vicente Blvd. , 11301 COMPANIES AFFORDING COVERAGE Beverly Hills, CA 90211 ................................... coMpmY A Northfield Insurance Co. LETTER ..................--................--........ ...... ......................................................................... INSURED LETTER COMPANY B Commercial Underwriters ................. ....... ............. .......................... All City Management, Inc. COMPANY C LETTER 5839 Green Valley Circle, 1201 .......... .............. Culver City, CA 90230 COMPANY D LETTER .............. .......................... ....... ..................... .............. COMPANY LETTER E THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 LTR TME OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LOM DATE IM"O" DATE(MMIDDNY) A.-0.E.N.0.M.L ................. ........ ...... GENERAL AGGREGATE s 2p000,,000 X COMAVIERCIA,GENERAL LIABILITY CP300643 PRODLICTS�COMP/OP AGO. 0 ........... CLAW MADE X OCCUR. . 11000,000 09/14/95 09/14/96 PERSONAL&ADVINJAM OWNERS&CONTRACTORS PROT. EACH OCCURRENCE S 1j0000000 FIRE DAMAGE(Any aM fire) 25,000 MED.EXPENSE(Ay pe,w)*$ ......... ........... ............................. 41,090 COMBINED SINGLE ANY AUTO LIMIT S .................................... ALL OWNED AUTOS BODILY INJURY (Per person) S SCHEDULED AUTOS HIRED AUTOSBODILY I NAM NON-OWNED AUTOS (Per=idwo GARAGE 1-LASIUffY PROPERTY DAMAGE ............................—.............. ....... EXCESS UAML"Y EACH OCCURRENCE 4,0004,000 W LWBRELLA FORM CELD12924 �09/3.4/95 09/ 14/96 AGGREGATE 4,000,000............ OTHER THAN UMBRELLA FORM .............. ....... WORKERS COMPENSATION STATUTORY LIMITS AND EACH ACCIDENT $ UOYMW LUUM DISEASE-POLICY LIMB.......... T . D -EACH EMPLOYEE Tj OTHER ry DEOCVM "OF OPWAT4KWLDCATONSriENCLZbng%CkAL ITEMS Certificate holder is an "additional insured" as their interiostr, may appear. 35 Additional insureds share the same occurrence ,a' C aggregate limits Limits of insurance shown may have been reduced ,by outstapdinS claims ......... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 32400 Paseo Adelando MAIL 30 DAYS WRITTEN NOTICE To THE CERTnCATE HOLDER NAMED To THE IN x San Juan Capistrano, CA 92675 LEFT, BUT FAILURE TO MAIL SUCFJfPC k%UrjWft OWQA TION OR Attn: Cheryl Johnson LIABILITY OF ANY KIND UPON THE COM Y, ITS AGENTS OR REPRESENTATIVES. ,—AUTHORQED REPRESENTATIVE AW; 000 wi Elinn 5.w�n2'n�'Ai..:;.;._•...�.:::...:.:.. ..:: :; : J[ � yn : on B: 3 ISSUE DATE IMLVDDfYY) eF.' w. i`an 07/14/95 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE BOLTON/RGV INSURANCE BROKERS DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 1100 EL CENTRO STREET POLICIES BELOW. PO BM 820 COMPANIES AFFORDING COVERAGE SOUTH PASADENA,CA 91030 COMPANY A Golden Bear Insurance Co. LETTER COMPANY B INSURED LETTER All City Management,Inc. LEDnER"Y C 5839 Green Valley Circle#102 Culver City,CA 90230 COMPANY D LTH LETTECOMPR E THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COrypE OFINSURANCE POLICY NUMBED POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD(YY) DATE(MM/DDIYV) GENERAL UABIUTY GENERAL AGGREGATE f 1,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGO. S 1,000,000 A CLAIMS MADE OCCUR. GBLO2800 07/14/95 07/14/96 PERSONAL f ADV.INJURY $ 1,000,000 OWNERS 6 CONTRACTOR'S PROT EACH OCCURRENCE $ 11000,000 FIREDAMAGE (Any oneiee) $ 50,000 MED.EXPENSE(Arry one parson) S 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY f SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident S GARAGE LIABILITY PROPERTY DAMAGE S EXCESS LIABILITY EACH OCCURRENCE S 4,000,000 A GBX21712 07/14/95 07/14/96 AGGREGATE S 4,000,000 X OTHER THAN UMBRELLA FORM '" "' "' '' WORKER'S COMPENSATION STATUTORY LIMITS AND EACH ACCIDENTf DISEASE—POLICY LIMIT f EMPLOYERS' LIABILITY DISEASE--EACH EMPLOYEE S OTHER -tel DESCRIPTION OF OPERATIONS/LOCATIONSVENICLESISPEC1AL ITEMS n U v � .: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLFiE-0 BEFORE THE City OF San Juan Capistrano A EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Attn: Cheryl Johnson MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 32400 Paseo Adelando LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR San Juan Capistrano,CA 92675 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE . ��. . ALL025 : STATE F!0. BOX 4208OTSAN FRANCISCO, CA94142{)807 oOmvPsNauromw PACE FUND��,mn� �� CERTIFICATE OF WORKERS^ COMPENSATION INSURANCE pou8Ywuxxosn� AUGi)ST 3 , 19,7E� <�snT|p|n/Tssxp|ns* 1435245 - 95 8-1-96 F- CITY OF SAN JUAN CAPRISTRANO DE��TDF BL|ILDING AND SAFETY/ATTN: GREEN �4( O 3PASEO ADELANTO '3YAN JUAN CAPRISTRANO CA 92675 JOB: COVERAGE PERIOD 8-1-95 TO E>-1-96 This is to certify that nmhave issued avalid Workers' Compensation insurance policy inuform approved by the California --- Insurance Commissioner to the employer named below for the policy period indicated. _ This policy is not subject to cancellation by the Fund except upon tetiWays'advance written notice to the employer. XX We will also give you THN days'advance notice should this policy be cancelled prior to its normal expiration. XX This certificate of insurance is not an insurance policy and does not amend, extend or after the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein iosubject toall the terms,exclusions and conditions nfsuch pu|ioieo rncu/oswr toe Nev� []NF`L(}YER'S LIABIiITY LIMIT INCLUDING [)E-FENSE C057'[;. $1 , 000 , 030 PER OCCi1RRE)`�(� ENDORSEMENT #2O65 ENTIT|'ED C£RTIFICATE HOLDERS� NOTICE EFFFCTIVE O8/O3/95 IS ATTACHED TO AND FORMS A PART OF THIS 01-ICY SPECIMEN ENDDRSEMENT 1*2065 ATTACHED. � o� n n ` smpuzvsn � � - F- A I L _ALL CITy MANAG :.:.MENT INC 5839 GREEN VALLEY CIRC|E :H;1. LiABILdTY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO f ' COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Juan Capistrano,California 92675 ATTN: A. POLICY INFORMATION Endorsement# I. Insurance Company Northfield Insurance Company ;Policy Number CP 300643 2. Policy Tem(From) 9/14/95 (To) 9/14/96 ;EadorsemeutEffective Date 9/14/95 3. Namedlnsured All City Management 4. Address of Named 5839 Green VAlley Ct. - #102 Culver Cit�,CA 90230 5. Limit of Liability Any One Occurrenc tAggregate$ 1 -000 000 7 2 000 000 General Liability Aggregate(Check one:) Applies"per location/project" Is twice the occurrence limit X 6. Deductible or Self-Insured Retention(Nil unless otherwise specified): $ 1,500 7. Coverage is equivalent to: Comprehensive General Liability form GL0002(Ed 1173) Commercial General Liability"claims-made"form CG0002 S. Bodily Injury and Property Damage Coverage is: "claims-made" "occurrence" If claims-made,the retroactive date is 35 Additional Insureds share the same occurrence & aggregate limits. Limits of,insurance shown may have been reduced by outstanding claims, if any. B. POLICY AMENDMENTS This endorsement is issued in consideration of the policy premium. Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto,it is agreed as follows: 1. INSURED. The City and the Community Redevelopment Agency, �are included as insureds with regard to damages and defense of claims arising from; (a) activities performed by or on behalf of the Named Insured,(b)projects and completed operations of the Named Insured,or(c) premises owned,leased or used by the Named Insured. 2. CONTRIBUTION NOT REQUIRED. As respects:(a)work performed by the Named Insured for or on behalf of the City;or(b)projects sold by the Named Insured to the City;or(c)premises leased by the Named Insured from the City, the insurance afforded by this policy shall be primary insurance as respects the City, ' or stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. In either event,any other insurance maintained by the City. onhwaftshall be in excess of this insurance and shall not contribute with it. 3. SCOPE OF COVERAGE. This policy,if primary,affords coverage at least as broad as: (1) Insurance Services Office form number GL0002(Ed. 173), Comprehensive General Liability Insurance and Insurance Services Office form number GL0404 Broad Form Comprehensive General Liability endorsement; or. (2) Insurance Services Office Commercial General Liability Coverage,"occurrence"form CG0001 or"claims-made" form CG0002:or. (3) If excess,affords coverage which is at least as broad as the primary insurance forms referenced in the preceding sections(1)and(2). t. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to each insured who is seeking coverage or against whom a claim is made or a suit is brought,except with respect to the Company s limit of liability. 5. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any fat7tae to comply with reporting provisions of the policy shall not affect coverage provided to the City and the Community Redevelopment Agency, 6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspended,voided,cancelled,reduced in coverage or limits except after thirty(3 0)days'prior written notice by certified mail return receipt requested has been given to the City. Such notice shall be addressed as shown in the heading of this endorsement. 10 Day Notice Of Cancellation For Non—Payment M Premium C. INCIDENT AND CLAIM REPORTING PROCEDURE Incidents and claims are to be reported to the insurer at ATTN: (Title) (Department) Canon Insurance (Company) 9171 Wilshire Blvd. , #509 (Street Address) Beverly Hills , CA 90210 (City) (State) (Zip code) (310) 859-8600 (Telephone) D. 'SIGNATURE OFSINSURER ORIN �/AUTHORIZED REPRESENTATIVE OF THE SURER [, oU-/b�^'� `�� C/ type name , ant that I have authority to bind the below listed insurance company and by my signature hereon do so bind d is company. SIG ATURE OF TH ED REPRESENTATIVE l ' sign a requued on endorsement famished to the City)f �l� �(M� ORGANIZATIOi� 4& " TITL(E� ADDRESS: 117 1 UD 1 1 S TELEPHO �� a ' v �4Js1�1� ��s .L F BROKERS 8 GENTS/113 NO.SAN VICENTE BOULEVARD,SUITE 301/BEVERLY HILLS,CA 90211 (213)655.99N i FAX(213)6550578 C/.. -2 C MEMORANDUM To: Sherryl Johnson City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 From: Shaida Monshi Date: September 26, 1995 Re: All City Management, Inc. 4t CP5Ca (oy3 ------------------------------------------------------------ Please find enclosed the original endorsement/certificate issued on the captioned policy as requested. If you have any questions, please contact our office. Thank you. cn 01 m n o +v 2 m cc: Cora Liang All City Management, Inc. ,� 5839 Green Valley Circle, #102 Culver City, CA 90230 Qncn aATL i—ANO NIM RTHIS CEp KATEISISSUEDASAMATT CONFENS NO MoNTS UPON THE CEWMCAW HOLDER. THIS CEHTaTOATE ' BOLTONR(;V INSURANCE.BROKERS DOER NOT AMEND, UXTEND OR ALTER THE OOYERAOE AFFORDED BY THE 1100 EL CENTRO STREET PoUCIESAFLOW. PO Box B20 'I COMPANIES AFFOAOING COVERAGE SOUTH PASADENA,CA 910311 - -- --- - - LETC T%11" A CAL COMP INSURANCE LTH _ .. ....- ---.. ...__.. compw B All City Management,Inc WIE RHr C 5839 Green Valley Circle#102 Culver City,CA 90230 °LE°rvTEn Y D Lf�TE~A E -. THIS IB TO CERTHFY THIN THE POLYAES OF MURANCE LISTED BELOW HAVE BEEN IMWO TO THE IMMMO NA ED ABOVE FOR THE Pq.ICY PERKED INDICATED.RMWITRSTANDNG ANY REDUWEAENT,TUM OR 00MENTION OF MN OO murr OR OTHER OQDAENI WITH FEWCOT TO*wm 71RS CERHHGTE NAY BE ISWJED OR MAY PERTAIN,THE HSURANCE AFFORUED BY THE POLICES DESCRIBED TEREBL IS W"CT To XLH,THE TERN1L EXCLUSIONS AND COFArrKMS OF O PCLK' & LIMBS SHOWTT LAY HAVE BEEN REM)CED BY PAID MABEL _._.-. _-... 00 TYPeWwau him POUCY IARAe9t PDIHCTigT ffm OPMATIM LEML. – TMTE oftwo m CATS TwM)n" aruFRALUAFU" awr Aswe"TE TdiYERCVL CEXER4.LmPRODUCT8C0MPKF AOO. L ClAlY9 MADFa OCCUR PER9M/K —4A WNW 0 OWWFM a CONTRACTORS EA Dcm1mONc.... 5 PIREDAYAOF IAYYMBu s.._.. aUTDuoae DA!•lTI MUN E0 8NOM a aNr ADTo uaR ALL OIMEO AUT08 PCOAr nnmr a 9aEdRFD NITUB �� _.. MEMO AUTOS 8001LY Ntll1Y a NaHOImED AUTOS � ...._ .__._. . GARMIE LMLRY ppOPEITIV DAMAOE 1 MM UAIRRY EM}I LIpYImFNfl i ..,,_ ADaEDA7E l On1EA TITIN LMOREUA DORY BTAIUTORM lMR1 MORKFR$CCMPBIMIIOM TVATHA poc _ a 1,OOpTBBO A + W9e91091i50 09ro1l94 09!01!95 asEASE wLKriPan t 1000.090 OIPLMW UMR a+EATE-FAm�eMnarEE s 1,009 WHEN pEeCBE71DNOF CPFMTIOIIMLOGTTIOIOYHaCLFaAPECIAL RFAHA All operations of the Named Insured S IM0,ANY OF THE ABOVE DESCRIBED POLIQWS BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE tSWNG COMPANY WP L ENDEAVOR TO 32400 Paseo Adelanin MAK SATs WRITTEN NOTICE TO THE =RTCMTE HOLDER NAMED To TMC San Juan Capistrano,CA 92675 LEFT, WIT FAILURE TO MA#L SUCH NOtHCE "LL NIIY]RF ND[AN CATION OR L14BUTY OF ANY KIND UPON THF COMPAI'N, RS AGENTS OR REPRESENTATIVES, AMTYPZW RVROBRAl1Ye dOd L00 1N3WA9VNNW 1.113 -RV 0666 OVE OLE 9E: 60 60-60-tr661 All tic ALL CITY MANAGEMENT SERVICES, INC. FACSIMU COM SH DATE 210 N0. OF PAGES TO FOLLOW -+- T0: CA-kl C& CT jy ORGANIZATION: rel hC7 FAX NUMBER:_21q—= FROM- 'SYmtt G Q+'G &' KE. _(a&�CC�� Off NOTES: 5839 Green Valley Circle, Suite 102 Culver City, CA 90230 3101348-9990 Fax 310/348-1167 IOd t00 1N3W39HNHW ),110 -1d 0666 9b£ OI£ L£=60 60-60-6661