05-0627_BAKALL, ERGUN_InsuranceJun 27 05 04:28p ERGLOBRKRLL 714 00480 p.l
A
Ergun Bakall, P.E.
Consulting Civil Engineer
June 27, 2005
City of San Juan Capistrano
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
Attention: Ms. Maria Guevara
14 Bonsall, Irvine, Ca 92602
Tel/Fax : 714 838 0480
VIA FAX 949 493 1053
Subject: Personal services Agreement to Provide 2005 Urban Water Management Plan Update
Dear Ms. Guevara:
As per our phone conversation this is to notify you that my firm does not employ anyone other than
myself as the sole proprietor. Therefore, I have no need for Workers Compensation Insurance since I
work alone.
As for the Automobile Insurance, I have the coverage's required by the contract and I am including a
copy of my policy with the Auto Club.
It is a pleasure to be of service to the City of San Juan Capistrano. Should you have any questions
regarding this letter, please feel free to call me at any time.
Very truly yours,
Ergun I3akall, P.E.
Principal
Jun 27 05 04:28p ERGUIWAKALL 714 10480 p.3
rInterinsurance Exchange of the Automobile Club
Automobile Insurance Policy Coverage and Limits
Policy Change Declarations —
Insurance is in effect only for the vehicles, coverages, and limits of liability shown on this declarations page and as
set forth in the insurance policy and endorsements. These declarations, together with the contract and the
endorsements in effect, complete your policy.
NAMED INSURED (Item 1.)
BAKALL, ERGUN AND CHERYL
14 BONSALL
IRVINE CA 92602-0950
AUTO POLICY NUMBER G 6395664
POLICY PERIOD (PACIFIC STANDARD TIME)
EFFECTIVE DATE 3-13-0512:01 A.M.
EXPIRATION DATE 3-13-06 12:01 A.M.
SUBJECT OF POLICY CHANGE THIS IS NOT A BILL
VEHICLE CHANGE This policy change will decrease your premium by $2468.00
VEHICLES
(Actual Cash Value unless otherwise stated, less deductible)
t 38
Vehicle t
Vehicle 2
Vehicle 3
VEHICLE
NUMBER
IDENTIFICATION
VEHICLE
USE
GARAGE
ZIP CODE
ANNUAL
MILES LEASED FINANCED
ACV
NUMBER
$500
$500
$500
$500
1 1993 TOYO CAMRY LE
JT25K12EOP0157774
COMMUTE
92602
5,001 - 7,500 NO
NO
2 1999 BENZ E320
WDBJF65HOXA860178
COMMUTE
92602
15,001 -20,000 NO
NO
3 2000 ISUZU RODEO
4S2CK58W5Y4302857
COMMUTE
92602
7,501 - 10,000 NO
NO
4 2005 PORS 911 CARRERA S CAB
WPOAB29965S740658
PLEASURE
92602
1- 5,OOD NO
YES
- COVERAGES AND LIMITS
ANNUAL PREMIUMS
Coverage is not in effect unless a premium or the word
"included" is shown
_
COVERAGES LIMIT OF LIABILITY
Vehicle 1
Vehicle 2
Vehicle 3 Vehicle 4
Vehicle
Liability
Bodily Injury $500,000 each person/ $1,000,000
each occurrence i
S 808
': $ 283
i $ 278 i 258
Property Damage $250,000 each occurrence
S 138
's S 137
$ 143 i S 131
Medical
NA
NA
i NA NA
Physical Damage
(Actual Cash Value unless otherwise stated, less deductible)
t 38
Vehicle t
Vehicle 2
Vehicle 3
Vehicle 4 Vehicle
Comprehensive
ACV
ACV
ACV
ACV
(Less Deductible)
$500
$500
$500
$500
Collision
ACV
ACV
ACV
ACV
(Less Deductible)
$500
$500
$500
$500
Car Rental Expense
(Per Day)
NA
$30
$30
NA
Uninsured Motwrst
Bodily Injury $30,000 each person/ $60,000 each occurrence
Uninsured & Underinsured Vehicles
Uninsured Deductible Waiver
Total Premium
PREMIUM DISCOUNTS
Please refer to the enclosed document entitled
'Premium Discounts Applied to your Automobile Policy.
i� 41s PROCESS DATE 3-14-05
$ 42
8 70
t 38
$ 321
$ 146
$ 386
; 6 225
i $ 1285
NA
:` $ 35
[ $ 31
NA
$ 38
; S 39
$ 38
S 30
lcluded
;Included
:Included
:Included
$ 672 $ 950 It 753 $ 2025
"NA' indicates coverage not purchased
Total Annual Premium' $4400
Net Premium $4400
-1„cludes all applicable disceunL
PLEASE ATTACH TO YOUR POLICY (SEE REVERSE)
Jun 27 05 04:28p ERGLWAKRLL
714 V#0480 p,4
Interinsurance Exchange of the Automobile Club
Automobile Insurance Policy Coverage and Limits
Changes to Declarations (continued)
AUTO POLICY NUMBER G 6395664 EFFECTIVE DATE: 3-13-05
DRIVERS (UNLESS LISTED AS EXCLUDED)
DRIVING RECORD
RATED
DRIVER
NUMBER OF
FIPST
DRIVERYEAR
NAME
VEHICLE
I
GENDER
MARITAL STATUS
MINOR
LICENSED
NUMBER
NUMBER
1
PRIMARY
2
1 RAKALL, ERGUN
MALE
MARRIED
fit
2 BAKALL,CHERYL
FEMALE
MARRIED
68
3 AKAY, ENIS E
MALE
SINGLE
96
ENDORSEMENTS AND CERTIFICATES
NUMBER I TITLE
2231 GUARANTEED RENEWAL
2052 LOSS PAYABLE - NOTICE TO LIENHOLDER
EQUIPMENT' SOUND EOUIPMENT'
Ynl cAYPFAI. orNEN jjIQA Ta u RAOp OTHBi
1
2
3
4
-Coverage is indicated by a "Yes" in the appropriate equipment
column. Coverage limitations apply unless coverage was purchased
specifically for certain equipment.
ANY PHYSICAL DAMAGE LOSS MAY BE MADE PAYABLE TO YOU AND ANY INTEREST LISTED BELOW:
VEH NO. 4
ORANGE COUNTY TEACHERS FCU
P O BOX 11547
SANTA ANA CA 92711
DRIVING RECORD
RATED
DRIVER
NUMBER OF
NUMBER OF TRAFFIC CONVICTIONS
DRIVER STATUS
VEHICLE
I
NUMBER
F."IALLY
AT FAUL_T_ACCIDEtRS
MINOR
SERIOUS MAJOR SEVERE SUSPENSIONS
NUMBER
1
PRIMARY
2
2
PRIMARY
3
PRIMARY
1
3
ENDORSEMENTS AND CERTIFICATES
NUMBER I TITLE
2231 GUARANTEED RENEWAL
2052 LOSS PAYABLE - NOTICE TO LIENHOLDER
EQUIPMENT' SOUND EOUIPMENT'
Ynl cAYPFAI. orNEN jjIQA Ta u RAOp OTHBi
1
2
3
4
-Coverage is indicated by a "Yes" in the appropriate equipment
column. Coverage limitations apply unless coverage was purchased
specifically for certain equipment.
ANY PHYSICAL DAMAGE LOSS MAY BE MADE PAYABLE TO YOU AND ANY INTEREST LISTED BELOW:
VEH NO. 4
ORANGE COUNTY TEACHERS FCU
P O BOX 11547
SANTA ANA CA 92711
Jun 27 05 04:29p ERGt)WAKALL 714 0480 p.5
r•
t/r
Interinsurance Exchange of the Automobile Club
Premium Discounts Applied to Your Automobile Policy
Auto Policy Number: G 6395664
The following show all automobile premium discounts offered by the Interinsurance Exchange for qualifying
drivers and/or vehicles. Discounts that currently apply to your policy premium are indicated with a "Yes-"
Multi-PolicyI Select Prof. & Claims Cost
Multi -Vehicle Groups Persistency Reduction
Homeowners condominium Renters Watercraft
YES YES
_.
_
Driver Improvement Certificate
Driver
Good
Good
(valid 3 years)
New
Number
Name
Driver
Student'
Driver
Mature Driver Driving Course
1 BAKALL, ERGUN YES
2 BAKALL,CHERYL YES
3 AKAY. ENIS E YES
*Good Student - Full-time high school, college, or university study (minimum of 12 units per term) with less than nine years
driving experionce who. have attained a current or cumulative grade paint average of at least 3.0.
VEHICLE DISCOUNTS
_
Anti -Theft
Device••'
Vehicle
Year
Make
I
Model
Air Bags'*
Garage
Elecroic
Other
Number
Lo
Parking
1
1993
TOYO
CAMRY LE
YES
NO
NO
YES
2
1999
BENZ
E320
YES
NO
YES
YES
3
2000
ISUZU
RODEO
YES
NO
YES
YES
4
2005
POPS
911 CARRERA S CAB
YES
NO
YES
YES
-Air Bags - Discount applies if Medical Payments and Uninsured Motorist Bodily Injury coverage Is purchased (refer to page one of
the declarations).
'•' Anti -Theft Device - Discount applies if Comprehensive coverage is purchased.
If you need additional information about any of the above discounts, please refer to the Available Automobile
Premium Discounts booklet included with your renewal offer (or the insert provided with your application). If
you have any additional questions about premium discounts or your auto policy, please call us at 1-877-422-2100.
ffWMA
s 12
Jun 27 05 04:29p ERGLIWRKRLL 714 V#0480 p.6
This policy provides at least the minimum anrounls of liability
Insurance required by the CA VEH CODE SECTION 160M for the
specified vehicles and named insureds and may provide cgw"o for
other persons and other vehicles as provided by the insurance policy.
PROOF OF INSURANCE
Interinsurance Exchange of the
0 Automobile Club
Named Insured Policy Number G 6395664 i
BAKALL, ERGUN AND CHERYL o
Effective Date: 03/13/05 Expiration Date 03/13/06
This policy prwldes at least the minimum amounts of liability
Insurance required by the CA VEH CODE SECTION 16056 for the
spxl8ed vehicles and named insureds and may provide coverage for
other Persons and other vehicles as provided by the insuranre policy.
VEHICLES ON POLICY
YEAR HAKE VEH I.D. 0
1993 TOYO JTZSKIZEUPOIS7774
1999 BENZ WDBJF65HOXA860178
20DO ISUZU 4S2CKSBWSY4302857
2005 PORS WPGAB2996SS74065B
DRIVERS ON POLICY
BAKALL. ERGUN
SAKALL.CHERYL
AKAY. ENIS E
Place the Proof of Insurance in each vehicle insured under your policy. In addition, we suggest that each listed
PROOF OF INSURANCE
PROOF OF INSURANCE
Irlteninsurance Exchange of the
VEHWAJ S ON POLICY
Autonrobile Club
1993 NAIa eel I.D.
1999 BOYO JrZSK1WDBJF2EOP0157774
1999 BENZ BS017
2000 4S2CKS VftT43WB57
z
PORS WPOA8 996SS706S
2005 PORS WPOAB299655740658
nelned Insured
Policy Number G 6395664
i
BAKALL, ERGUN AND CHERYL
9
DRIVERS ON POLICY
BAKALL. ERGUN
Effective Date:
03/13/05 Expiration Date: 03/13/06
BAKALL. CHERYL
AKAY, ENIS E
This policy provides at least the minimum anrounls of liability
Insurance required by the CA VEH CODE SECTION 160M for the
specified vehicles and named insureds and may provide cgw"o for
other persons and other vehicles as provided by the insurance policy.
PROOF OF INSURANCE
Interinsurance Exchange of the
0 Automobile Club
Named Insured Policy Number G 6395664 i
BAKALL, ERGUN AND CHERYL o
Effective Date: 03/13/05 Expiration Date 03/13/06
This policy prwldes at least the minimum amounts of liability
Insurance required by the CA VEH CODE SECTION 16056 for the
spxl8ed vehicles and named insureds and may provide coverage for
other Persons and other vehicles as provided by the insuranre policy.
VEHICLES ON POLICY
YEAR HAKE VEH I.D. 0
1993 TOYO JTZSKIZEUPOIS7774
1999 BENZ WDBJF65HOXA860178
20DO ISUZU 4S2CKSBWSY4302857
2005 PORS WPGAB2996SS74065B
DRIVERS ON POLICY
BAKALL. ERGUN
SAKALL.CHERYL
AKAY. ENIS E
Place the Proof of Insurance in each vehicle insured under your policy. In addition, we suggest that each listed
Jun 27 05 04:28p
JO�OpBI(f�lG
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yFRN CA���`
ERGLOBRKRLL
714 VV0480
Interinsurance Exchange of the Automobile Club
P.O. Box 25001, Santa Ana, CA 92799-5001
www.aaa-calif.com
1-877-422-2100
BAKALL, ERGUN AND CHERYL
14 BONSALL
IRVINE CA 92602-0950
Automobile Policy: G 6396664
Dear Valued Member,
MARCH 14, 2005
The enclosed declarations page reflects a recent change to your policy. A description
of the change appears on the back of this letter.
Please take a moment to review this document. The policy charge you have made
has resulted in a credit of $2468.00 for the remainder of this policy period.
A new set of Proof of Insurance cards is included. You will need to destroy your
previous set of Proof of Insurance cards, which are no longer valid, and replace them
with the new set.
We are pleased to have the opportunity to be of service to you, and look forward to
providing you with dependable, high quality service for years to come. If you have any
questions, call us toll-free, Monday through Friday from 8 a.m. to 7 p.m. or Saturday
from 9 a.m. to 2 p.m. at 1-877-422-2100.
Sincerely,
Greg L. Backley
Group Manager
Policy Management Group
Enclosures
tl ddscription zif your pglf}r a harj$e;8plears ijn ihe:tidck of thls 1e11er
iTs .. Insurance provided to qualified Auto Club members by the Interinsurance Exchange of the Automobile Club
EI 4w
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