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05-0614_BELAIRE - WEST LANDSCAPE INC._Insurance CertificateAC 111!dk iffi:od ............. D ATE isilIk DNY) FATE19 I I xo. T .... ..... .. 05 PRODUCER 909-941-6699 THIS CERTIFICATE IS ISSUED AS A MATTEROF INFORMATION Driver Alliant Insurance Jay Freeman ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3270 Inland Empire Blvd., #100 COMPANIES AFFORDING COVERAGE COMPANY A Landmark American Ins Co/STL Ontario, CA 91764 INSURED COMPANY Belaire West Landscape, Inc. B P.O. Box 6270 COMPANY Buena Park CA 90622 C COMPANY .. ... .... .. ... 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY LHA127627 2113/05 2/13/06 GENERAL AGGREGATE 9 2,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS MADE 1XI OCCUR PRODUCTS - COMP/OP AGG Is 2,000,000 PERSONAL & ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) 0 50,000 X BIIPD Ded: 1 1 $5,000 MED EXP (Any one person) $ 5,000 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY lPer accident) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE a GARAGE LABILITY AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT 0 I AGGREGATE a EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATUS TORY LIMIT OTH- EIR EL EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE - POLICY LIMIT EL DISEASE EA EMPLOYEE T$ OFFICERS ARE: EXCL OTHER 10 Days Notice for Non -Pay. DESCRIPTION OF OPEMTIONS/LOCATIONSNEHICMSISPECIAL ITEMS Re: San Juan Capistrano Public Library Phase 1, Site Work. City of San Juan Capistrano, its officers, agents and employees are additional insureds as per form attached. This cancels and replaces the certificate issued on 6/11/05. City of San Juan Capistrano SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Attn: Brian Perry .30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 32400 Paseo Adelanto OUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY San Juan Capistrano, CA 92675 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUT EZED REP ENT VE _&n I 4641 • 0 LANDMARK AMERICAN INSURANCE COMPANY This Endorsement Changes The Policy. Please Read /t Carefully. ADDITIONAL INSURED BLANKET - PRIMARY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: City of San Juan Capistrano, its officers, agents and employees. PER CERTIFICATE ATTACHED Any person or organization to whom or to whichi you are obligated by virtue of a written contract or by the issuance or existence of a permit, to provide insurance such as is afforded by this policy. (If no entry appears above, information requird to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION II - WHO IS AN INSURED is amended to incluee 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. If you are required by a written contract to provide primary insurance, this policy shall be primary as respects your negligence and SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance does not apply, but only with respect to coverage provided by this policy. This endorsement effective: 2/13/2005 forms part of Policy Number: LHA127627 issued to: Belaire West Landscape, Inc. by: Landmark American Insurance Company Endorsement No. RSG 15001 0903 (CG 2010 1185) Includes copyrighted material of Insurance Services Office, Inc. 1984 with its permission