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05-0415_ALL CITY MANAGEMENT SERVICES, INC._Insurance CertificatreACORD CERTIFICAT@PF LIABILITY INSURANO OP ID G DATE(MM/DDNYYY) ALLCI-1 04/15/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISV 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. VE AUTHIPlif E BE AIR Pasadena CA 91101 Phone: 626-449-3870 Fax:626-449-5268 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Admiral Insurance Company INSURER B: Scottsdale Ins. Company PREMISES Facccurence) INSURER C: All City Management, Inc. INsuRER D: 1749 South La Ciener Blvd. Los Angeles CA 90035 INSURER E: 04/01/05 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. LTR NSRE TYPE OF INSURANCE POLICY NUMBER DATE MMi DATE IMWDDM/ LIMITS REPRESENTA ES. VE AUTHIPlif E BE AIR GENERAL LIABILITY chae T. ur EACH OCCURRENCE $1,000,000 PREMISES Facccurence) $50,000 A X COMMERCIAL GENERAL LIABILITY CA000003653-05 04/01/05 04/01/06 CLAIMS MADE Ix I OCCUR MED EXP (Any one person) $ excluded X Owner/Cont Prot. a DEDUCTIBLE $5,000 PERSONAL&ADV INJURY $1,000,000 PER CLAIM GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $1,000,000 POLICY JEo LOC Emp Ben. excluded AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSrUMBRELLA LIABILITY EACH OCCURRENCE $4,000,000 B X OCCUR ❑CLAIMSMADE XLS0027391 04/01/05 04/01/06 AGGREGATE $4,000,000 $ DEDUCTIBLE $ X RETENTION $10,000 WORKERS COMPENSATION AND TORYLIMITS I I ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNCUTIVE . E.LEACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED' It yes, describe under SPECIAL PROVISIONS below - —'--- 1 $ ----'-- E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *10 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 SANJUA2 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 c/o City Clerk's Office IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 32400 Paseo Adelanto REPRESENTA ES. VE AUTHIPlif E BE AIR San Juan Capistrano CA 92675 chae T. ur ACORD 25 (2001/08) 0 ACORD CORPOR ION 1988 0 Policy Number: CA000003653-05 0 CG 20 10 07 04 Effective Date: 04/01/05 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 Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations The City of San Juan Capistrano Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 Policy Number: CA000003653.05 AD 06 5712 03 Effective Date: 04/01/05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PP- ARY/NON-CONTRIBUTING INSURANCE ENDORSEMENT TLis endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABIEM COVERAGE PART ANY PERSON OR ORGANIZATION QUALIFYING AS AN INSURED UNDER THE ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS ENDORSEMENT FORM OG 20 10 10 01 ATTACHED TO THIS POLICY. It is agreed that. Commercial General Liability Coverage Form CG 00 01 Section IV paragraphs 41. and 4.c, do not only with respect to other valid and collectible Commer- cial General Liability insurance, whether primary or excess, available to the person or organization shown in the Sched- ule and: 1) Who is an insured under an Additional Insured - Owners, Lessees or Contractors endorsement at- tached to this policy; and AD 06 5712 03 2) Who requires by specific written contract that this Inman a is to be primary and/or non.-comtn'butary to other valid and collectible insurance available to that person or organization. This endorsement does not change the scope of coverage provided to the Person or organization by any Additional AE other term and conditions remain unchanged. Pave 1 of i 0 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: 132 CERTIFICATE EXPIRES: 10-01-2005 10-01-2004/10-01-2005 CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANTO 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. �6� 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 ANGELS CA 90035 [B18,SC] PRINTED: 08-02-20D5 SCIF 10282E Accept this cantlimte only X you see a feint weten0ar, That mads 'OFFICIAL STATE FUND DOCUMENP PAGE 1 OF 1