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04-0921_RBF CONSULTING_InsuranceACORD CERTIFICATODF LIABILITY INSURANCE OPID xt� DgTE(MM/DD/nr anTPrn—� I na/9�/n� United Captive Ins. Brokers - HOLDER. THIS CERTIFICATE DOES NOT AM 17151 Newhope St., Ste 211 ALTER THE COVERAGE AFFORDED BY THE Fountain Valley CA 92708�����D Phone:714-708-4370 Fax: 714-70 G INSURERS AFFORDING COVERAGE INSURED INSURERA: U.S. Fidelity and Guarant, ( 105 JUL _S P b$ Q SURER B: RBF Consulting, Inc. INSURER Cr 14725 Alton Parkway INSURER D: Irvine CA 92718 CITY CLERK Cl ^ADICTRA &SURER E: COVERAGES NAIC # OR 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 LTR ROM NSR TYPE OF INSURANCE POLICY NUMBER DATE EFFECTIVE POLICY DATE M�DM N LIMITS GENERAL LIABILM EACH OCCURRENCE S PREMISES Ea occuarice $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE 11 OCCUR MED EXP (Any one Person) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO S POLICY jE T LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY $ (Per Person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY accident) S (Par accleeM) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ ANY AUTO AUTOONLY: AGO $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR El CLAIMS MADE S $ DEDUCTIBLE E RETENTION S WORKERS COMPENSATION AND X STA U- TORVUMRB ER A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE D123WO0118 07/01/05 07/01/06 EL EACH ACCIDENT $1000000 -- E.L. DISEASE - EA EMPLOYE $1000000 OFFICERIMEMBEREXCLUDED9 It yes, Describe under SPECIAL PROVISIONS below EL DISEASE -POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECU\L PROVISIONS *10 days notice of cancellation for non-payment of premium. ER City of San Jaun Capistrano Dir. Admin. Services 32400 Paseo Adelante San Juan Capistrano CA 92675 CITYSJC I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC 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 BO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR S T.uen w: l:VN3VL ALORD.M CERTIFIC E OF LIABILITY INSU NCE 1129/U4Dml PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P. O. Box 10550 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana, CA 92711-0550 714 427-6810 INSURERS AFFORDING COVERAGE INSURED INSURER A. Travelers Property Casualty Co of Am RBF Consulting PO Box 57057 Irvine, CA 92619-7057 COVERAGES N 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. IN5R T POLICY EFFECTIVE ATE MM POLICY EXPIRATION TE MM D LIMRS A GENERAL LIABILITY P63050OD409204 11/30/04 11/30/05 EACH OCCURRENCE $1006000 X COMMERCIALGENERALLIABILITY FIRE DAMAGE (Anyanefire) $1000000 CLAIMS MADE X OCCUR INDP.CONTRACTORS MED EXP (Any one person) $5000 PERSONAL BADV INJURY $1000000 X_!CONTRACTUAL_ INCLUDED _ GENERAL AGGREGATE $2000000 X_1BFPD XCU _ GEN -1- AGGREGATE LIM ITAPPLIES PER: PRODUCTS-COMPIOPAGG 52000006 POLICY I X I PE U X LOC __-- B AUTOMOBILE LIABILITY X ' ANY AUTO 57UENTL0126 11/30/04 11/30/05 COMBINED SINGLE LIMIT $1,000,000 (E. .c Lent) BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per acmdent) $ X HIRED AUTOS NOWOWNEO AUTOS PROPERTY DAMAGE $ (Per amdent) RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ IANY AUTO 7, AUTO ONLY: AGG $ C EXCESS LIABILITYr XSM00086597721 11/30/04 11/30/05 EACH OCCURRENCE $10 000 000 AGGREGATE 510 000 Q-00---- 00___is _ X f OCCOR , CLAIMS MADE Professional Llab. E isExcluded $_ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION ANDWCSTATU- —7 -0T -H-- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ D , OTHER Professional P1049400 11/30/04 111130/05 $1,000,000 per claim !ability $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS General Liability policy excludes claims arising out of the performance of professional services All Operations as performed by the named insured. City of San Juan Capistrano is Additional Insured as respects to General (See Attached Descriptions) City of San Juan Capistrano Aft: city Clerk's Office 32400 Paseo Adelanto San Juan Capistrano, CA 92675 LD ANYOF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION THEREOF, THE ISSUING INSURER WILL ZXPWWM3P MAIL 30--DAYSWRRTEN ETOTHE CERTIFICATE HOLDER NAMEDTOTHELEFT, BKWA7VtRORXAAA=AKXXX ACORD 25-8(7/97)1 oft #M115917 P--- v ,.,s '-VtfBG O ACORD CORPWTION 1988 D RIPTIONS (Continued from ge 1) Liability. AMS 25.3 (07197) 2 of 2 #M115917 POLICY NUMBER: P630500D409204 COMMERCIAL GENERAL LIABILITY 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: City of San Juan Capistrano Att: city Clerk's Office 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (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. CG 20 10 11 85 '(MMD)ACORD CERTIFICA� OF LIABILITY INSURAlk� ROPODKOAT.' 7/07/04 PRODUCER THIS CERTIFICATE 1a .3SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE United Captive Ins. Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 17151 Newhope St., Ste 211 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fountain Valley CA 92708 Phone: 714-708-4370 Fax:714-708-2300 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: U.S. Fidelity and Guaranty o. INSURER B: RBF Consulting INSURER C: 14725 Alton Parkway INSURER D. ,Irvine CA 92718 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. LTR NSR TYPEOFINSURANCE POLICY NUMBER DATE MM/DDM' DATE MM/ODM' LIMITS NOTICE TO THE CERTIFICATE HOLOER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL City of San GENERAL LIABILITY Dir. Admin. EACH OCCURRENCE f PREMISES Ea ocwrence f IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER RS AGENTS OR 32400 Paseo COMMERCIAL GENERAL LIABILITY CLAIMS MADE EOCCUR REPRESENTATIVES. AUTHORG.EDREPRESENTI� MED EXP (AmJ one parson) S PERSONAL B ADV INJURY $ Mark Barrie GENERAL AGGREGATE $ GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ POLICY PRO - ECT OC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY f (Per parson) HIRED AUTOS NON-0WNED AUTOS BODILY INJURY (Per euident) PROPERTY DAMAGE f (Per accident) _ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT f OTHER THAN EA ACC S ANY AUTO - -AUTO ONLY. AGS f EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE f OCCUR FICLAIMS MADE AGGREGATE f f f DEDUCTIBLE f RETENTION f A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE D123W00096 07/01/04 / /O4 07/01/05 X TORY LIMITS ER E.L. EACH ACCIDENT $1000000 E.L. DISEASE - EA EMPLOYEE $1000000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERAnOkS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *10 days notice of cancellation for non-payment of premium. CFRTIFICATE HOLDER CAN('FI I ATION ACORD 25 (2007108} © ACORD CORPORATION 1938 CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL EMAIL *30 DAYS RRUTTEN NOTICE TO THE CERTIFICATE HOLOER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL City of San Jaun Capistrano Dir. Admin. Services IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER RS AGENTS OR 32400 Paseo Adelante REPRESENTATIVES. AUTHORG.EDREPRESENTI� San Juan Capistrano CA 92675 Mark Barrie ACORD 25 (2007108} © ACORD CORPORATION 1938 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 (949) 493-1171 (949) 493-1053 FAx ww .sanjuancaprstrano.org June 2, 2004 Robert Bein, William Frost & Associates 14725 Alton Parkway Irvine, CA .92618-2069x MEMBERS OF THE CITY COUNCIL SAM AL EVATO DIANE L. BATHGATE WYATT HART JOE SOTO DAVID M. SWERDLIN RE: Compliance with Insurance Requirements — Plan Check Services/Corrosion Protection Agreements The following insurance documents are due to expire: ✓ Workers Compensation Certificate 07/01/2004 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400,faseo Adelanto, San Juan Capistrano, CA 92675 by the above expiation datesAf )/ have any questions, please contact me at (949) 443-6309 cc: Dawn Schanderl, Administrative Assistant San Juan Capistrano: Preserving the Past to Enhance the Future f Clie &5 ORRFCONSIIt AC RD„, CERTIFICATE OF LIABILITY INSURANCE °"' POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LSR 12/222/0 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates P. O. Box 10550 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana, CA 92711.0550 GENERALLIABIUTY 714 4276810 INSURERS AFFORDING COVERAGE INSURED RBF Consulting PO Box 57057 NSURERA Travelers Indemnity Co. of Illinois NsuRER B: Hartford Fire Ins. Co. INSURER c: Fireman's Fund Insurance Co. Irvine, CA 92619-7057 NsuaeR D: Underwriters at Lloyd's London 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. LSR TYPE OF INSURANCE POLICY NUMBER DArEFFECOTNE ffin O MMI RATION Lwas A GENERALLIABIUTY P630SOOD409203 11/30/03 11/30/04 EACH OCCURRENCE $1000000 FIREDAMAGE(AAyme6m) $1000000 X COMMERCMLGENERALLABLTTY CLAMS MADE QX OCCUR INDP.CONTRACTORS MED EXP (AM aro parson) s5000 PERSONAL&ADVINJURY _ $1000,000 X CONTRACTUAL INCLUDED. X BFPD, XCU, OCP I GENERAL AGGREGATE s2.000.000 GENLAGGREGATE LIM RAPPLIES PER: PRODUCTS-CAMP/OPAGG $2000000 POLICYFxj M X LOC Ij B AUToMosiLELIABILJry X ANY AUTO 57UENTL0126 11/30/03 11/30/04 (Ea-d�Q l"GLE UNIT $1,000,000 BODILY INJURY (Pp Pa ) $ ' ALL OWNED AUTOS SCHEDULEDAUTOS eooxrauuar s (Px amtlenl) X HIRED AUTOS X I NON-OWNEDAUTOS PROPERTY DAMAGE $ (Px aaitlenl) GARAGE LJABIUTY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO - AUTO ONLY: AGO S C EXCESSUAB1urY X OCCUR CLAMS MADE XSM00097333165 11/30/03 11/30/04 EACH OCCURRENCE $10000000 AGGREGATE $10000000 PROFESSIONAL s _ ----- ---- $ - - -- - --- DEDUCTIBLE LIABILITY IS RETENTION s EXCLUDED. $ WORKERS COMPENSATION AND WCSTATU- I TH EMPLOYERS'LIABILITY E.L. EACH ACCIDENT S E.L. DISEASE -EA EMPL OYEE $ E.L. DISEASE . POLICY UNIT $ D OTHER Professional P1039400 11/30/03 11/30/04 $1,000,000 Per Claim Liability $2,000,000 Anil Aggr. DESCRPTION OF OPERATKINSILOCATIONS/VEMCLEWEXCLUSKMIS ADDED BY ENDORSFMENTISPECIM. PROVISIONS General Liability policy excludes claims arising out of the performance of professional services. All Operations as performed by the named insured. (See Attached Descriptions) SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXRRATLON City of San Juan Capistrano DATE THEREOF, T"r nsuNG INSURER WILL wgeomW MAIL 30_._-DAYSWWREN Aft: city Clerk's Office NOTICETOTHE CERTIFICATE HOLDER NAMED TOTH E LEFT, BN7QaIXRNAxIPAMxKAOLXx 32400 Paseo Adelanto wleXlaxXDmDanoeioNonmtABacNxmtxNxx°wwemxxxxa�I San Juan Capistrano, CA 92675 21108=1101000EFxx AUTHORIZED REPRESENTATIVE / ACORD 25S (757)1 of 2 #M81822 TMP1 0 ACORD CORPORA)TI N 198: POLICYNUMBER: P63050OD409203 COMMERCIAL GENERAL LIABILITY 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: City of San Juan Capistrano Att: city Clerks Office 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (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. CG 20 10 11 85 • 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 (949)493-1171 (949) 493-1053 (FAX) 1vwlesanjuancapis[rano. org October 12, 2003 +A��/p mmnm UNRUH 1961 1776 Robert Bein, William Frost & Associates 14725 Alton Parkway Irvine, CA 92618-2069x MEMBERS OF THE CITY COUNCIL DIANE L BATHGATE JOHN S. GELFF WYATTHART JOE SOTO DAYIO M. SWERDLIN INTERIM CIT' MANAGER PAMELAGISSON RE: Compliance with Insurance Requirements — Plan Check Services/Corrosion Protection Agreements The following insurance documents are due to expire: ✓ General Liability Certificate 11/30/03 — 0A- ✓ General Liability Endorsement Form naming the City of San Juan Capistrano as additional insured. J Automobile Liability Certificate 11/30/03 ✓ Professional Liability Certificate 11/30/03 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) 443-6308. cc: William M. Huber, Engineering and Building Director Dawn Schanderl, Administrative Assistant San Juan Capistrano: Preserving the Past to Enhance the Future