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05-0619_RBF CONSULTING_InsuranceACORD CERTIFICA F LIABILITY INSURAN OF Ip DATE (MMR DYVYY) 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. RBFCO-1 06/27/05 PRODUCER TYPE OF INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE United Captive Ins. Brokers 17151 Newhope St., Ste 211 POLICY EXPIRATION DATE MMIDDM/ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Fountain Valley CA 92708 ED Phone: 714-708-4370 Fax:714-70 "EIV INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: U.S. Fidelity and Guaranty o. RBF Consulting, Inc. PbE Q I INS 1 _ SURER B. INSURER C: D: 14725 Alton ParkwayINSURER Irvine CA 92718 CITY CLERK yNSURER E'. COVERAGES 5AM .JsJ"" — - 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMR)DIYV POLICY EXPIRATION DATE MMIDDM/ LIMITS GENERAL LIABILITY EACH OCCURRENCE S PREMISES Ea occurence $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE El OCCUR MED EXP (Any one Person) S PERSONAL 3 ADV INJURY $ GENERAL AGGREGATE $ SEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ POLICY IRI LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per Parson) $ BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per accident) S PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ ANYAUTO AUTO ONLY: AGS $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE E E $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND X TWiTLIMITS ER A EMPLOYERS' LIABILITY D123W00118 07/01/05 07/01/06 E.L. EACH ACCIDENT $1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE --- — E.L. DISEASE - EA EMPLOYE $ 1000000 OFFICER/MEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICVLIMIT 81000000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *10 days notice of cancellation for non-payment of premium. City of San Jaun Capistrano Dir. Admin. Services 32400 Paseo Adelante San Juan Capistrano CA 92675 CITYSJC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI! DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OFANY KIND UPON THE INSURER, ITS AGENTS OR cI4J:1*14:lrAt /x -i1 ACDJW,. CERTIFICA`rE OF LIABILITY INSURANCE � X1/29/04°"" 1 Dealey, Renton & Associates P. O. Box 10550 Santa Ana, CA 92711.0550 714 427-6810 INSURED RBF Consulting PO Box 57057 Irvine, CA 92619-7057 COVFRArsFS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Travelers Property Cas11 ualty Co of Am INSURER 8_ Hartford Fire Ins. Co. INSURER c: Fireman's Fund Insurance Co. INSURER D: Underwriters at Lloyd's of London INSURER E: 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 LTR TYPE OF INSURANCE POLICY EFFECTIVE POLICY NUMBER DATE M POLICYEXPIRATION AT MM LIMITS A GEN_ERALLIABILITY P630500D409204 11/30/04 EACH OCCURRENCE $1000000 FIRE DAMAGE (Anyone tire) $1000000 iXCOMMERCIALGENERALLIABILITY 111/30/05 _ CLAIMS MADE F X1 OCCUR INDP.CONTRACTORS ',, MED EXP (Any one person) $5000 PERSONAL a ADV INJURY $1000000 _ IX CONTRACTUAL INCLUDED GENERAL AGGREGATE X BFPD XCU $2000,000 PRODUCTS COMPIOPAGG GEN'L AGGREGATE LIMITAPPLIES PER: $2000,000 POLICY X PRO- X1 LOC -- ..-. B AUTOMOBILE LIABILITY 57UENTLO126 111/30/04 11/30/05 COMBINED SINGLE LIMIT (Ed accident) $1,QQD,000 ANY AUTO BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY (Per accident) $ Y X HIR ED AUTOS X ' NON -OWNED AUTOS PROPERTY DAMAGE $ - (Per accident) IkqANAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EAACC $ ANYAUTO AUTO ONLY: AGG $ C EXCESS LIABILITY XSM00086597721 11/30/04 11/30/05 EACH OCCURRENCE- $10,000000 - _AGGREGATE - - $10,000,000 X, OCCUR __ ] CLAIMS MADE Professional Liab. is Excluded $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND_ WC STATU- OTH- ESL EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ ' D OTHER Professional P1049400 '.11/30/04 '11/30/05 $1,000,000 per claim (Liability $2,000,000 annl aggr. DESCRIPTION OF OPERATIONWLOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENINSPECIAL 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 Att: city Clerk's Office 32400 Paseo Adelanto San Juan Capistrano, CA 92675 LD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ARRQBNDRx7P MAIL 30.... DAYSWRITTEN ETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BVISADt1RxXARA'AAAN$$xx ACORD 25-S (7/97)1 of 2 #M115917 I � -� � -� v vw � r,_`I- 41BG 0 D CRIPTIONS (Continued from 7age 1) Liability. AMS 25.3 (07/97) 2 of 2 #M115917 POLICYNUMBER: 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 ll) 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 0 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 (949) 493-1171 (949) 493-1053 FAX wwwsal#uancapistrana org November 22, 2004 mcRRVMRUX � [RiRBIISXfp � 1961 1776 Robert Bein, William Frost & Associates 14725 Alton Parkway Irvine, CA 92618-2069x MEMBERS OF THE CITY COUNCIL SAM ALLEVATO DIANE L BATHGATE WYATT HART JOE SOTO DAVID M. SWERDLIN RE: Com Hance with Insurance Requirements — Plan Check Services/Corrosion Protection Agreements The following insurance documents are due to expire: J General Liability Certificate 11/30/04 J General Liability Endorsement Form naming the City, of San Juan Capistrano as additional insured. J Automobile Liability Certificate 11/30/04 J Professional Liability Certificate 11/30/04 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 324P 0 Paseo Adelanto, San Juan Capistrano, CA 92675 by the above expiration dates. If you have any questions, please contact me at (949) 443-6309. Adminir 1ve Secretary cc: awn Schanderl, Administrative Assistant San Juan Capistrano: Preserving the Past to Enhance the Future