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00-0701_ORANGE COUNTY FIRE AUTHORITY_Insurance CertificatesACORD„ 6ERTtF1cA & LI 91I � �T:E�1A . E DATE IMM/Donn ,.. 6/20/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ARS of Northern California ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Market ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spear Street Tower Ste. 2100 COMPANIES AFFORDING COVERAGE San Francisco, CA 94105 COMPANY _415-543-9360_ A Royal Insurance Company_ INSURED I COMPANY - Orange County Fire Authority - B 180 South Water Street COMPANY Orange, 92666 Attn: Fausuato Reyes COMPANY D COYEttAG�5 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/DDNY) POLICY EXPIRATION DATE IMM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE 3 1000000 A X COMMERCIAL GENER�AL LIABILITY CLAIMS MADE 1 1 OCCUR OWNER'S a CONTRACTORS PROT RHJ090073-01; AGG. APPLIES TO P.O. LIAB. ONLY; LIMIT SUBJ. TO 7/01/00 7/01/01 PRODUCTSCOMP/OP AGG 3 PERSONAL & ADV INJURY 3 EACH OCCURRENCE s X PROF. LIAR./E&O FAIRA'S $250,000 SIR _1000000 FIRE DAMAGE (Any one Bre) 3 MED EXP (AOY one Person) 5 A AUTOMOBILE LIABILITY AAUTO RHJ090073-01 7/01/00 7/01/01 COMBINED SINGLE LIMIT S 1000000 BODILY INJURY 3 ALL owNED Autos 1 yJ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS (Per person) BODILY INJURY IPer accitlentl 5 PROPERTY DAMAGE : $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT 5 AGGREGATE 3 EXCESS LIABILITY � UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE- 5 3 OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY T RV LI TWC U ITS ER OER CEL THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EACH ACCIDENT S Y LIMIT 3 EL DISEASE POLICY OFFICERS ARE: EXCL DISEASE - EA EMPLOYEE 13 OTHER _FEL DESCRIPTION OF OPERATIONS/LOCATIONSMEHICLES/SPECIAL ITEMS This Certificate shall serve as evidence of insurance covrage in force. CER'1FICR7E HOLOER __ _ CANOELLATION _ , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano RATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 32400 Paseo Adelanto 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Ban Juan Capistrano, CA 92675 UT FAILURE T MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY I N THE WMPANY, ITS AGENTS OR REPRESENTATIVES, CD RE p 11 234315129 V\ VY t,1Lf,J: A0()R025 9 {31953 f . & ACORD CORPORATION 4988. .tea^ A/I./IItIL I°K."011 ■ ...... ..'. g ..F.. S'i MM TTTt:R' It 10 10.i3f.F���4t* OF UNFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ARS of Northern Cal Ifornis HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Market ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spear Street Tower Ste. 2100 COMPANOESA F ING COVERAGE COMPANY San Francisco, CA 94105 415-543-9360 A Royal Insurance Company COMPANY Orange County Fire Authority B 100 South Water Strut COMPANY Orange, CA 92666 C Attn: Fausto Reyes COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OFINSURANCE LISTED BELO W HAVE BEENISSUED T O THE INSURED NAMED ABO VEFOR THE POLICY PERIOD INDICATED. NOT W ITHST ANDINGANYREOUIREMENT,TERMORCONDITIONOF ANYCONTRACT ORO THERDOCLMENT WITHRESPECT TO WHICHTHIS CERTIFICATE MAYBE ISSUED OR MAY PERT AN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. Do LTG TVP[OF ROMANOR POLIOVNUMa[a POLMYIYY[OTW[ DATE(MWDWYY) POLIOVEMNATON DATE(MMO001YY) LIMITS GENNALLINLRV GENERAL AGGREGATE { 1000000 PRODUCTSCOIP/OP AGO 1 A X COMMERCIALCENERALUABLRY RHJ090073;AGGREGATE 7/01/99 7/01/00 CLAIMS MADE X❑ OCCUR APPLIES TO P.O. L IAB. PERSONAL a ADV MARY s EACH 0005WNCE { 1000000 OWNER'SL CONTRACTOR'S PROT ONLY; LIMIT SUBJ. TO FIRE DAMAGE (Any r fire) { X PROF. LIAR./ERG FAIRA'S $250,000 SIR MED EIB (Any rw preen) i AUTOMOBL[ LMaLUV SINGLE LIMIT i A X ANY AUTO RHJ090073 7/01/99 7/01/00 1000000 BODILY INJURY i ALL OWNED AUTOS SCIEDLLED AUTOS roar W—) HIRED AUTOS BODILY IKARY { NONOWNED AUTOS (Pr awitl Q PROPERTY DAMAGE i GMINa LINLWV AUTO ONLY EA ACCIDENT { ANY AUTO OTHER THAN AUTO OILY: .{.:.:: EACH ACCIDENT AGGREGATE i [XOMLMGLRY EACH OCCURRENCE 1 UMBRELLA FORM AGGREGATE { OTHER THAN UMBRELLA FORM 1 WORX[Ra OONP[HGATMMf! ANSI STATUTORY LIMITS [APLOY[aa'LINLRr EACH ACCIDENT { THE PROPRIETOR I INCL DISEASE - POLICYh,7MIT { PARTNERS/EXECIJIIVE OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE �7 OTHER n n N n OF �ATMAKWATM m�Molm Mm The Certificate Holder is included as Additional Insured as respects the ao agreement to provide fire protection, prevention and suppression services as a ov d a o d b etu s. Ind •'ux' xn .+en e ..<�u.. . u. �..�s.V w,..i.sAwnv..L..3�.�R .. .. •a �� �. ..: snolLa v or TNs Aaov[ Ixsoaaro Pelpali a[ oAN06laa aVOK TAI[ I:xPmA 'OAT[ TNMmeor. TNe Iasulrr eoMnwr war aTmeAvaa »MAL City of Ran Juan Capistrano jQ O SWR lO[TO 1Ml OPATG'pAT[NOMOBI NAA[O TO TIK L[PT. 32400 Paseo Ade I en t o eIR rA ro MA NgTlo[ sNAu IMPOa[MO oxmATloM oa uNLRr San Juan Capistrano, CA 92675 or AN Xrn TH[ oowwr. oe IATTIlaMTATIr[L Attn: City Manager GU In� J 234315129 1� ODOb�103<f9��. POLICY NUMBER: RHJ090073 CARRIER: ROYAL INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION DISTRICT: ORANGE COUNTY FIRE AUTHORITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PUBLIC ENTITY LIABILITY AUTO LIABILITY SCHEDULE Name of Person or Organization: City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 RE: Agreement to provide fire protection, prevention and suppression services As approved and authorized by State Statute. (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 as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 26 1185 Copyright, Insurance Services Office Inc., 1984 elkiB #: �Y�Bb� 3 "No= ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ARS of Northern California HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Market ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Spear Street Tower Ste. 2100 COMPANY San Francisco, CA 94105 415-543-0360 A RoyalInsurance Company SISTIBISTCOMPANY Orange County Fire Authority B COMPANY 100 South Water Street Orange, CA 92666 C COMPANY Attn: Fausto Reyes D e.+RFY THATs�'A,.y�`g THE LICIES i`a�>; OFURA >.HISTE)B iL#a„s3.YVE ..S U uk$t:n.eG'THEIEONAO EFORTHEa'awn'�'�'�'.��.'�e�ok.'ye&.�'.�i'st".m THIS IS THAT VOLICY PERIOD HEINSUREDNAMEDABOVERESPEC INDICATED.NO WI ANDING NYRE UIREMIANCE ERMORBELOWHAVEBE INDICATED. NOT WIT HST ANDINGANV REOUIREMENT.T ERM ORCONOITIONOF YCONEDTOT TOWHCHTHIS ANVCON7 RACT OROTFERDOCLMENT W ITHRESPECi T O W HICHTHIS 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. LIMITS SHOWNMAV HAVE BEEN REDUCED BY PAID CLAMS. W LTD ilTlOr SAYIIANOa FOLIOYNYIBG POLICY EFFECTNE DATE(MMIDDIVY) P OV EIPBAT DATE(MWDDIVY) LIA1lTJ SUMAL LIMLRV GENERAL AGGREGATE f 1000880 PRODUCT&COIF/OP AGO f A X COMMERCIAL(EIERALUABIDTY RHJ090073;AGGREGATE 7/01/99 7/01/00 .. CLAIMS MADE © OCCLA APPLIES TO P.O. L I AB. PERSONAL L ADV INJURY f EACHOccuwENCE 1 1000000 OWNERS LCONTRACTORSPROT ONLY; LIMIT SUBJ. TO FIRE DAMAGE (ArW" lira) f X PROF. LIAR./ERO FAIRA'S $250,000 SIR LED EXP (Arty Ona parson) 1 AYTOMFOaaa LIMLRY COMBINED SINGLE LIMIT 1 A X ANY AUTO RHJ090073 7/01/99 7/01/00 1000000 BODILY WARY IT (Per Per—) ALL OWNED AUTOS SCHEDLLED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per aooiMnt) f PROPERTY DAMAGE 1 DAMAGE LIMLIFV AUTO ONLY - EA ACCIDENT 1 ANY AUTO OTHER IVAN AUTO ONLY: EACH ACCIDENT 1::.:. AGGREGATE f EXOESDLIIA L?Y EACH OCCLRTENCE / UMBRELLA FORM AGGREGATE 1 OTHER THAN UMBRELLA FORM f WORKERS COMPENSATION AND S1AIUIORV LIYITS EAPLOVOWLIMLRY EACH ACCIDENT f..... TIE PROPRIETOR/ INCL PARTNERS/EXECUTIVE DISEASE - POLICY LIMIT i DISEASE EACH EMPLOYEE 1 OFFICERS ARE: EXCL OTHER L. C r This Certificate shall serve as evidence of p insurance covng• in force. n m w,�,.,....,. ..�.,... a�..�.,..,..:.;2w a' �;..:`.�:'...;? ,....A... .x.., s .. .. ....... ...... ..e u.. ....s,,;,,: °�F>F:µ�:" J. �T#`'.•aEi3'sDyOiY SHOULD ANY OF THE ABOVE DESCRIBED POLIOES BE OAMMMM'BPOIE ME EXPBAT DATE THEREOF. ME M M COMPANY WILL U AVOIL TO MAL City of San Juan Capistrano 32400 Paseo Ad o l on t o 30 AV" WRITTEN �NOTION TO THE OOIT.IOATE HOLDER NAbmq!gmE LEFT. BVT FAL TO MA 1111110111 THIN SHALL IMPOSE NO OBLMATMN OR LIABILITY San Juan Capistrano, CA 92675 OF ANY KM E OOMPANY. aR MMNEMArATNM I A' F1iy26St SO- ti r'n 234315129 W` FaStCs> ,L ! ` Fes', e�r1y�.�aa1� �i, Fy�.W `p� �i 11,I"'•'I' �MPMI1� # �a4PR'1!# .a�aaL�■a 7B •7 :... DAYI iM/,YCf)IYY) '.: ,�*� Imp CERTIFICATE IS ISSUED AS A MATTER Rawl I UP- IN ONLV AND CONFERS NO RIGHTS UPON THE CERTIFICATE ARS, Of Northern California One'#Market HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW. Spear Street Tower Ste. 2100 COMPANIES AFFORDING COVERAGE COMPANY San Francisco, CA 94105 415-543-9360 A Insurance Company of the West COMPANY Orange County Fire Authority B NORM— COMPANY -- ;3 180 South Water Street Orange, CA 92666 C n COMPANY -- m Attn: Fausto Reyes THIS IS TO CERTIFY THAT THE POLICIES OFINSUPANCE LISTED BELO W HA V E BEENISSUED TOT HE INSURED NAMED ABOVE FORT HE POI-91r-0ERIOD INDICA TED. NOT WIT HST ANDINGANYREOUIREMENT, T ERM ORCONDIT IONOF A NYCONT PACT ORO THERDOCUMENT WITHRESPECT TO W WCH THIS CERTIFICATE MAYBE ISSUED ORMAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL r&TEPUS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. LTR TYPEOF INSURANCE POLICY NUMBER POLICY EPFEOTIVE DAT! (MMIDDIYY) POLICYUPIRATION DAT! (MMIDOIYY) LIMITS 01NERALLNABLRY GENERAL AGGREGATE It COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGO f CLAIMS MADE F—J OCCLR PERSONAL L ADV INJURY f OWNER'S L CONTRACTOR'S PROT EACH OCCURRENCE $ 1 FIRE DAMAGE (Ary one lire) f MED EXP (Any one person) f A AUTOMOBLE X LIABILITY ANY AUTO CSR120834405; LIMIT 7/01/98 7/01/99 COMBINED SINGLE LIMIT i 1000000 BODILY INJURY Persm) f ALL OWNED AUTOS SCHEDULED AUTOS(Per SUBJ. TO FAIRA'S HIRED AUTOS NON OWNED AUTOS(Per $250,000 SIR BODILY INJURY Rcoiolerr) f PROPERTY DAMAGE f GARAGE LIMLITV AUTO ONLY - EA ACCIDENT f ANY AUTO OIHER THAN AUTO ONLY: EACH ACCIDENT f AGGREGATE f !KOESSLMBLITY EACH OCCURRENCE f UMBRELLA FORM AGGREGATE f OTHER THAN UMBRELLA FORM f WORKERS COMPENSATION AND EMPLOYERS'LIABLITY STATUTORY LIMITS EACH ACCIDENT TNF} PROPRIETOR/ INCL EXECUTIVE DISEASE POLICY LIMIT i OPA F;IC RS OF.iCERS ARE: EXCL DISEASE EACH EMPLOYEE f OTHER This Certificate shall serve as evidence of coverage in force. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE OANCELLID BEFORE THE IKPIRATION DAT! THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAL City Of San Juan Capistrano 30 DAY ITTEN NOTICE O ME MRTFIOAM HOLDER NAMED TO THE LEFT, 32400 Paseo Adelanto BUTFAILU 0MAL WESHALLIMPOSENOOBLIGATIONONLIMLITY San Juan Capistrano, CA 92675 OF ANY UPON COMPANY. RS AGENTS OR REPRIESENTATNES. lifRD�bl$@=i9a3 a AUT PSENT 234315129 W� dR orl .: A1/111tike ..:Plldbil02M..... ... ...... ... .::. .. .: .�. ,:� ... ..plaVill t -OK AWN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ARS of Northern California HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Market ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spear Street Tower Ste. 2100 COMPANIES AFFORDING COVERAGE COMPANY San Francisco, CA 94105 415-543-9350 A Insurance Company of the West INSURED COMPANY Orange County Fire Authority B 190 South Water Street COMPANY Orange, CA 92566 C Attn: Fausto Reyes COMPANY D y 6S: .. . THIS IS TFVTHAT THENLISTWHAVEBEENISSUEDTO T HEINSUREDNAMEDABOVEFORTHEPOLICVPERIOD INDICA TED, NOT WIT HST ANDINGANYREOUIREMENT,TEPX ORCONDIT IONOF ANY CONT PACT ORO THERDOCUMENT WIT HRESPECT TOW HICH THIS CERTIFICATE MAY BE ISSUED ORMAY PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. Do LTR TYPEOFINSURANOE POLICY NUKE POLIOVEMOTIVE DAM(MMODDIVY) POILWYEXPIRATION DATE(MMIDWYV) LIMITS GEMERALLIABLITY GENERAL AGGREOATE 1 1000000 PRODUCTS-COMP/OP AGO S A X COMMERCIAL GENERAL LIABILITY CSR120834405;AGGREGAT 7/01/98 7/01/99 CLAIMS MADE © OCCUR APPLIES TO P.C. L I AB . PERSONAL L ADV INJURY f EACH OCCURRENCE 1 1000000 OWNER'S L CONTRACTOR'S PROT ONLY; LIMIT SUBJ. TO FIRE DAMAGE (Any one lire) S X PROF. LIAB. E&O FAIRA'S $250,000 SIR MED EXP (Arty one person) t AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 A X ANY AUTO CSR120834405; LIMIT 7/01/98 7/01/99 1000000 BODILY INJURY 1 (Per Person) ALL OWNED AUTOS SCHEDULED AUTOS SUBJ . TO FA I RA' S BODILY INJURY (Per axidenl) i HIRED AUTOS NON OWNED AUTOS $250,000 SIR PROPERTY DAMAGE 1 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 1 ANY AUTO OTTER THAN AUTO ONLY: EACH ACCIDENT 1 AGGREGATE S EXCESSLIABLITY EACH OCCURRENCE 1 4000000 AGGREGATE S 4000000 UMBRELLA FORM 1 q X OBER THAN UMBRELLA FORM ESR120634505 7101/98 7/01/99 WORKERS COMPENSATION AND STATUTORY LIMITS _S EMPLOVERS'LIABLITY EACH ACCIDENT THE PROPRIETOR/ INCL PARSNERS/EXECUTIVE DISEASE - POLICY LIMIT 1 DISEASE EACH EMPLOYEE Is OFFICERS AAE: EXCL OTHER The Certificate Holder is included as Additional Insured as respects the agreement to provide fire protection, prevention and suppression services as a oved and ■utho ized b State Statue. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED WOW THE EXPIRATION ATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAL City Of San Juan Capistrano 30 Drs WRITTEN NOT O THE CERTIFICATE HOLDER NAMED TO THE LEFT, 324100 Paseo Ade l onto BUT FAL TO MAL THIS MALL IMPOSE N0 0101.10ATKIN CA LIABILITY Sar", Juan Capistrano, CA 92675 OF AN KRB THE COMPANY. ITS AGENTS OR REPRESENTATNES. Attn: City Manager 1 q;NC$..tfj I� 234315129 l/1 C R�Ytt?ff(1RA11UfttJp�: 0 POLICY NUMBER: CSR120834405 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION MEMBER DISTRICT: ORANGE COUNTY FIRE AUTHORITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS PUBLIC ENTITY LIABILITY SCHEDULE Name of Person or Organization: City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 as respects: the agreement to provide fire protection, prevention and suppression services as approved and authorized by State Statue. (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 as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 26 1185 Copyright, Insurance Services Office Inc., 1984 AUG 2 5 1997 ACHORiL1' DAItl(M1IWCWVY) a�U ONLV AND CONFERS NO RIGHTS UPON THE CERTIFICATE Aon Risk Svcs Inc of No. Cal. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Market ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW. Spear Street Tower Ste. 2100 COMPANIES AFFORDING COVERAGE San Francisco, CA 94105 COMPANY 415-543-9360 A Insurance Company of the West INSURED COMPANY Orange County Fire Authority B 180 South Water Street COMPANY Orange, CA 92666 1 C Attn: Fausto Reyes COMPANY D AyE ' THIS IS T CERTIFY T HA 7 THE POLICIES INSURANCE LISTED ITHA V E BEENISSUED T O THE IN`iUAEO NAMED ABO VEFOR T POLICY PERIOD INDICATED, NOT W W IT HST ANDINGANVREOUIREMENT. T ERM ORCONCONDIT IONOF ANVCONT FACT ORO THERDOCU.AENT WIT HRESPECT 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. LMITS SHOWNMAV HAVE BEEN REDUCED BY PAID CLAMS. 00 LTR TYPEW INSURANCE POLmV NUMBER POLIOVErrlOTNE DATE (MMDOIYV) POLIcy"PIRATION DATE (MMI)DIVY) LIMBS aENERLLIMLITY GENERAL AGGREGATE f COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP ADD r CLAIMS MADE F-1 OCCUR PERSONAL 6 ADV INJURY f OWNER'S L CONTRACTOR'S PROT EACH OCCURRENCE f FIRE DAMAGE (Ary one fire) t MED EXP (Any we perm) r AUTOMOBILE L14OLITY COMBINED SINGLE LIMIT IT A X ANY AUTO CSR120834404; LIMIT 7/01/97 7/01/98 1000000 BODILY 191AY t (Per W—) ALL OWNED AUTOS SCHEDULED AUTOS SUB J . TO FA I RA' S BODILY INJLRV (Per acciOerA) t HIRED AUTOS NON -OWNED AUTOS s250,000 SIR PROPERTY DAMAGE f GARAM LIMLRY AUTO ONLY - EA ACCIDENT 1 ANY AUTO ....... ... .... .. ... OTTER THAN AUTO ONLY; EACH ACCIDENT i... AGGREGATE i EXCESSLUMILITY EACH OCCWiENCE S UMBRELLA FORM AGGREGATE t OTHER THAN UMBRELLA FORM r WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS'LIABLRV EACH ACCIDENT _ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE DISEASE -POLICY LIMIT IT DISEASE EACH EMPLOYEE { OFFICERS ARE: EXCL OTHER C N r. Vl .'9 - rn m This Certificate shall serve as evidence of coverage in force. ^X < m m SHOULD ANY or THE ABOVE MAWROM POLICa:a BE CANDEL en BaME THE MEREM, THE IMNG OOMPANY WILL ENDEAVOR TO MAL EXPIRATIVAn City Of Son Juan Capistrano 30 TW No T THlomrrgATe "OLDER NAMED TO TMEMDPT. 32400 Paseo Adelanto euT PALAL TIDE SHALL IMPOK NO OBLIGATION OR LIABLRY San Juan Capistrano, CA 92575 Or ANYP MPANV. ITS/IAGENTIIiI OR REPRESENTATmL I L% 234315129 MFI li1R(Y26str�E _c ...... a,ucnax��s.i AUG 2 5 1997 a�:�aii� RTt�I�AT� �� MN�II�;AI� "` D17[�MAYtlD(YY) ..... rj ONLV AND CONFERS NO RIGHTS UPON THE CERTIFICATE ARS of Northern Cal Ifo rn1a HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Market ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spear Street Tower Ste. 2100 COMPANIES AFFORDING COVERAGE COMPANY San Francisco, CA 94105 415-543-9360 A Insurance Company of the West snumCOMPANY Orange County Fire Authority B 180 South Water Street COMPANY Orange, CA 92666 C Attn: Fousto Reyes COMPANY D .s ' T HIS IS T O CERTIFY THAT 7 HE POLICIES OF INSURANCE LIST ED BELO W HA VE BEENISSUED TO T HEINSURED NAMED ABO VEFOR THE POLICY PERIOD INDICA TED, NOT WIT HST ANDINGANYREOUIREMENT, TERM ORCONDIT IONOF ANY CONTRACT ORO THEP DOCUMENT WIT HRESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED ORMAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. I.111 TWEOF NSMRANOE POLICYNMMMM POI.IOV EFTECTNE DATE(MDDIVIO DATE PMMV RXPMAT DATE(MDDIYY, AO LIMITa GENENALLIABLRY GENERAL AGGREGATE f 1000000 PaCGUCTS-COMP/OP AGO s A X COMMERCIAL GENERAL LIABILITY CSR120834404;AGGREGAT 7/01/97 7/01/98 CLAIMS MADEFX OCCUR APPLIES TO P.O. L I AB. PERSONAL L ADV IKKAY f EACH OCCURRENCE f 1000000 OWNER'S L CONTRACTOR'S PROT ONLY; LIMIT SUBJ. TO FIRE DAMAGE(AIW one lire) f X PROF. LIAB. E&O FAIRA'S $250,000 SIR MBD EXP (Arty one parson) f AUTOMOBILE LIABILITY COMBINED SINGLE OMIT f A X ANY AUTO CSR120834404; LIMIT 7/01/97 7/01/98 1000000 BODILY INJURY If (Pr person) ALL OWNED AUTOS SCHEDULED AUTOS SUBJ . TO FA I RA' S BODILY INJURY (Per acoldern) f HIRED AUTOS MONOWNED AUTOS $250,000 SIR PROPERTY DAMAGE f GARAGE LIADLRY AUTO ONLY - EA ACCIDENT f ANY AUTO ........ ... .. .. .... OTHER THAN AUTO ONLY: EACH ACCIDENT f..... AGGREGATE i lXOESSLIABLGY EACH OCCURRENCE If 4000000 AGGREGATE If 4000000 UMBRELLA FORM f A I X OTHER IHAN UMBRELLA FORM ESR120834504 7/01/97 7/01/98 WORKERS WPOnAT10N AND STATUTORY LIMITS EMPLOVM'LIABLRY EACH ACCIDENT f THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE DISEASE-POLICY LIMIT If DISEASE EACH EMPLOYEE f OFFICERS ARE: EXCL OTHER pal IN OF OPMA7MSILOCATIONSI�MICLES'Snajx-ffgur- The Certificate Holder is included as Additional Insured as respects the agreement to provide fire protection, prevention and suppression services as a oved and autho ized b State Statue. ': a:::.. ., .....: .. ..:.� ... . .:.i . ..... ,:: �... .:.:: ..�.....� . �.....�.... J..' �...u... .. V: ..... v �:�an c 77.r....: �. MOL" ANY Of THE Anon DEmon POLIOlt BE CANCELLED BEFORE THE EXPIRATIONDA THEREOF. THE IUUffM OOMPANY WILL ENDEAVOR TO MAL City Of San Juan Capistrano 30 DAYS RTEN NOTICE TO THE OERTIFICATE HOLDER NAMED TO THE LEFT. 32400 Paseo Ad e I an t o RNT FALURE MAL SUa1 LXALL IMPOSENO OBLMATKIN OR LIABILITY Juan Capistrano, CA 92675 or ANY K UPON V. ITS Aqwm OR ROMENWATrves. Attn: City Manager 234315129 GV mC1Wd�ii+S/f9s� �°fi(lSt� 11CAtt1�IN.�ill�M AUG 2 S 1997 POLICY NUMBER: CSR120834404 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION MEMBER DISTRICT: ORANGE COUNTY FIRE AUTHORITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS PUBLIC ENTITY LIABILITY SCHEDULE Name of Person or Organization: City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 as respects: the agreement to provide fire protection, prevention and suppression services as approved and authorized by State Statue. (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 as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 26 1185 Copyright, Insurance Services Office Inc., 1984 r A0/1„RIL 1M►IM.:;�aIK '��Mr :� .:<,. bAYCI'WA116WVV) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ARS of Northern California HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Market ALTER THE COVERAGE AFFORDED By THE POLICIES BELOW. Spear Street Tower Ste. 2100 COMPANIES AFFORDING COVERAGE COMPANY San Francisco, CA 94105 415-543-9360 A Insurance Company of the West INSURED COMPANY Orange County Fire Authority B 180 South Water Street COMPANY Orange CA 92666 C Attn: Linn Livingston COMPANY D C.;C BRA48 'c THISIS TOCERTIFY THAT THE POLICIES OF INSUR ANCE LISTED BELOWHA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FORT HE POLICY PERIOD INDICAT ED, NOT WIT HST ANDING ANY REQUIREMENT. TERM ORCONDIT IONOF ANY CONT PACT OROT HERDOCUdENT WIT HRESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERT AIN, 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 CLAMS. CO TYPlOF INSURANCE POLICY NVMBER POLIOVEFFECTIVE DATE(MMIDDIYY) POLICY EXPIRATIONLIMITS DATE(MMIDDIYY) GENZAALLIABLITV GENERAL AGGREGATE t 1000000 PRODJCTS-COMP/OP AGO t A X COMMERCIAL GENERAL LIABILITY CSR120834403; AGG. LI 7/01/96 7/01/97 CLAIMS MADE [j] OCCUR APPLIES TO P.O. LIAB. PERSONAL d ADV INJURY t EACH OCCURRENCE t 1000000 OWNER'S L CONTRACTOR'S PROT ONLY; LIMIT SUBJ. TO FIRE DAMAGE (Any one lire) t X Prof, Liab. E&O FAIRA'S $250,000 SIR HIED EXP (Any one Person) t AUTOMOBLE LIABILITY coMelNEo SINGLE LIMIT t A X ANY AUTO CSR120834403 7/01/96 7/01/97 1000000 BODILY INLRY t (Per P&p) ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS BODILY IN.AIRY (Per aocid t) t PROPERTY DAMAGE t GARAGE LIABILITY AUTO ONLY " EA ACCIDENT 1 ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT 5 AOOREGATE t EXCESSLIABILITY EACH OCCURRENCE t 4000000 AGGREGATE t 4000000 AUMBRELLA FORM t X OTHER THAN UMBRELLA FORM ESR120834503 7/01/96 7/01/97 WURKlRS COMPENSATION AND STATUTOftV LIMITS �{�� EMPLOYERS'LIA80.1TV EACH ACCIDENT THE PROPRIETOR/ INCL PARINERS/EXECUTIVE DISEASE" POLICY LIMIT S DISEASE. EACHEMPLOYEE f OFFICERS ARE: EXCL OTHER PERATJCNSILCOATICNSIVZHIOLASISPECIAL ITEMS C The Certificate Holder is included as Additional Insured as respects the agreement to provide fire protection, prevention and suppression services as approved and ■utho iEed b State Statue. �""" m SHOULD A of THE ABOVC DESCRIBED POLICIES Ba-CANDLi' .120 a1�eR! lN� City Of San Juan Capistrano EXPIRAT N AT THEIR THE ISSUING OOMPANY...!.W,IL�EAVO''R�- pTTO MJg 'J0 SWRITTER NO ICC TOTNEOERTEIO ATE HI NAMED TIL;IE LEFT. 32400 Paseo Adelant0 BUT FA TO MAL NO110l SHALLIMPOSC NO OBLIGATION I�ABLRY San Juan Capistrano, CA 92675 OF A KIND C COMPANY. ITS AGEOR REPR!>♦TTATIVEL Attn: City Manager C 234315129 ,4pOR0 45 S ?�S8 'l POLICY NUMBER: CSJ?*834403 COMMWIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION MEMBER: ORANGE COUNTY FIRE AUTHORITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS PUBLIC ENTITY LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 as respects: the agreement to provide fire protection, prevention and suppression services as approved and authorized by State Statue (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 as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. A00401tll. ' �� 1 ►�Y :CIS nisuR ATE (MEUdUJVn .. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ARS of Northern California HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Market ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spear Street Tower Ste. 2100 COMPANIES AFFORDING COVERAGE San Francisco, CA 94105 COMPANY 415-543-9350 A Insurance Company of the West INSURED COMPANY Orange County Fire Authority B COMPANY 180 South Water Street Orange, CA 92665 1C COMPANY Attn: Linn Livingston D , • THIS IS TED,NO FVT THAT THE POLICIES WHAVEBEENIS TO T HEINSUREDNAMEDA BOVERESPEC OLICY IOD ANDINGREQUIREMCE ENT.ORCON INDICA TED.NOT WIT HST ANDINGANVREOUIREMENT,TERMORCONDITIONOF THIS ANVCONTRACT ORO THERDOCLMENT WITHRESPECT TO WHICHTHIS NTA TO CERTIFICATE MAYBE ISSUED OR MAY PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWNMAV HAVE BEEN REDUCED BY PAID CLAMS, CO LTR TYPE OF INSURANCEPOLICY NUMBER POLIOVEFFEOTIVE DATE(MMIDDIYV) POLICY EXPIRATIONLIMBS PATE(MWDDIYY) OBNERALLIABLITY GENERAL AGGREGATE f COMMERCIALGENERAL LIABILITY PRODUCTS-COMP/OP AGO f CLAIMS MADE❑ OCCUR 77 PERSONAL & ADV INJURY f OWNER'S& CONTRACTOR'S PROT EACH OCCUPAENCE f FIRE DAMAGE (Any one lire) f MED EXP (Am one Person) IT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f A X ANY AUTO CSR120834403 7/01/96 7/01/97 1000000 BODILY INJURY f ALL OWNED AUTOS SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY f NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE _ DARAOE LIABLRY AUTO ONLY EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT IT AGGREGATE $ EX9E11SLIABLITY EACH OCCURRENCE If UMBRELLA FORM AGGREGATE f OTHER THAN UMBRELLA FORM f WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS'LIABILITY EACH ACCIDENT THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE DISEASE POLICY LIMIT f DISEASE - EACH EMPLOYEE f C. OFFICERS ARE: EXCL OTHER C Y` t� o hr (V This Certificate shall serve as evidence ofcoverage in force. ., .:: SHOULD ANY OF THE ABOVE DESCRIBED POLIOIES BE CANCELLED BEFORE THE THEREOF, THE ISSUWO OOMPANY WILL ENDEAVOR TO MAL EXPIRATIOrWjMT City of San Juan Capistrano 30 DITTEN NO TO THE CERTIFICATE HOLDER NAMED TO THELER, 32400 Paseo Adelanto BUT PAT MALS TICE SHALL IMPOSE NO OBLWATION OR LIABLRY San Juan Capistrano, CA 92575 OF ANY COMPANY, US AGENTS OR REPRESENTATNE& 234315129 tL �� 1 u:rc +waals:ar9s� rloRrbrt�ridk;:tn; 0 ANNUL, CE RTIF19, RHH of,Northern California One market Sp 0AT Street Tower Ste. 2100 San Francisco, CA 94105 415-543-9360 Orange County Fire Authority 180 South Water Street Orange CA 92666 T 3 MAV OF SU TYPE OF INSURANCE POLgYNUMBER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPAN LETTER A Insurance Comoany of the West COMPANY LETTER B COMPANY LETTER C -L coMPANv W LETTER D COMPANY LETTER E A X I COMMERCIAL GENERAL LIABILITY CSR120834402;AGG LIMI CLAIMS MADE 0 OCCUR. APPLIES TO P.O. L IAB . OWNER'S& CONTRACTOR'SPROT. ONLY; LIMIT SUBJ TO X Prof. Limb. E&O FAIRA'S $250,000 SIR AUTOMOBILE LIABILITY A PANY AUTO CS8120834402 ALL OWREO AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOVERS'LIABILITY OTHER JNUI- ANY GUNIHAL; _wIIMKt Js'tUf IUWH iRDED BY THE POLICIES DESCRIBED HEREINISSUBJECT TO ALL THE Y HAVE BEEN REDUCED BY PAID CLAMS, POLIOV EFFECTIVE I POLICY EXPOIATI LIMITS 7/01/95 7/01/96 PRODUCTS-COMP/OP AGR S PERSONAL & AGY. INJURY S EACH OCCURRENCE S FIRE DAMAGE (Any one lire) S MED. EXPENSE (Any one person S 7/01/95 7/01/96 COMBINED SINGLE $ LIMIT BODILY INJURY $ (Per person) BODILY INJURY S We, accident) PROPERTY DAMAGE IS f — Tt BE SORPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS - '1 The Certificate Holder is included as Additional Insured as respects the agreement to provide fire protection, prevention and suppression services as _ v City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 Attn: City Manager SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ft-itORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAVSJED IT TENNO TICE TO THECERTIFICA TE HOLDERNAMED TO THE LEFT, BUT FAILURS,N MAIL QH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANYIO UPON COMPANY. ITS AGENTS OR REPRESENT ATIVES. V\ 234315129 0 E POLICY NUMBER: CSR120834402 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY • ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION MEMBER: ORANGE COUNTY FIRE AUTHORITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS PUBLIC ENTITY LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 as respects: the agreement to provide fire protection, prevention and suppression services as approved and authorized by State Statue. (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 as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. L `NUS :: :: ISSUE DATE (MM/OD/VV) Nib Itiavoi�i�TM�I►i .:: ::: Ibbut:u H of Northern California CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE e Market POLICIES BELOW. COMPANIES AFFORDING COVERAGE Spear Street Tower Ste. 2100 San Francisco, CA 94105 co"' LETTER A In u ance Company of the West 415-543-9360 COMPANY LETTER B INSURED Orange County Fire Authority 180 South Water Street COWANY LETTER C COMPANY LETTER D Orange CA 92566 COMPANY LETTER E ...... 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 CONTRACTOR OTHER DOCLMENT 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 SHO WNMAV HAVE BEEN REDUCED BY PAID CLAMS. 0* LT TYPE OF INSURANCE POLIOY NUMBER POLIOVEFFEOTIVE DATE(MM/OD/VY) POIJOYE)UPIRATION DATE(MM/OD/YY) LIMITS GENERAL LIABa.nY GENERAL AGGREGATE % 1000000 PRODUCTS-COMP/OP AGO. 1 A X GENERAL LIABILITY CSR120834401;AGG LIMI 3/01/95 7/01/95 LAIMS MADE 0OCCUR. APPL1ES TO P.O. LIAB. PERSONAL & ADV. INJURYR'S& EACH OCCURRENCE 1 1000000 qION"ERCIAL CONTRACTOR'S PROT. ONLY; LIMIT SUBJ TO FIRE GAMABE (Any one Fire) t Xrof. Li ab. E&O FAIRA'S $250,000 SIR MED. EXPENSE (Any one person t A AUTOMOBILE LIABEITV ANY AUTO CSR120834401 3/01/95 7/01/95 COMBINED SINGLE = LIMIT 1000000 X BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY t HIRED AUTOS NON -OWNED AUTOS IPer accident) PROPERTY DAMAGE _ GARAGE LIABILITY EXCESSLIABaFTV EACH OCCURRENCE t 4000000 AGGREGATE 1 4000000 UMBRELLA FORM AX OTHER THAN UMBRELLA FORM1/01/95 WORKER'S COMPENSATION I STATUTORY LIMITS .s EACH ACCIDENT AND EMPLOYERS'LIABILITY DISEASE -POLICY LIMIT t DISEASE -EACH EMPLOYEE t OTHER a J ice) DESCRIPTION OF OPERATIONSILOOATIONa1VEMWLESISPEOIAL ITEMS- : rn The Certificate Holder is included as Additional Insured as respects the -- ;V m agreement to provide fire protection, prevention and suppression services as wmr a SHOULD ANY OF THE ppp///p/p/p/777gggggg777OVE DESCRIBED POLICIES BE CANCELLED BUORE THE EXPIRATION DATE T REOF, THE ISSUING COMPANY WILL ENWVOR TO MAIL 30 DAYSWRIT ENNO E TOTHECERTIFICATE HOLDERNAMEDTO THE City Of San Juan Capistrano 's!' LEFT,BUT FAILURE TOMAIL H NOTICE SHALLMPOSE NOOBLIGATIONOR 32400 FESS* Adelant0 Y` LIABILITY OF ANY KIND UOMPANY. ITS AGENTS OR REPRESENT ATIVES. San Juan Capistrano CA 92675 Attn: City Manager AMORTIZED REPRE TATTY! 234315129 4Y� � 1tiCOIip �6-5;1;7Xitl} .. " hC �Qk.Hdk�At1(1� 199tl l- I 0 0 POLICY NUMBER: CSR 120834401 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION MEMBER: ORANGE COUNTY FUZE AUTHORITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS PUBLIC ENTITY LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 Attn: City Manager (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 as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. aRoLLiNs HUDIG HALL Date: To: From: SUBJECT MEMORANDUM March 21, 1995 All Certificate Holders Rollins Hudig Hall of Northern California, Inc. Insurance Services One Market, Spear Toon r. Suite 2100 San 6"r:mcisco. CA 9410.5 Telephone -415 543-9360 FIx -IIS 543-5628 Susan Blankenburg, Rollins Hudig Hall Public Entity Division ORANGE COUNTY FIRE AUTHORITY LIABILITY INSURANCE Enclosed is the Certificate of Insurance and the original Additional Insured Endorsement referenced in the Certificate we issued on February 28, 1995. Please contact us if you have questions or if we may be of further assistance. cc: Joan Steiner, Administration Division Manager An bAW Compam