Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
11-0623_RINCON_Insurance
JUN -15-2011 THU 02:47 PSI FLwcRAT2D CPU FAX NO, 5074,,44852 P, 03 _.... � �� Y,e j ir;'j. t �PhP ; h i �F Ir y3,Y lii� V'n ?!I'� f1yk�,J �'—� ? S Yr... m5rt„ t. +�,... r•Y.i.,r, x'. :..t�. wa. z.y ��>a±.�4f�<,><Ih•w�Ryj .' Eh..F.n. RRt3C3i3I EH ., -} { �jir } 'f•m'S IA�y't "14iy y. a � .... ...1: w� e $aFr, zt gltYClalfsd+f7dlfiYY1. " 3 s ` .Y?�,.d� � ,.N�� jt .+ s �- - THIS CERTIFICATE IS ISSUM AS A MArrE,IR OF IWORMATION ONLY AND CONFERS NO RIGHTS UPON THR CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Home Office: P.i Box 328 ALTER THe COVII A! r-OfiDED BY THE POLICIES EFLOW. a N1 3 AFFOR caRAG Owatonna, MN 55060 Phone, 1-808-=.4949 camp NY MRRATM MiJt'iIAL INSURANCE COMPANY OR A FMERAT tI $ERVICE INSI 00MPAN'V _ INSURED RINCON TRUCK CENTEH iNG 114 RINCON CT COMPANY s �3AnPANY SAN CLEMENTE GA 92972 C COMPANY I� N3 - i t7"?4 -'' X n r,'•t 3 , s; ;w. kF, a••, � ,>; w, a,' £rr..a«. P V:,, _.mar N ..ia."v �' R ti rf Y Ire : 15 ? fi rail@.Fis a w"r <i Z r La B' ,; v r,a THIS IS TO CERTIFY THAT THE POUCIESS OF INSURANCE IISTE'R F1KOW HAVE BEEN ISSUED TO THE INSURED NA.MFp A817VE FOR THE POLICY PFR[00 INDICATED, NOTWITHSTANDING ANY F'ItiiiCLIiIti KNT, TERM OR CONQJTJOW OF ANY CONTI I" OR OTIi POCUMENT WITH ii TO WHtGH THIS ct'RYEPICATE MAY BE ISSUED OR MAY PERTAIN, TIDE iN%JMANCE AFFORDED BY THE I'41.ICIES D1:SCRIEIED HEREIN IS aUWEVT TC ALL THE TIZRMS, E3CCV1 JONS AND OONI�iTI9NC OF SUCH POLICIES. LIMITS SHOWN MAY HAVP WN 19FOU±ED OY PAID CLAIMS. - ....... C4 LTA ,. TYPE or p guRANCA _ K"CY N€lMRER �"�«p•�-�.W�'....�� ,r I dLIOY Pli DATE(i - POLICY k%PIRAY114INN DATE IMII�It#aDJYYt jIM(1 G GGh6>3iAL LIAEIi.IT!' i�IrF.tEPAL AGGFiEfiAY� A � I..� I�[} PAfll7iJOY£ •CCIh?�'f PAC:3 4 2,000,W0 C0Mv$fTC'TAi,C-FNERALUANUTY A `'' CLAIMS MADE � pCCUR 9420426 03/01111 03/01 /12 PEAgONAI. re AOV INJURY 4 1 {1Qi3_ 000 EACH oLcumigi Ov`NEFrS & CONTRACTORS TROT nFIE DAMAGE !An m o Liza 6 100,0m �� �hEO E7iP IAii4 nn8 p<3rigi?) � AVTOMLIOM X LUABILITY ANY ALFF S CrGI`AFfINE6i 61N= -LIMIT f3l1 6 11 01000 IINJURY mi?"-") ' A ALI. ®45+N0 AUTO SCH iliAi 9420426 0/91/11 OW01/12 pCiTi II4JLIRY m liar �t�ld�tt4l � X KRED Au -m NON-ClVdNED AUTOS PRpfnERTY OAMA+'a'" 9 , BARAC19 LIAFNLiI Y A,U1" O OAY , kA,4CCJDENT 3 ATplii THAN Auto tSNLS' �.. , ` ANY AUT0 'aAC}I ACC€TIENT 0 ^ ACtlEGATk a EXCM LIABILITY EACH OCCLifiRENCk . L-11-00-01-000 AGGAI s 1,000,000 A UIolaRFld FOAM 9420428 03/01/11 0,1/1 f ajHii i THAN m4ii ikLt.A i"r}RNl YdMEnr. C(irjli`:iP>1SATIOtd AND we STATLI- FT.l.PLOYEI�` tlAAN-iY� THE PROPRE£i£IIt! 11 INCL PAMT`N9P,S�EkI»Ci.ITIVE 1 ii MCH ACCIDEtiT EL OI:,GL'AgE PF3LECY1.lMiT } Fi4 dlssASk -EA P PLiiYEt: -. 6 h OFf`lr-'li Ai I;xcL OTHER i 1011 Tiiild OF DPERATIONSiWCATiQY'7St"1 EH. CUZtAt'gCiAI.ITM is 0TIFICATENCUM lS AN AWY109AL 1 fisUAEil FOR GENERAL UASIOW, ,?.'v];V?5i 7 3 "- 1 'F Y1 x'^5''r 7 is lfi'? SG. ? �7 �I OF SAN JUAN CA1iEAIQ �•.,;,�� 26 vt f'l _`j;I;ry�tnn A. dk a:•ii F•.r�;>.. ?...c•', Ly%?;dhirr�Y•"i'f �� OF THE AnOVE rCCBC#IFfiPA POLICIES BE CMCVLi BkFafiF THE Si py I�1.•9^� 32400 PASFO AC F=e N I O rxpi ilAEs]N DATE TH `i THE ISSUING GpmPAPdY WILL C^t EAVAR TO MAIL SAN ,JUAN CAPISTRANO CA 92675 _j-00AYs WFMEN NuncIi TO THIS (WTIFICATE HOLDER i TO VE LEFT, BUT FAILURE TO Tis L SU011 NOTICE Si IRfti NO OBLIGATION UH LIFpIL3"fY aP ANY X€N€7 UFON THP COMPANY, ITS Aefli OR fiSPf{E5 fiTATIVF6< AUTHORIM REPRKENtATIV{E fk U r )- f", Y', VY L �Y" J}q.LR� SKLix Y- l- 1 �, 1. •.. ll�p } S1 flv 7yh ?JIN'1,..:,'*�"�'*f$1,2 u�7>(I,�•.�i (32J,_2p5,.j1F„)�Y;�>?f tia Alii t.r'.''��'t 1`i.'v.�!.", RviiF,IL� JUN -16-2011 T U 02:47 PM PEucRA 'FD CPI FAX NO, 5074qi4852 P, 04 .... ie lit',/ :•. \ w' J:¢ -IJV. 5�. R{. #' .f j` V%V:,�{ Q? i'. 'i5 fJ ;�.5. \{ Nle.\'; };4 �'� i C 4 _ r r.r.v •'.... - - , fr1 0411101.1" yy „ . YT, a Fy� "E' t � 1' i" j'_K r- S ✓ t a,w;. !. !,, tiny. .1 `€n�v� .rti Is .N, r.. .h'P�E.n;ry;¢x ,•.r �.:, K:�I 4{W y. fl,�R `itSr+F ; 2. 4"S?� ', nt- 'Q?♦;4 L �Y f.. PROPUCEA THIS CERTIFICATE IS ISSUED AS A NIATTIZA OF INFORMATION ONLY ANIS CONFERS NO RIGHTS UPON THE CERTIFICATE qDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AWN0, EXTEND OR f oMe Off rw F'.0. Box 328 ALTER THIS EOVMA GE AFFORDED BY THE POL.ICiES BELOW, Owatonna, Mtn 85060 COMP IES AFFORDING COVERAGE Phone: 1-888-333-4949 COMPANY FFORRATED MUTUAL INSUFIANCE OOMPANY OR A I=FOEnATCD SERVICE INSURANCE COMPAW IA6LIRW 3 e HINCCN TRUCK CENTER INC 114 RINCON CT COMPA Y � COMPANY SAN CLEMENTE CA 92672 E COMPANY I] Y (,IS ;; 'sa 3. :�3"•�'r?r.' 4, F a �.• K. X �}.� 3I 11 t.;y. ,. !Fri \ J Xh. t Y fir" T,TS:j✓`�. ( SY �S3 �4`�::iTl, N 3 } " .� 1: .'��f 5 q s So':�is',-. ..•, a....�:�.rg:_..r,4 .r.�: ., „��•�F. :�.,..�5�� 1•:v.�E�'c�ti���a�s`s`�.rd,�;.Vx'��'-Mss,--.i;•,�,�;��dti:.aR.e�-� .rl fid;: ���1.H.W vii .�i. �,,, :9f .i.lz'-�„a,� 3•,n:".r',ae; TH[S IS TO CEATIPY THAT THE POOCIC-s OF INSUAANCE i.IBTlin allOW HAVE 386N ISSUED TO THE INSURED AlAmEU ABUIJF POR THE POLICY PERIOD INDIWCO, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR ormW DOCUNIFNT WITH RESPECT TO WHICH THIS CEFITIFICATE MAY BE ISSUED OIR MAY PFRTRtN, Tlit IN:WFIANCE AFFORDED BY THE POL,[C16S DESCRIBED HEREIN IS SULi. 6CT TO ALL THE T;Rms, EXCI-USIONS ANN CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIhAS. TR TYPE OFINSVRpN1.`£ ! F>aIaCY NIJ 't'dF.4i POLICY crPlInvc DATE (rdMID17INY) "way FxpKhrlf3N UTF INIIL4II'30)YYI UltI7S GtNERALUAWL37'Y - 133ENERALAiXRWATC 4 2,000,000 x COMM ERCIAL G�NrAAL LiA©4JTYh� I _Pidi3L1wrs • comp 4F AGO— 6 2,000 000 Q ;:;, GLAlhq hthDE � OCCUR �42,042C � 03/V1/11 03/01/12 PfIi5CltdAL fkACV INJI.IFYY 0 1 �� EACH OCCURRENCE _��� C3VVN�F#`G 8, rONTRACT6R'& Mar FIRE OAMAGE IAn_V Wo flea) MED £xP IAnv ons rem# d • atyT«�plx®ILF ''�� X L[Afl€Lrty I ANY ALiTO � E 1 i COMOINPii SINGLE LIMIT E 4 9bt11LY Ita,llJftY {Pf Pr” "i � A ALL QWNW AUTOS CCHLODUD kUTEIS 9420426 03101/11 001112 J300ii-Y Ir JUNY €Isar xc*m) 6 x 1418ECa AUTnS NQN-OWNEt WT4S - r P80KRTY DAMAGE B I ARA13E UANLITY ANY AUTO AUTCT ONLY - EA A.CCICfENT 6 27HER THAN AVY0 ONV: EACf j ACCIDENT t AL4 nS! 'AY£ $ PI"99 LIABILITY EACH aCGuiiR£RCE M 1 DO A A�UMBRELLA FORM W04128 03/01/11 03/01/12 Ai3GREQAT& � � 1,000,000 4 QTHVf THAN UM3AELLA FOAM NfOROM COMPE€YSRTION ANp WEMPLffMS' UAaLaTY I - y WC 9TATu. C'rts �;; 1 EL EAGpI ,kCViDEN r EL MEEAE0 - POLICY LIMIT 4 TNF INCL FArfrNER5iExI:CtJ NkR ❑WCE99 AliEi ERCL MFL p,SEAa'k -CR Fdo{IpLOYI'E 4 C3TfIF-R E CESCRIP-nON OF 4P;nRAT€Gi{9§1LflCATIgASdYEH[CLE&i�WY lA1. fELMS CVffIFICATrrH0L fk 15 RH ADDITIONAL INSURED YON (ii:144£Y4R6 iIRB€L€TYr M ,:?.r•°`iz.#r�i,`1"?h'I,M1,'r�;%s'!,•rc:>es.il;'.+r,rt,",si ".,F .L''r.i1„�v.r� r ...:.!P,..�r.'i1�ibn ar}�r:z;F•3-:.•9:.•i,,5'1.,.•.`r:'°r.`,.i,^Forinhr':;<h+�':Sti.....,.Y, �y.,:Fzi: 7 OF SAi,+�I JUAN CAPISTRANO 26 rw00,ia ANY OP THE ABOVE € WaMft£b POIJOIn BE GANCF 0 PE�ri£ THE rCITY DATE iHgnpor, 'I p lssooi0 COMPAW 413111 wt[ vafv TO MAIL $ W€3 PAilE0 ,i tDC A �iTO .iPIRATION SAN JUAN CAPI TRANO CA 922675 _J()_ RAYS WMrtN NOT= TO YHTw nFRTIFJGATE HOLDER NAMW TO THE tWr, BUT FAIWAr,. TQ MAIL &UCH NOTICE SHALL IAA'P064 N6 6BLI4ATiON OR LIA81UTY 00 ANY IIlNd UflQH TILE' COMPANY. ITS AGENTS OH RI<Pilf'PEiYfATNE3, AUT•HIONBED REPM4104YATIVE F �„ �rh �Y a.>;3Y2{ �7 r�, f ..: 1 "tti e- �,4J'✓3i, l l' ii' l rt^ji Ea !}Silo' ' s L'i hr �. it _ K+ d,/,�. i f �(..�/ l� 1 .'i.. f� `i, T,v 41if•.'�?'�, `` ,.'I. rb iii)y i •>-I'�';! S •.;/:�°. �. 11:, arAvl'+f�'., Ca&D TIFI�ATE LIA�ILIT"Y IRI UI IN � OP IIS 1203 DATE {MMtDDIYYYY) RINCO_l C)6106/11 PRODucER Protection Group/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONDealer City of San Juan Capistrano ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arroyo Insurance Services HOLDEP, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 36 Discovexy, #130 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Irvine CA 92618 Kevin G. McWilliams Phone:949-203-8550 F'ax:949-208-8560 -- INSURERSAFFORDING COVERAGE NAIL# INSURED —_ INSURER ICR Group Tnauranca Campantao - W 09229 INSURER B: Riricon Truck Center INSURER C' 114 Rincon tet Clemente CA 92672 ; INSURER �:$an , m.. �. INSURER E: WVw 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. TNS Tr -TOTOT Y LTR 1tSRD TYPE tJF INSURATtCE P'LICY NUMBER DATE SN1Nfftrtr A Y) DATE MWODEYY LIMITS DATE THEREOF, THE ISSUING ENSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN GENERAL LIABILITY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL City of San Juan Capistrano IMPOSE NO OBLIGATION OR LIASILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR EACH OCCURRENCE S San Juan Capistrano CA 92575 AUTHORIZED REPRESENTATIVE COMMERCIAL GENERAL LIABILITY I CLAIMS MADE OCCUR Kevin G. McWilliams PREMISES (Ea occur_ oa) 5 MED EXP (Arty one person) $ PERSONAL d ADV INJURY $ „. f( _. GEN'L AGGREGATE L TMST APPLIES' PER: POLICY 1r,__1LOC GENERAL AGGREGATE S PRODUCTS - COMPIOP AGG. -mm AUTOMOBILE LIABILJTY ANY AUTO COMBINES] SINGLE LIMIT (Ea ecaident) � � 5 -- - - - -- ALL AWNED AUTOS SCHEDULED AUTOS I BODILY INJURY (Per person) »T.-.._......_ 5 HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per actident) $ PROPERTY DAMAGE (Per accident) 5 -- GARAGEUABILETY I AUTO ONLY »EA ACCIDENT mm �$ _ ANYAUTO R OTHER THAN EAACC 5 - 5 I AUTO CINLY- AGG I EXCESS UMORELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE mm S OFOUCTIBLE i 5 RETENTION $ $ i WORKERS GONPENSATION AND Y EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE OFPICERIMEMBER EXCLUDED? li yes, dasrril a ender SPECIAL PROVISIONS below OTHER 5001896 Q 07 /'28/10 07/28/11 30RY LIMITS ER E.L,FACHAccvrNT 51.,000,000 E.L. DISEASE - EA EMPLOYE ..__ ..._. 5 1 Ci 00 0 Q Q r r E.L. DISEASE -POLICY LIMIT 5 1 r 600 ,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES i EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL FRO%A$IONS Evidence of insurance. v�rc�ertjani � r1wLAjr_re C:Afff-Ft 1 ATICIN M%,Utcu Au JAUU "vat (DACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING ENSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL City of San Juan Capistrano IMPOSE NO OBLIGATION OR LIASILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 32400 Paseo Adelanto REPRESENTAT€UT 9, San Juan Capistrano CA 92575 AUTHORIZED REPRESENTATIVE Kevin G. McWilliams M%,Utcu Au JAUU "vat (DACORD CORPORATION 1988 If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate molder in lieu of such endorsements). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon, n..vnu 4S kcvv IrVuj JUN -08-2011 WED 12:43 PM FAX NO, P, 03/03 .. ... .. . ... .... ... ®,CMRD,, rY PRODUCER VIR A klyy THIS CERTIFICATE IS ISSUED AS A MATTER OF lNrORMATION THIS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY Home Otfice: P.O. Box 328 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR THE COVERAGE ArFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Owatonna, MN 55060 i CQMrANy FEDERATED MUTUAL INSURANCE COMPANY OR Phone: 1-888-332-4-949 A FEDERATED SERVICE INSURANCE COMPANY RINCON TRUCK CENTER INC 114 RINCON CT COMPANY SAN CLEMENTE CA 92672 COMPANY COMPANY D "R THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE. I-ISTIEDPELOW HAVE KEEN ISSUED TC]THE INSJREr) NAMED ABOVE FOR THE POLICY PERICID INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR ql)NDIIION OF ANY CONTRACT OR OTHER DOdLIMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANPE AFFDRDEP BY THE PGLICIE$ prSCRIDED HEREIN IS SOBJECT TO ALL THE TEPMS, EXCLUSIONS AND CONDITIONS Cir SUCH POLICIES. LIMITS SHgW RY PAID CLAIMS. �_M?AY HAVE SE115N AECILI Fuwuy EFFECTIVE FFOLICY Wt"ATIONCED ca 'rYPF OF INSURANCE POLICY NUMBER Limits LTR DATE (MMlDDfYY) DATR iMMIDDiVY) ltgNORAJ. LIABILITY Gfj3EjiAL AciciR(A�E �Er, i cam' 000 000 PAOPUCTS-COMPIOPA GG o Z000.000 GEN11RAL LIAO IkITY PRSSDNAL & ADV INJUMY 0 1,000,000 A fMEARJCIAL $ NIAD� FX71 OCCUR 94204-26 CLAIMS 03/01ji 1 03AW-12 OWNER'S & CONTRACYOR'S PHOT EACH 0Ct IKS= 0 1 gol) 000 FIRE DAMAGE (AOV OM 11ril1 0 160,000 MkO EXP lAMF,` Ono pvtHcin) 0 At X "AIMLITY ANY AUTO COMBINED SINGLE LIMIT 4 1,000,000 A ALL OWNED AUTOS SCHEI)UaD AUTOS 9420426 03101/11 03/01112 BOVLY 04juay 1` par I'l LX 1 X HIRED AUTOS NON -OWNED AVTOP, BODILY INJURY (per tircidoO. PROPERTY QAMW gA419 UASIUTY AUTO ONLY - ]FA ACCIDENT 0 OTHER THAN AUTO ONLY. TMCA THAN A, Ar N ACCIDEN I �BA ANY AUTO AIZOArGATP 0 I EXCESS UAOIUYY rAcil OCCURnINCT AgmuATu a 11000,000 A v 942042EI UNIRK" FORM 71111 03/01/12 OTHER THAN UMRAgLLA FORM WQW9R8 OMPENSATION AND 0 - I WC STAITIJOTIi ,, 1. 'Y-' FrAl HIL I EACH ACCIDENT EMPLOYffis* LIABILITY jELQjSfASI]i - POLICY llmr YHFPR0PNFTOA/ INCL PARTNFASaXiCUTIVE FrECERS ME.EXCL IL:lS5ASaAMpL( 0 YHM nESCRIPTIDN OF OFf;RAYIONS/LDCATIONWVFH;CLIMMFCCI" ITMS .7 t n 3376902 CITY OF SAN JUAN CAS p1 26 SHOLIUD ANY OF THE ABOV9 WF4CRIPM POLICIES BE CANCELUP 0WOftA THR 32400 PASEO ADELANTO eXPisArIM DATP THEREOF, THE ISSUiNQ COMPANY WILL ENOFAVOR TO MAIL SAN JUAN CAPISTRANO CA 92675 1 10 DAYS WRITTEN Nnog TO THE CERTIFICATE HOLDERNAMED TO THE LN -7, OUT, fAILL111 TO MAII 6U0H NOTICE WALL IMPOSE I'D 1111"ICIATION OR UAlIUTY OF ANY KIND UPON THE COMPANY. ITS AGENT$ OR RMFSENTATIVES, AUTHOAl2RD REPRFSENTATIVO ......Ix F it N, MO.— A—CWW, CEkTiPfcATE FEDERATED MUTUAL INSURANCE.COMPA H T Home Offim P,O- Box 328 Cvlatonna,, tvIN 55060 Phone: 1-888-333-4949 INWfico RINCON TRUCK CENTE-9 INC 114 RINCON '--T SAN CLENUEN FE CA 92672 CERT'W)CATCLHOLDER tO AN A0 Of MsOKAL MZURtl) rOi� GENLRAL UASIUTt .. . . .. . .. ...... .. .. .... .. . ...... CffYOF SANJUAN CAPISTRANO 26 5R40UD ANY Of" TOE AkOVE O1SCF,18ED FQLW,[ES Bf CAAN(�CUXU: 11,U ORE. THE 32400 PASEO ADE.LANTO f-,XP�RAr1QR OATF THERFO, 7HE 158UNG WUPAWY WILL ENDWOR 10 MML SAN JUAN'CAP6T..RAN0 CA 92-675 DP/ , WRITTEN WUCETO T.411 GERHOCATL JiuuiFm NAPAIED TO THE un" Rtr, �,xfl-URC- 70 MAIt 50NA. Wrr'r q4ALL fmPOSt NO 0SUCATiON. 00 MASUTY dj OF ANY MNO UpWq THP: comp)";4y- mN On ........ ........ ..... . . ... (D A CORD CORP !WS f C--i2T I FY THA', 7NE !°ODCIES OF iNSURANCF L.IS I' 1) E1,EL0Vv' HAV' --. BEFN t-SSUED, THE iN'�iURED N'ATVF'r11 ABOVE. �FCJ,Hf, iPOL k -,Y p6R!OD ANY REQUIR. MENT, IEPU CR CONDII [ON OF ANY CONIf4,ACT Ok OTHER 0000MENr VV"H kCSFECT 70.V,�HtCm Tm� CTC""Tlf]CATF NIAY LIE SSUED 0Q, tAAY PCERTAN, THE jN13k)?WNcr AFFGWIEDI BY 71�c 1"1()U('1E5 HFR.F.q,1 ;CSUpjE(-,T1'0Ai.L7Hr. TMMS; EXULISIONS AND?CONCA . TH)NIIS 0"�Url . . . .... It POLIG!F'S. Uf'AITS SHOWN MAY HAVE BEP -4: REDOUE.D t3Y PAID CLAUS, ..... . ...... ..... .... I .......... . —11 ... ... . .... . .. . ................ . . .......... - .. ....... .... .. TYPE OF INSVRAM�-� i;Ct7 i;AP mwin.4i DATE jMt,11DDNY1 OArzwmfo"wyyk WATTS S-'Em�u't UAIO"Ty_-;c Nf'F7'- AGl ECA r, o --gpoo' ,.ATC, 7 '-,0 M 5 0000 A CLAIMS M,%Or- X occnot 94204126 0"Yo. Ill 1 03/01/12 OWNEWS -% CONTRAC71e17` 5}1�07 ....... .... . .. ..... 000,0010 NU 100,000 r- mwuTy -�yTom*-4 X .......... . A41 OWNER AUTOS A SCHEDWEV AUTOS 94-20426 1011 1 0310111.2 ...... ... .. . x N-101111=01mwpl Au to jGAIiA0r--' LIAMUTv'r AL)TX) DJLY 'A ArCOEN ANY AUTO rizCl T#'IANW)TQ, ONLY-' EA(,H T EXCF5S 1JAERUTY . ......... EACH $ 0 10 0000 A X FOO RO 9420428 03/0 1114 03/W/12 rU�% L"MURELLA FORM WORK ERS CtA4F-.741;A.r30N AND -E' UC Lt -T CERT'W)CATCLHOLDER tO AN A0 Of MsOKAL MZURtl) rOi� GENLRAL UASIUTt .. . . .. . .. ...... .. .. .... .. . ...... CffYOF SANJUAN CAPISTRANO 26 5R40UD ANY Of" TOE AkOVE O1SCF,18ED FQLW,[ES Bf CAAN(�CUXU: 11,U ORE. THE 32400 PASEO ADE.LANTO f-,XP�RAr1QR OATF THERFO, 7HE 158UNG WUPAWY WILL ENDWOR 10 MML SAN JUAN'CAP6T..RAN0 CA 92-675 DP/ , WRITTEN WUCETO T.411 GERHOCATL JiuuiFm NAPAIED TO THE un" Rtr, �,xfl-URC- 70 MAIt 50NA. Wrr'r q4ALL fmPOSt NO 0SUCATiON. 00 MASUTY dj OF ANY MNO UpWq THP: comp)";4y- mN On ........ ........ ..... . . ... (D A CORD CORP rn POUCY NUM RER .9.420426: COMMERCIAL, GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE. POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL: INSURED - OWNERS,. LESSEES OR. CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION "his endorsement modifies 4isurance provided under tile foflowin-g., COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Person(s) Or Organizations Location(s) Of Covered Operations CITY OF SAN JUAN CAPISTRANO I ANY COVERAGE PROVIDED BY TMS: 132400 PASEO ADELANTO lEENDORSEMENT APPLIES ONLY TO SERA CE AND !,SAN JUAN CAPISTRANO CA 92675 EPAIR WORK WHILE AT: CfTY OF SAN JUAN APISTRANO 32400 PASEO A DELANT0,SAN JUAN CAPISTRA111) CA 12615 �o cofffjje�te thr. ��c)edule, if not �S�OWII above, W01 �ej mininthe-Delclara-dons, Ax Section 11 Who Is An Insured is mer led: toS-, 10Mh respect to the insurance afforded to these indude as an addifional insured the:person(q) o'r additional insureds, the ffad owing additicna[ organization(s) s�*wn in the:SCh.e.dUle,. but only with respect to fiability for 'bodily injury", 1. 1 h.is insurance does notapply to "bodity'inju'ry., property damage" or "personal:Prid adverfisng or"property dama injury" doused,. aused,. in whole, or in pa . part, t, by:,,, go" uccurring after'- 1. It worki. including materials, parts or I Youf acts or omlssdons�. or equipment furnished - in connectinn with such Z. Tho- acs or on.Ws&iom of those: an'ting of) work, on the, project {other than service. your beh8ff. maintenance or repairs) to be performed by [11 the Perl"OFMarice of your ongaing operations or on behalf of the additional inured(,q) at for the addffionaf imt;ur(�Id(s) at the location,(s) the tocation of the ;�overed operatians has desigmited above. been completed; or 20 That portion of "your work" out of which the injury or damage arises has boen put to its intended use by any Person or organization other than �inother contractor or subcontractor engaged in perforMirig operations for a principai as a part. of t h o same project, RiNCON TRUCK CENTER INC 114 RINC ON CT SAN LE ITR CA 92672 C ISO Properties, fric,, 2,004 Pago I of I CG 20 10 07 04 Polk,Y Number, 9420426 Transaction Effective Date, 015-16-2WI A C QRV,M PRODUCER INSURED FEDERATED MUTUAL INSURANCE COMPANY Home Office: P.O. Box 328 Owatonna, MN 55060 Phone: 1-888-333-4949 RINCON TRUCK CENTER INC 114 RINCON CT SAN CLEMENTE CA 92672 .- -DATE WMfDWYYj .L'If�►1E .I 06/06/11 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 TYPE OF INSURANCE I POLICY NUMBER POLICY EFFECTIVE I POLICY LYPMATION I ! LIMITS LTR I i PATE IMMIppfYY} DATE (M1VIlODlYYI GENERAL LIABILITY GENERAL AGGREGATE S 2,.000,000 X COMMERCIAL GENERAL LiA6':LiTY PRODUCTS - COMP/OP AGCz S 2 000 000 A ;.; CLAIMS MADE � OCCUR 9420420 ... 03101/1 1 03/01/12 PERSONAL & ADV INJURY $ 1 ,000,000 ` EACH OCCURRENCE .., 5 1,000,000 OWNER'S &CONTRACTOR'S PRO'I' FIRE DAMAGE Any one. fire) S 100,000 I MED EXP iAny one person} $ AUTOMOBILE LIABILITY X I ANY AUTOi COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY ! ALL OWNED AUTOS A : SCHEDULED AUTOS 9420426 03/01/11 03/01/12 (Per person} $ is BODILY INJURY _.,..-._._.._......_._, - I X IHIRED AUTOS _E X E `JON-CWNED AUTOS I (Per accident) S E I- s .............. ._._.,,,,,, i � ` I iIi PROPERTY DAMAGE $ GARAGE LIABILITY ! [ AUTO ONLY - EA ACCIDENT S ANY AUTO I OTHER THAN AUTO ONLY: - EACH ACCIDENT $ € AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S 1,000,000 Ax UMBRELLA FORM /0/ ... .............. 100_--o9420428 03/01/12 C OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND i [[[ WC STATU- iOTH-I EMPLOYERS' LIABILITY ? 70RY LIMITS . ER I"ACH ACCIDENT THE PROPRIETOR/ '- INCL ; EL DISEASE- POLICY LIMIT 6 PARTNERSILXECUTIVE ; -- OFHCFRS ARE: �'�� EXCL' EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS CITY OF SAN JUAN CAPISTRANO 26 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 02400 PACS'EO ADELANTO EXPIRATION BATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL SAN JUAN CAPISTRANO CA 92675._Q,_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE NOW - Company ID Number: 419889 .t the P. ...... Information I t" h C' re a ing. o: ....J.,�rpqram Adrnin.istrat0s),f r:6ur!.,.01.....;411 n: policy y ....MP Y.O r ppera.'. a b questions o UproVe"MS." ....GARVGjACOMIINT... mhe E-maji Address: r Name;: RARRA ........ 4A:: JAY, e[ephioe Nvrrber: (949J 492 3524 Quit. 223: Fax:.NuMb 6 -mail Addiess, Page 13 of 13 1 L -Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify Registration Page 1 of 2 Physical Location: Mailina Address: Address 1: 114 RINCON COURT Address 1: 114 RINCON COURT Address 2: Address 2: City: SAN CLEMENTE City: SAN CLEMENTE State: CA State: CA Zip Code: 92672 Zip Code: 92672 County: Additional Information: ORANGE Employer Identification Number: 330753337 Total Number of Employees: 101019 Parent Organization: CORPORATION Administrator: How did you hear about E -Verify? Someone else in your current company/organization Other Marketing Channel: Organization Designation: Employer Category: None of these categories apply NAICS Code: 811 - REPAIR AND MAINTENANCE (811) Hiring Sites: 1rc�t' CALIFORNIA 1 E -Verify Users:. V d{ Last Name First Name M.I. Phone GIACOMINIGARY (949) 492 - 3520 ext GIACOMINI GARY (949) 492 - 3520 ext JAY BARBARA (949) 492 - 3520 ext E-mail 222 gary@rincontrucks.com MOU Signatory 222 gary@rincontrucks.com 223 barb@rineontrucks.com I certify that the information provided for this registration is correct. I am aware that Federal law provides for imprisonment and/or fines for knowing false statements or other fraudulent conduct in connection with this registration. I am aware that providing any false information may be grounds for terminating participation in -Verify, i agree https:He-verify.uscis.gov/eD.roll/Registration.aspx?TS=YES 6/3/2011 Illil. Company ID Number: 419889 THE E -VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION MEMORANDUM OF UNDERSTANDING ARTICLE I PURPOSE AND AUTHORITY This Memorandum of Understanding (MOU) sets forth the points of agreement between the Department of Homeland Security (DNS) and RINCON TRUCK CENTER INC (Employer) regarding the Employer's participation in the Employment Eligibility Verification Program (E - Verify). This MOU explains certain features of the E -Verify program and enumerates specific responsibilities of DHS, the Social Security Administration (SSA), and the Employer. E -Verify is a program that electronically confirms an employee's eligibility to work in the United States after completion of the Employment Eligibility Verification Form (Form 1-9). For covered government contractors, E -Verify is used to verify the employment eligibility of all newly hired employees and all existing employees assigned to Federal contracts or to verify the entire workforce if the contractor so chooses. Authority for the E -Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. § 1324a note). Authority for use of the E -Verify program by Federal contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibility Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as a "Federal contractor with the FAR E -Verify clause") to verify the employment eligibility of certain employees working on Federal contracts is also found in Subpart 22.18 and in Executive Order 12989, as amended. ARTICLE 11 FUNCTIONS TO BE PERFORMED A. RESPONSIBILITIES OF SSA 1. SSA agrees to provide the Employer with available information that allows the Employer to confirm the accuracy of Social Security Numbers provided by all employees verified under this MOU and the employment authorization of U.S. citizens. 2. SSA agrees to provide to the Employer appropriate assistance with operational problems that may arise during the Employer's participation in the E -Verify program. SSA agrees to provide the Employer with names, titles, addresses, and telephone numbers of SSA representatives to be contacted during the E -Verify process. 3. SSA agrees to safeguard the information provided by the Employer through the E -Verify program procedures, and to limit access to such information, as is appropriate by law, to individuals responsible for the verification of Social Security Numbers and for evaluation of the E -Verify program or such other persons or entities who may be authorized by SSA as governed Page 1 of 13 1 E -Verify MOU for Employer I Revision pate 091€11109 www.dhs.gov/E-Verify Christy Jakll From: Christy Jakl Sent. Tuesday, June 14, 2011 3:11 PM To. .till Thomas Subject: Tuttle -Click & Rincon Agreements Hi .dill, After reviewing Rincon's insurance, they did not provide the General Liability Endorsement form. We also need to receive all the insurance and e -verify documents for Tuttle Click -Ford. Thank you! Please let me know if you have any questions. Kindest Regards, Christ-� J akl Deputy City Clerk City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (949) 443-631.0 1 (949) 493-1053 fax