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04-0512_SOUTH COUST WATER DISTRICT_Insurance Association of Arnie Water Agencies/Joint Powers I6ance Authority 5620 Birdcage Street, Suite 200, Citrus Heights, CA 95610 CERTIFICATE OF COVERAGE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER TITAN THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED HEREIN. ,I 1 . MEMBER South Coast Water District P.O. Box 30205 \v Laguna Niguel,CA 92607-0205 - • yUBLt�WORKS COVERAGE INFORMATION This is to certify that coverage documents listed herein have been issued to the Member Agency herein for the Coverage period indicated. Notwithstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. Type of Coverage Certificate# Effective Date Expiration Date Limits General Liability Commercial General Liability Contractual Liability Products/Completed Operations Occurrence Auto Liability Owned Autos Hired Autos Non-Owned Autos Auto Physical Damage Scheduled Autos Hired Autos Property Special Form Mobile Equipment Boiler and Machinery _ Crime Workers'Compensation MOWC&EL-070105 7/1/2005 7/1/2006 0 Coverage A-Workers'Comp. Per Accident Statutory Limit 0 Coverage B-Employer's Liability Per Accident $2,000,000 CERTIFICATE HOLDER DESCRIPTION City of San Juan Capistrano In reference to the Emergency Interconnection Agreement dated January 20,2004,for Attn:Amy Amirani, Public Works Director the Doheny Park Road Water Pipeline. 32400 Paseo Adelanto San Juan Capistrano,CA 92675 CANCELLATION:Should any of the coverage documents herein be cancelled before the expiration date thereof,ACWA/JPIA will endeavor to provide 30 days written notice to the certificate holder named herein. r Signed by: r Date: May 06, 2005 (Aut I rued Repres axsve) Association of California Water Agencies/Joint Powers Insurance Authority 5620 Birdcage Street, Suite 200, Citrus Heights, CA 95610 CERTIFICATE OF COVERAGE THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THAN THOSE PROVIDED IN THE COVERAGE DOCUMENT, THIS CERTIFICATE DOES NOT AMEND,EXTEND 01 t R E VE G AF R t1Y THE COVERAGE DOCUMENTS LISTED HEREIN. - I MEMBER OCT 8 2004 __- South Coast Water District P.O.Box 30205 Laguna Niguel,CA 92607-0205 PUBLIC WORKS COVERAGE INFORMATION This is to certify that coverage documents listed herein have been issued to the Member Agency herein for the Coverage period indicated. Not withstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. Type of Coverage Certificate# Effective Date Expiration Date Limits General Liability MOLC-100104 10/1/2004 10/1/2005 Aggregate $2,000,000 0 Commercial General Liability Per Occurrence $2,000,000 0 Contractual Liability 0 Products/Completed Operations 0 Occurrence Auto Liability MOLC-100104 10/1/2004 10/1/2005 Per Occurrence $2,000,000 0 Owned Autos 0 Hired Autos 0 Non-Owned Autos Auto Physical Damage Scheduled Autos Hired Autos Property Special Form Mobile Equipment Boiler and Machinery Crime Workers'Compensation Coverage A-Workers'Comp. Coverage B-Employers Liability CERTIFICATE HOLDER DESCRIPTION City of San Juan Capistrano The Certificate Holder,has been added as an Additonal Covered Party to the Liability Attn: Amy Amirani,Public Works Director Program,but solely with respect to those causes of action arising directly out of the 32400 Paseo Adelanto activities covered by the Emergency Interconnection Agreement between South Coast San Juan Capistrano,CA 92675 Water District and the City of San Juan Capistrano,dated January 20,2004,to construct the Doheny Park Road Water Pipeline. CANCELLATION:Should any of the coverage documents herein be cancelled before the expiration date thereof,ACWA/JPIA willeadeaveHe provide 30 days wri notice to the certificate holder named herein. !I n Signed by: r ! , �'h� '* Date. September 23. 2004 (AL rized Repres nt„4ve) 0 ADDENDUM to the Memorandum of Liability Cove a e for the a i OCT 8 2004 ASSOCIATION OF CALIFORNIA WATER AGENCIES JOINT POWERS INSURANCE AUTHORITY PU-,IC 41 OiiKS MEMBER: South Coast Water District COVERAGE PERIOD: 10/1/2004 - 10/1/2005 ADDENDUM DATE: 10/1/2004 ADDENDUM NUMBER: 5 Change in WHO IS COVERED The following entity is hereby added as an Additional Covered Party: City of San Juan Capistrano, but solely with respect to those causes of action arising directly out of the activities covered by the Emergency Interconnection Agreement between South Coast Water District and the City of San Juan Capistrano, dated January 20, 2004, to construct the Doheny Park Road Water Pipeline, and subject to a $2,000,000 per occurrence and annual aggregate limit of liability. Signed By: Date: Member 23. 2004 Auth6ozed Repres ive) Jwa„ 32400TO ® � SAN JUANNCA CAPISTRANSTRANO,CA 92675 fy ifi(OVORRN MEMBERS OF THE CITU COUNCIL (949)4931171 ' [RROUSRFR I IB61 SAM ALLEVATO (949)493-1053 FAX 1776 DIANE L.BATHGATE • WWwSanjaancaplSlYanO.Oig • JOEWYATr SOT ART JOE DAVIDD M.M.SWERDLIN September 17, 2004 South Coast Water District P.O. Box 30205 Laguna Niguel, CA 92607-0205 RE: Compliance with Insurance Requirements — Emergency Interconnection Agreement The following insurance documents are due to expire: / ✓ General Liability Certificate 10/01/2004✓ ✓ General Liability Certificate Form naming the City of San Juan Capistrano as additional insured. ✓ Automobile Liability Certificate 10/01/2004 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 seo Adelanto, San Juan Capistrano, CA 92675 by the above exp' n S. o have any questions, please contact me at (949) 443-6309. uevar Secr ary cc: Michelle Perea, Administrative Assistant San Juan Capistrano: Preserving the Past to Enhance the Future 0 Association of California Water Agencies /Joint Powers Insurance Authority 5620 Birdcage Street, Suite 200, Citrus Heights, CA 95610 CERTIFICATE OF COVERAGE THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED HEREIN. MEMBER South Coast Water District P.O. Box 30205 Laguna Niguel,CA 92607-0205 COVERAGE INFORMATION This is to certify that coverage documents listed herein have been issued to the Member Agency herein for the Coverage period indicated. Notwithstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. Type of Coverage Certificate# Effective Date Expiration Date Limits General Liability Commercial General Liability Contractual Liability Products/Completed Operations Occurrence Auto Liability Owned Autos Hired Autos Non-Owned Autos Auto Physical Damage Scheduled Autos Hired Autos Property Special Form Mobile Equipment Boiler and Machinery Crime Workers'Compensation MOWCBEL-070104 7/1/2004 7/1/2005 0 Coverage A-Workers'Comp. Per Accident Statutory Limit 0 Coverage B-Employer's Liability Per Accident $2,000,000 CERTIFICATE HOLDER DESCRIPTION City of San Juan Capistrano In reference to the Emergency Interconnection Agreement dated January 20,2004,for Attn:Amy Amirani, Public Works Director the Doheny Park Road Water Pipeline. 32400 Paseo Adelanto San Juan Capistrano,CA 92675 CANCELLATION:Should any of the coverage documents herein be cancelled before the expiration date thereof,ACWA/JPIA will endeavor-to provide 30 days written notice to the certificate holder named herein. Signed by: / Date: June 24. 2004 (Autb0rized RepresenS"ve) • • 32400 PASEO ADELANTO �% f� � A MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 �i' ILLS' 1�Q�1 VWTO (949)493-1171 /,y SAM AL L. BATH DIANE LGATE . (949)493-1053 FA% • if mmAlaAAlm FSIAIMME1 IA 6I WYATT HART www.Sanjuancapistrano.org 1776 JOE SOTO DAVID M.SWERDLIN June 8, 2004 South Coast Water District P.O. Box 30205 Laguna Niguel, CA 92607-0205 RE: Compliance with Insurance Requirements — Emergency Interconnection Agreement The following insurance document is due to expire: ✓ Workers Compensation Certificate 7/1/2004y=/ 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 e*Secreta itida If you have any questions, please contact me at (949) 443-6309. cc: Gena Schenkenberger, Secretary San Juan Capistrano: Preserving the Past to Enhance the Future Association of California Water Agencies/Joint Powers Insurance Authority 5620 Birdcage Street,Suite 200, Citrus Heights, CA 95610 CERTIFICATE OF COVERAGE THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED HEREIN. MEMBER ` ((-,ll uL_Ll South Coast Water District tiS f P.O. Box 30205 Laguna Niguel, CA 92607-0205 MAR 2 J' 2004 COVERAGE INFORMATION This is to certify that coverage documents listed herein have been issued to the Member Agency herein for the Coverage period indicated. Not withstancring any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. T e of Covera a Certificate# Effective Date Expiration Date Limits General Liability MOLC-100103 10/1/2003 10/1/2004 Aggregate $2,000,000 •Commercial General Liability Per Occurrence $2,000,000 0 Contractual Liability 0 Products/Completed Operations 0 Occurrence Auto Liability MOLC-100103 10/1/2003 10/1/2004 Per Occurrence $2,000,000 m Owned Autos 0 Hired Autos 0 Non-Owned Autos Auto Physical Damage Scheduled Autos Hired Autos Property Special Form Mobile Equipment Boiler and Machinery Crime Workers'Compensation Coverage A-Workers'Comp. Coverage B-Employer's Liability CERTIFICATE HOLDER DESCRIPTION City of San Juan Capistrano The Certificate Holder,has been added as an Additonal Covered Party to the Liability Attn: Amy Amirani,Public Works Director Program,but solely with respect to those causes of action arising directly out of the 32400 Paseo Adelanto activities covered by the Emergency Interconnection Agreement between South Coast San Juan Capistrano,CA 92675 Water District and the City of San Juan Capistrano,dated January 20,2004,to construct the Doheny Park Road Water Pipeline. CANCELLATION:Should any of the coverage documents herein be cancelled before the expiration date thereof,ACWA/JPIA will endeavec-te provide 30 days written notice to the certificate holder named herein. Signed by: S}j_ Al A `4 � Date: March 25. 2004 (Authorized RepresOntatjve) + � • • ADDENDUM to the Memorandum of Liability Coverage for the ASSOCIATION OF CALIFORNIA WATER AGENCIES JOINT POWERS INSURANCE AUTHORITY MEMBER: South Coast Water District COVERAGE PERIOD: 10/1/2003 - 10/1/2004 ADDENDUM DATE: 1/20/2004 ADDENDUM NUMBER: 6 Change in WHO IS COVERED The following entity is hereby added as an Additional Covered Party: City of San Juan Capistrano, but solely with respect to those causes of action arising directly out of the activities covered by the Emergency Interconnection Agreement between South Coast Water District and the City of San Juan Capistrano, dated January 20, 2004, to construct the Doheny Park Road Water Pipeline, and subject to a $2,000,000 per occurrence and annual aggregate limit of liability. r r,rr Signed By: Date: March 25. 2004 (Auth6r,ized Representative) • 0 Association of California Water Agencies/Joint Powers Insurance Authority 5620 Birdcage Street, Suite 200, Citrus Heights, CA 95610 CERTIFICATE OF COVERAGE THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED HEREIN. MEMBER South Coast Water District P.O.Box 30205 Laguna Niguel,CA 92607-0205 COVERAGE INFORMATION This is to certify that coverage documents listed herein have been issued to the Member Agency herein for the Coverage period indicated. Notwithstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be issued or may pertain,the coverage afforded by the coverage documents listed herein is subject to all the terms,conditions and exclusions of such coverage documents. Type of Coverage Certificate# Effective Date Expiration Date Limits General Liability Commercial General Liability Contractual Liability Products/Completed Operations Occurrence Auto Liability Owned Autos Hired Autos Non-Owned Autos Auto Physical Damage Scheduled Autos Hired Autos Property Special Form Mobile Equipment Boiler and Machinery Crime Workers'Compensation MOWC&EL-070103 7/1/2003 7/1/2004 a Coverage A-Workers'Comp. Per Accident Statutory Limit O Coverage B-Employer's Liability Per Accident $2,000,000 CERTIFICATE HOLDER DESCRIPTION City of San Juan Capistrano In reference to the Emergency Interconnection Agreement dated January 20,2004,for Attn:Amy Amirani,Public Works Director the Doheny Park Road Water Pipeline. 32400 Paseo Adelanto San Juan Capistrano,CA 92675 CANCELLATION:Should any of the coverage documents herein be cancelled before the expiration date thereof,ACWA/JPIA will endeaver to provide 30 days written notice to the certificate holder named herein. Signed by: �Ik ( I `;I ' Date: March 24. 2004 (Auth rized Represiittetive)