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)