1993-0907_ORANGE COUNTY HEAD START_Insurance Certificate (Commercial 8-25-96) A/.00I I . CERTIFICA OF INSURAN 40 ISSUE DATE(MM/DD/YY)
10/3/95
PRODUCER 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
' CALDWELL INTTRERCE AGENCY INC
15935 E WHITTIER BLVD . COMPANIES AFFORDING COVERAGE
WHITTIER , C A 90603 COMPANY A
LETTER Frontier Pacific Ins . Company
CODE SUB-CODE —
COMPANY B
INSURED _._.... _.. -. _.. �" LETTER
COMPA
ORANGE COUNTY HEAD START INC . EITENYC
1440 E. First St . , Ste . 320 COMPANY D
Santa Ana , CA 92701 LETTER
COMPANY E
LETTER
COVERAGES
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 POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION'! ALL LIMITS IN THOUSANDS
LTR± DATE(MM/DD/YY) DATE(MM/DD/YY)
A GENERAL LIABILITY GENERAL AGGREGATE '3 , 000 ,
x COMMERCIAL GENERAL LIABILITY PROD_ . __.PRODUCTS-COMP/OPS AGGREGATE $1 ,0 O.Q,
CLAIMS MADE X OCCUR. GLM 0 0 0 4 0 3 8/25/95 8/25/96 PERSONAL&ADVERTISING INJURY $1 , 0 0 a,
OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $1 , 000 , —
( FIRE DAMAGE(Any one fire) j $5. 0 ,
J
i MEDICAL EXPENSE(Any one person) $cJ ,
-.. _. .._..._. 3 .
AUTOMOBILE LIABILITY 1 COMBINED i
ANY AUTO SINGLE I$
LIMIT
ALL OWNED AUTOS 1 BODILY ^--��—
_-+- INJURY $
1 SCHEDULED AUTOS (Per person)
r--- 1 HIRED AUTOS ;BODILY
# ? INJURY $
NON-OWNED AUTOS i (Per accident)
_.___ GARAGE LIABILITY PROPERTY
i DAMAGE $
EXCESS LIABILITY j ' EACH AGGREGATE
3 I - OCCURRENCE
$ $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION STATUTORY
,..._.
AND i } $ (EACCIDENT)
LIABILITY
l $ I (DISE-POLICY LIMIT)
t3 --�+�--
$ X. r»? (DISEASE-EACH EMPLOYEE)
OTHER Z—71 =
`D--I M
t t+.-< C)
,o'z.c-, t`J m
"J= 1-+ <
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS --1 x -_=
Certificate holder is added as additional insured with respects to lagation
at , 32502 Paseo Adelanto , San Juan Capistrano , CA 92675 CJI
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of San Juan Capistrano
32400 Paseo Adelanto
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
San Juan Capistrano , CA 92675 MAIL 3 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Attn : Mary TY OF ANYIND UPON THE COMPANY, ITS AG.NTS OR REPRESENTATIVES.
AUT O IZED REP S T
ACORD 25-S(3/88) 6• •ORD CORPORATION 1988
43611
(-ere
MEMBERS OF THE CITY COUNCIL
COLLENE CAMPBELL
1� WYATT HART
DRUG USE 1,01,014. GIL JONES
1S EUennM(p 1961 CAROLYN NASH
•
51 176 DAVID SWERDLIN
• • CITY MANAGER
GEORGE SCARBOROUGH
•
July 26, 1995 q'9-lqs Q 1
- � -� p
Mr. Marco T. Pena, Director
Orange County Headstart, Inc.
1440 East First Street, Suite 320
Santa Ana, California 92701
Re: Renewal of General Liability Certificate of Insurance (Lease of City Property - Head Start
Program)
Dear Mr. Pena:
The General Liability Certificate of Insurance, regarding the above-referenced lease, is due to expire
on August 25, 1995. In accordance with your agreement, the insurance certificate needs to be
renewed for an additional period of one year.
Please forward the updated certificate to the City, attention City Clerk's office, by the August 25,
1995 expiration date.
If you have any questions, please contact me at (714) 443-6310.
9// T z//ii
Thank you for your cooperation.
gIcay k .
Very truly yours, q/a 9 4/A1//fl
/Tat ;(
/0a,WYPh•cZ5b,itari-d-r---A-L,
Dawn M. Schanderl
Deputy City Clerk
cc: Cheryl Johnson, City Clerk
Mary Laub, Management Analyst II
32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171