1993-0907_ORANGE COUNTY HEAD START_Insurance Certificate (Commercial 8-25-95) '"'OtitITIPICA1 Or""INSORAN00471,4'1'"'A' ISSUE DATE(MM/DD/YY)
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
alclwell Ins.Agency Inc
POLICIES BELOW.
15935 Whittier Blvd
Whittier, CA 90603-2567 COMPANIES AFFORDING COVERAGE
TrETY A Insurance Company of Evanston
BOH
COMPANY
INSURED LETTER B (111)
COMPANY
Orange County Head Start,Inc LETTER
1440 E First Street Ste.#320
Santa Ana,CA 92701 COMPANY D
LETTER
COMPANY E
LETTER
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 POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER LIMITS
LTR DATE (MM/DD/YY) DATE(MM/DD/YY)
GENERAL UABIUTY GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 1,000,000
A CLAIMS MADE X OCCUR 8502CY003098 08/25/94 08/25/95 PERSONAL &ADV.INJURY $ 1,000,000
OWNERS & CONTRACTORS PFT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (My one fire) $ 200,000
MED.EXPENSE(Any one person) $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE
ANY AUTO LIMIT
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per Person)
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS (Per accident)
GARAGE LJABIUTY
PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURRENCE $
AGGREGATE
OTHER THAN UMBRELLA FORM
I STATUTORY UMITS
WORKER'S COMPENSATION
EACH ACCIDENT
AND
DISEASE—POLICY UMIT $
EMPLOYERSLIABILITY
DISEASE—EACH EMPLOYEET,,$
OTHER
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DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL fTEMS rn Ill
Certificate holder is added as addditional insured with respects to
-3c
premises leased to named insured.
Loc 7-1:32502 Paseo Adelanto,San Juan Capistrano, CA 92675 -
c..c)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City Of San Juan EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
Capistrano MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
32400 Paseo Adelanto LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
San Juan Capistrano, CA 92675 Li. I OF ANY KIND UPON THE COMiP, NY, ITS AGENTS OR REPRESENTATIVES.
/9?THO REPRESE TATI,
Loan#: loc.7
V4A11(111A( 1)
7400 ...
Viddeyk:,
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• _ .
fysJ. MEMBERS OF THE CITY COUNCIL
el COLLENE CAMPBELL
4 GARY L.HAUSDORFER
U GIL JONES
DRUG USE AIAAAAAAno CAROLYN NASH
IS • f11AIlI1NfI 1961 JEFF VASOUEZ
• V76il�
• CITY MANAGER
GEORGE SCARBOROUGH
•
August 2, 1994
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, 1994. 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 25th
expiration date.
If you have any questions, please contact me at (714) 443-6310.
Thank you for your cooperation.
Very truly yours,
A. kA aka,u*AL
Dawn M. Schanderl
Deputy City Clerk
Enclosure
cc: Cheryl Johnson, City Clerk
Mary Laub, Management Assistant II
32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 S (714) 493-1171
re• •
tY011` MEMBERS OF THE CITY COUNCIL
COLLENE CAMPBELL
• �� 19 GARY L.HAUSDORFER
J , GIL JONES
I io(ORPOAAlto CAROLYN NASH
• FSfIIIISIFI 1961 JEFF VASQUEZ
n ' 1776
• I', • CITY MANAGER
GEORGE SCARBOROUGH
September 6, 1994
Mr. Marco T. Pena
Director, Orange County Headstart, Inc.
1440 East 1st Street #320
Santa Ana, CA 92701 OjArYiT
RE: Renewal of General Liability Insurance
Dear Mr. Pena:
The general liability insurance in place for the City owned property leased by Headstart has expired.
In accordance with the agreement between the City and Headstart, a current insurance certificate
needs to sent to the City Clerk's office immediately. The certificate should be valid for a one year
period.
Please take care of this at your earliest opportunity and please don't hesitate to call me at (714) 443-
6303 with any questions you may have.
Sincerely,
Mary Laub
Management Assistant II
32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171