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1996-0210_ORANGE COUNTY TRANSPORTATION AUTHORITY_Insurance Certificates RECEIVED OCTA JAN 13 2 02 P14 '97 CITY C(_E RK BOARD OF DIRECTORS Q H A R T H E NT CITY OF '-"td William G.Steiner January 8, 1997 JUAN CAPIC iRAN0 Chairman Bob Wahlstrom Vice-Chairman City of San Juan Capistrano Marian Bergeson Attention. City Clerk's Office Director 32400 Paseo Adelanto SarahSan Juan Capistrano, CA 92675 Direcctortor Laurann Cook Director SUBJECT: Renewal of Worker's Compensation Certificate of Insurance Tom Daly (Senior Transportation Service). Director James H.Flora Gentlemen/Ladies- Director Donald J.SaltarelliIn response to your letter dated December 12, 1996 requesting an updated Diarectreaorr James W.Silva Certificate of Insurance be forwarded, I'm attaching a copy of the current Director Certificate of Insurance for Dave Transportation Services, Inc. for your records. Charles V.Smith Director If you have any questions, please contact me at (714) 560-5619. Thomas W.Wilson Director Sincerely, Brent Felker Governor's Ex-Officio Member Arthur Brown Alternate Rebecca Potter Roger R.Stanton Procurement Administrator Alternate Contracts Administration and Materials Management Gregory T. Winterbottom Alternate cc: Carolyn Fergeson Orange County Transportation Authority 550 South Main Street/P.O.Box 14184/Orange/California 92613-1584/(714)560-OCTA(6282) ,? ISSUE DATE(MM/DD/YY) CERTIFICAT. JF INSURANCE 1064 10/26/96 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE RODES-ROPER-LOVE INSURANCE AGENCY DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. BOX 700 MELBOURNE, FL 32902 COMPANIES AFFORDING COVERAGE LETTER A UNITED PACIFIC INSURANCE CO. INSURED LETTERNY B LEXINGTON INSURANCE CO. DAVE MANAGEMENT, INC., COMPANY DAVE TRANSPORTATION SERVICES, INC., LETTER C+ VAN TRAN OF TUCSON, INC., COMPANY DAVE FLEET MANAGEMENT, SUTRAN, INC., LETTER D DAVE TRANSPORTATION SERVCIES, INC.,DBA COMPANY E LETTER COVERAGES THISIS 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 M;^Y BE ISSUED OR MAY PERTAIN, "HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE '1 ERMS, 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 LIMITS LTR DATE(MMlDD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE S 2,500,000 X COMMERCIAL GENERAL LIABILITY IGL4000013 11/01/96 11/01/98 PRODUCTS-COMP/OP AGG. $ 2,500,000 CLAIMS MADE X OCCUR. PERSONAL&ADV. INJURY s 2,500,000 OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE S 2,500,000 FIRE DAMAGE(Any one tire) S 50,000 MED.EXPENSE(Any one person) S 5,000 A AUTOMOBILE LIABILITY COMBINED SINGLE S X ANY AUTO ICA4000011 11/01/96 11/01/98 LIMIT 2,500,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE S B EXCESS LIABILITY 5108836 11/01/96 11/01/98 EACH OCCURRENCE $ 2,500,000 X UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS EACH ACCIDENT $ AND _. ..-__..._._. DISEASE—POLICY LIMIT $ EMPLOYERS'LIABILITY DISEASE—EACH EMPLOYEE $ OTHER B PHYSICAL DAMAGE 8893758 11/01/96 11/01/98 $10,000 DED.COMP. $10,000 DED.COMP. 9C.11 Y101-DJAN XWWRLIiW8N11 J 8ffMffgC�6gTg AND EMPLOYEES ARE SHOWN AS ADDITIONAL INSUREDS AS RESPECTS TO THE OPERATIONS OF THE NAMED INSURED ONLY CERTIFICATE HOLDER CANCELLATION CITY OF SAN JUAN CAPISTRANO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN: DAWN SCHANDERL EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL )u0P0w4xm RECORDS COORDINATOR 30 32400 PASEO ADELANTO CITY HALL MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE SAN JUAN CAPISTRANO, CA 92675 LEFT, AUTJ ND IZ�EPRE17ATIVE ACORD 25-S 7/90 CACORD CORPORATION 1990 ADDITIONAL INSURED ENDORSEMENT Attached to and forming a part of the Certificate of Insurance dated 10/26/96 Policy: #5108836 Issued to: CITY OF SAN JUAN CAPISTRANO ITS OFFICERS, AGENTS AND EMPLOYEES The Certificate Holder named above is shown as an Additional Insured as respects to the operations of the Named Insured only to the extent of liability assumed by the Named Insured under the contract between the Certificate Holder and the Named Insured pursuant to which this certificate is issued, subject to the policy terms and conditions. Richa d P. ove, Jr. Authorized Representative Lexington Insurance Co. ►_ �` �1�. m"MI)e PEI STI IC E OF I'NSURANC DATE(MM10D/Y1� 12/17/96 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Averbeck Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3270 Inland Empire Blvd #100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ontario, CA 917 64 COMPANIES AFFORDING COVERAGE COMPANY AGreat States Ins . Co. INSURED COMPANY Dave Transportation Services , Inc . SFireman' s Fund Insurance Company - - 26111 Antoni `COMPANY Parkway COM I� Rancho Santa Margarita, CA 92668 - COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE'LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDNAMEDABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEFMFICATE MAY BE LSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCR19ED HEREIN IS SUBJECT TO ALL THE TERMS, OCCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. f ^ I POUCTEFFECTIVEPOLICYEXPIRTIONI LO TYPeOfINSURANCE POLICY NUMBER LIMITSTR OATE(MM/OOrM I OATEIMMJDOrYY) GENERAL LIABILITY GENERAL AOOREOATE 13 I ` OMMERCIAL GENERAL L!ABILI I PRODUCTS•COMP/OP AOOjS CLAIMS MADE I' OCCUR !PERSONAL 5 ADV INJURY I3 WNER'S S CONTRACTOR'S PRO I EACH OCCURRENCE S FIRE DAMAGE(Any are f IrE)l S _ MED EXP IAny one perscn) ,5 AUTOMOBILE LIABILITY 1 ANY AUTO i COMBINED SINGLE LIMIT S ALL OWNED AUTOS BODILY INJURY I SCHEDULED AUTOS g 1 Per parson) I j HIRED AUTOS BODILY INJURY E NON.OWNED AUTOS 1 (Por accloenp IhPROPERTY DAMAGE I3 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT i5 ANY AUTOOTHER THAN AUTO ONLY! T EACH ACCIDENT S AGGREGATE IS HXCESS LIABILITY EACH OCCURRENCE S UMBRELLAFORM AGGREGATE i OTHER'HAN UMBRELLA FORM S A WORKERS COMPENSATION AND � GWN1012 619 7 01/01/97 1 01/01/98 1 STATUTORY L.Mrs I EMPLOYrAS'LIABILITY EACH ACCIDENT 'l 0 0 0 0 0 0 THE PROPRIE70RIX INCL DISEASE-POLICY LIMIT sl O O O O O O PARTNERS/EXECUTIVE OFFICERS ARE: JEXCL OISEASE-EACH EMPLOYEE I 31 000, 000 g OTHER MXX60662762 12/31/96 12/31/97 $120 , 000 Limit . lanket Employee $1, 000 Deductible. ishonesty �Coverage DESCRIPTION OF OPERATIC NSI LOCATIONS/VE HICLEsrSPECIAL ITEMS Verification of Insurance , *10 Day Notice of Cancellation applies for Non Payment of Premium. CERTIFICATE HOLDER: CANCELLATION' , SHOULD ANY OF THE ABOVE DESCRIBED POUCIE3 BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Attn. Linda Evans *3Q DAYSWRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMEOTOTHE LEFT, 32400 Paseo Ade 1 ant o/ City Hall BUTFAILURB TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIUTY San Juan Capistrano, CA 92675 OF ANY KIND UM THE COMPANY IT9 AGENTS OR REPRESENTATIVES. AUTHORIZED R R EN7 TIVH I L ACORD 25-S 319311 of 1, S442 3' n 3 3 7a RATION 1993 JAN-08-199? 13:50 7148881571 97% P.02