Loading...
03-1202_NINYO AND MOORE_Insurance Client#: 70 ACORQa CERTIFIcAPE OF LIABILITY INS NCE 0DATE(MMID 4129/05IDNY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton &Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P. O. Box 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland, CA 94604-2675 510 465-3090 Sandra Patterson INSURERS AFFORDING COVERAGE INSURED INSURERA: National SUret Cor Ninyo& Moore, Geotechnical Consultants y P__-_-- INSURER B: Fireman's Fund Insurance Co. 475 Goddard, Ste 200 INSURER c: American Automobile Ins. Co. Irvine, CA 92618 INSURER D: Great American Assurance Co. INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE M/DD/YY DATE MMIDD/YY LIMITS A GENERAL LIABILITY MZX80833434 10/03/04 10/03/05 EACH OCCURRENCE $1,000,000 X COM MERCIALGENERAL LIARILITY FIRE DAMAGE(Any one fire) $1 OOO,QQO - _j CLAIMS MADE X OCCUR MED EXP(Any one Verson) $10,000 X 'Contractual PERSONAL&ADV INJURY $1,000,000 X RR Cont CG2417 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIM ITAPPLIES PER: , PRODUCTS -COMP/OPAGG $2,000000 POLICY X JECT X LOC A AUTOMOBILE LIABILITY MZX80833434 10/03/04 10/03/05 COMBINED SINGLE LIMIT _XI ANY AUTO $1,000,000 _ ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per Person) I$ XI HIRED AUTOS li BODILY INJURY X NON-0WNED AUTOS 'I (Peraccitlent) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTOONLV: AGO $ IS '', EXCESS LIABILITY X.SM00097620892 10/03/04 10/03/05 LEACH OCCURRENCE $9,000,000 _J OCCUR EICLAIMS MADE ' AGGREGATE $9,000,00 $ DEDUCTIBLE $ _- RETENTION $ $ C WORKERS COMPENSATION AND WZP80929188 05/01/05 05101/06 X WCSTATU- iOTH-', EMPLOYERS'LIABILITY �QRY LIMITS ER EL EACPoACCIDENT $1,000,000 E.L.DISEASE-EA EMPLOYEE $1,000,000 E.L.DISEASE-POLICY LIMIT $1,000,000 D OTHER Professional EDN5850305 - 10/03/04 10/03/05 $2,000,000 per claim Liability(incl $2,000,000 annl aggr. Pollution Liab DESCRIPTION OF OPERAnONSrLOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS GENERAL LIABILITY POLICY EXCLUDES CLAIMS ARISING OUT OF THE PERFORMANCE OF PROFESSIONAL SERVICES. Ref: N&M#202531002. NIT-City of San Juan Capistrano/Rozbicka v. Estrella. (See Attached Descriptions) CERTIFICATE HOLDER I ADDITONALINSURED;INSURER LETTER: CANCELLATION SHOULD ANYOFTH E ABOVE DESCRIBED POLICIESBE CANCELLED BEFORE THE EXPIRATION City of San Juan Capistrano DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAILAn DAYSWRITTEN Attn: City Clerk's Office NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUTFAILURE TODOSOSHALL 32400 Paseo Adelanto IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON TH E INSURER,ITS AGENTS OR San Juan Capistrano, CA 92675 REPRESENTATIVES. AU ZED REPRESENTATIVE ACORD 25-S(7/97)1 Of 2 #M112136 DAC 0 ACORD CORPORATION 1988 D RIPTIONS (Continued from ge 1) The City of San Juan Capistrano, its elected and appointed officials and employees are additional insureds to general &excess liability. AMS 25.3(07/97)2 of 2 #M112136 • 0 POLICY NUMBER: MZX80833434 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Na ne of Person or Organization: City of San Juan Capistrano Attn: City Clerk' s Office 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II •WHO IS AN INSURED is amended to (1)All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations services, maintenance or repairs) to be performed for that insured. performed on or on behalf of the additional insured(s) at the site of the covered B. With respect to the insurance afforded to these operations has been completed; or additional insureds, the following exclusion is added: (2)Thatportion of "your work' out of which injury njury or damage arises has been put 2. Exclusions to its intended use by any person or organization other than another contractor This insurance does not apply to "bodily in- or subcontractor engaged in performing jury" or "property damage"occuring after: operations for a principal as a part of the same project. Ref : N&M#202531002 . N/T - City of San Juan Capistrano/Rozbicka V. Estrella. The City of San Juan Capistrano, its elected and appointed officials and employees are additional insureds to general liability. CG 20 10 10 01 • ate„ • 32400 PASEO ADEI—ANTO v �� J ® MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 DIANE(949)493m[oAvl MiFe DD1171 /,y IANE SATHGATE VATO (949)4931053 FAX e lY fflllufRm � )96) WYATT HART www.sanjuancapistrano.org 1776 JOE SOTO DAVID M.SWERDLIN April 15, 2005 Ninyo & Moore Geotechnical Consultants 475 Goddard, Suite 200 Irvine, CA 92618 RE: Compliance with Insurance Requirements —South Open Space Landslide Geotechnical Services The following insurance document is due to expire: J Workers Compensation Certificate 04/15/2005 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's ice, 32400 Pa eo Adelanto, San Juan Capistrano, CA 92675 by the above E i d t If u ve any questions, please contact me at (949) 443-6309. r ly uev Administratiw Secretary cc: Michelle Perea, Administrative Assistant San Juan Capistrano: Preserving the Past to Enhance the Future Pnn1ed an re cle paper Client#: 7 OMOORI ACORD CERTIFICATE OF LIABILITY INSU NCE 1 7/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland,CA 94604.2675 510 465-3090 INSURERS AFFORDING COVERAGE INSURED INSURERA: National Surety Corp. Ninyo&Moore, Geotechnical Consultants INSURER B: Fireman's Fund Insurance Co. 475 Goddard,Ste 200 INSURER c: American Automobile Ins.Co. Irvine,CA 92618 INSURER D. Great American Assurance CO- INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE M ° DATE MMIDDIYY LIMn3 A GENERAL LIABILITY MZX80833434 ', 10/03/04 10/03/05 EACH OCCURRENCE $1000000 X COMM FECAL GENERAL LIABILITY This policy FIRE DAMAGE(My one Are) $1000000 CLAIMS MADE 1XI OCCUR excludes Claims MED EXP(Any one Person) $10,000 X Contractual arising out of PERSONAL&AUV INJURY $1000000 X RR Cont CG2417 the performance i GENERAL AGGREGATE_ $2,000,000 GEN'L AGGREGATE LIM IT APPLIES PER: of professional PRODUCTS-COMP/OPAGG $2,000,000 POLICY X JECT X Lac liability. A AUTOMOBILE LIABILITY MZX80833434 10/03/04 10103105 COMBINED SINGLE LIMIT X ANY AUTO (Ea amident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNEDAUTOS i (Per amdenp PROPERTY DAMAGE $ (PereCG4anl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGO $ B EXCESS LIABILITY XSM00097620892 10/03/04 110/03/05 EACH OCCURRENCE $9000000 X OCCUR EICLAIMS MADE AGGREGATE _ $9,000,000 $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND WZP80922283 'O5I01/04 05/01105 X WC STATU- OTH- MT EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1,000,000 E.L.DISCO SE-EAEM'PLDYEE $1,000,000 E.L.DISEASE-POLICY LIMIT $1,000,000 D OTHER Professional EDN5850305 10/03104 10/03/05 $2,000,000 per claim Liability(incl $2,000,000 annl aggr. ollution Liab DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Ref: N&M#202531002. NIT-City of San Juan Capistrano/Rozbicka v. Estrella. The City of San Juan Capistrano,its elected and appointed officials and employees are additional insureds to general&excess liability. CERTIFICATE HOLDER ADDmONA_NSURED;INSURERLETTER: CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIESBE CANCELLED BEFORE THE EXPIRATION City of San Juan Capistrano DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30—DAYS WRITTEN Attn:City Clerk's Office NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUT FAILURE TODOSOSHALL 32400 Paseo Adelanto IMPOSE NO OB LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR San Juan Capistrano,CA 92675 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25.5(7/97)1 of 1 #M112136 DAC @ ACORD CORPORA ION 1986 • POLICYNUMBER: MZX80833434 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of San Juan Capistrano Attn: City Clerk' s Office 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II -WHO IS AN INSURED is amended to (1)All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations services, maintenance or repairs) to be performed for that insured. performed on or on behalf of the additional insured(s) at the site of the covered B. With respect to the insurance afforded to these operations has been completed; or additional insureds, the following exclusion is added: (2)That portion of "your work" out of which the injury or damage arises has been put 2. Exclusions to its intended use by any person or organization other than another contractor This insurance does not apply to "bodily in- or subcontractor engaged in performing jury" or "property damage" occuring after: operations for a principal as a part of the same project. Ref : N&M#202531002 . NIT - City of San Juan Capistrano/Rozbicka v. Estrella. The City of San Juan Capistrano, its elected and appointed officials and employees are additional insureds to general liability. CG 20 10 10 01 Client#: 7 OMOORI ACOR CERTIFICATE OF LIABILITY INSURANCE DATE 10710°" � PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey,Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland,CA 94604-2675 510 465-3090 INSURERS AFFORDING COVERAGE INSURED INSURER A: National Surety-Corp. Ninyo&Moore,Geotechnical Consultants INSURER B: Fireman's Fund Insurance Co. 475 Goddard,Ste 200 INSURER c: American Automobile Ins.Co. Irvine,CA 92618 INSURER D: Great American Assurance Co. INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR CY POLICY EFFECTIVE POLIEXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MMIDD LIMBS A GENERAL LIABILITY MZX80833434 10103/04 10103/05 EACH OCCURRENCE $1 000 ALM OO IGOMMERCIALGENERALLIABILITY This policy FIRE DAMAGE(Any one fire) $1000000 CLAIMS MADE 1XX1 OCCUR excludes claims MED EXP(Any one parson) $10 QQQ X Contractual arising out of PERSONAL&ADV INJURY $1,000,000 X_f RR Cont CG2417_ the performance GENERAL AGGREGATE _ s2000,000 GE_N'L AGG R E GATE L IM IT APPLIE S PE R: of professional PRODUCTS-COMP/OPAGG $2000,000 POLICY X PRO X Loc liability. A ���AUTOMOBILE LIABILITY MZX80833434 10103/04 10/03105 COMBINED SINGLE LIMIT X ANYAUTO (Ea aoddent) $1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per....rt) $ PROPERTY DAMAGE $ (Per acddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC_ $ I :: AUTO ONLY: AGG $ B EXCESS LIABILITY _ XSM00097620892 '10/03/04 10/03/05 EACH OCCURRENCE _ $9,000,000_ X OCCUR CLAIMS MADE AGGREGATE _ _ $9,Q�00 _ $ DEDUCTIBLE RETENTION $ $ C WORKERS COMPENSATION AND WZP80922283 05/01/04 05/01/05 X WCSTATULIM T, - OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1,000,000 EL DISEASE-EA EMPLOYEE $1,000,000 E.L.DISEASE -POLICY LIMIT $1,000,000 D OTHER Professional EDN5850305 10/03/04 10/03/05 $2,000,000 per claim lability(incl $2,000,000 annl aggr. ollution Liab DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Ref: N&M#202531001. NIT-City of San Juan Capistrano/Rozbicka v. Estrella. The City of San Juan Capistrano, its elected and appointed officials and employees are additional insureds to general&excess liability. CERTIFICATE HOLDER ADDnroNALINSURED;INSURERLETTER: CANCELLATION SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of San Juan Capistrano DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL30 DAYSWRITTEN Attn:City Clerk's Office NOTKIETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT,BUTFAILURE TODOSOSHALL 32400 Paseo Adelanto IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERJTS AGENTS OR San Juan Capistrano,CA 92675 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25S(7197)1 of 1 #M112136 DAC 0 ACORD CORPORATION 1988 POLICYNUMBER: MZX80833434 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of San Juan Capistrano Attn: City Clerk' s Office 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II -WHO IS AN INSURED is amended to (1)All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations services, maintenance or repairs) to be performed for that insured. performed on or on behalf of the additional insured(s) at the site of the covered B. With respect to the insurance afforded to these operations has been completed; or additional insureds, the following exclusion is added: (2)That portion of "your work" out of which the injury or damage arises has been put 2. Exclusions to its intended use by any person or organization other than another contractor This insurance does not apply to "bodily in- or subcontractor engaged in performing jury" or "property damage"occuring after: operations for a principal as a part of the same project. Ref : N&M#202531001 . N/T - City of San Juan Capistrano/Rozbicka v. Estrella. The City of San Juan Capistrano, its elected and appointed officials and employees are additional insureds to general liability. CG 20 10 10 01 32400PASEOTO SAN JUAN CAPISIRANISTRANO,CA 92675 ),y 10(BA1olIIfB MEMBERS OF THE CfTV COUNCIL(949)493.1171 ' ESTABLISHED �i 1961 SAM ALLEVATO (949)493-1053 FAX 1776 DIANE L.BATHGATE WWW.sanjuancapistrano.org WYATr HART JOE DAVIDD M.M.SWERDLIN September 17, 2004 Ninyo & Moore Geotechnical Consultants 475 Goddard, Suite 200 Irvine, CA 92618 RE: Compliance with Insurance Requirements — South Open Space Landslide Geotechnical Services The following insurance documents are due to expire: y. ✓ General Liability Certificate 10/03/2004 ✓ General Liability Endorsement Form naming the City of San Juan Capistrano as additional insured. ✓ Automobile Liability Certificate 10/03/2004 ✓ Professional Liability Certificate 10/03/2004 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32 00 Paseo Adelanto, San Juan Capistrano, CA 92675 by the above p ation date . you have any questions, please contact me at (949) 443-6309. Si ria u ara Administ tive Secretary cc: Michelle Perea, Administrative Assistant San Juan Capistrano: Preserving the Past to Enhance the Future Client#:704 NINYOMOOR1 Aci CERTIFICA�.` OF LIABILITY INSU NCE 05io7// 04°'"" PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealay, Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland, CA 946042675 510 465-3090 INSURERS AFFORDING COVERAGE INSURED INSURER A:American Automobile Ins.Co. Ninyo&Moore Geotechnical Consultants INSURER B: 475 Goddard,Suite 200 - - - INSURER C: Irvine, CA 92618 ' INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - _ IPOLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OFINSORANCE POLICY NUMBER DATE MM/DD/ AT M DD/ LIMITS GENERAL LIABILITY THIS CERTIFICATE EACH OCCURRENCE $ _COMMERCIAL GENERAL LIABILITY ' ''I FIRE DAMAGE(Anyone fire) $ ULAIMSMADEI - I OCCUR9STOEVIDENCETHE MEOEXP(Anyoneper50n) $ PERSONAL&ADV INJURY $ 5/1/04 RENEWAL GENERAL AGGREGATE is GEN'LAGGREGATE LIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ POLCv PRO - Loc OF WORKERS I_AUTOMOBILE LIABILITY COMPENSATION COMBINED SINGLE LIMIT 1 I$ANY m AUTO (Eaactlent) ALL OWNED AUTOS COVERAGE ONLY. BODILY INJugr� SCHE O RLED AUTOS (Per person) $ HIRED AUTOS IALLOTHER BODILY INJURY $ NON-OWNED AUTOS (Peraccident) COVERAGES, PROPERTY DAMAGE (Peraccidenp $ GARAGE LIABILITY INCLUDING ENDORSE- AUTOONLY_-EAACCIDENT $ ANYAUTOOTHEEA ACC $ AUTO MENTS,REMAIN IN RTHAN AUTO ONLY: qGG $ EXCESS LIABILITY__- (FULL FORCE EACH OCCURRENCE $ _ OCCUR CLAIMS MADE AGGREGATE $ — AND EFFECT $ - DEDUCTIBLE _ '$ RETENTION $ $ A WORKERS COMPENSATION AND WZP8O922283 05/01/04 05/01/05 1n 110 STAT U- OTH-. EMPLOYERS'LIABILITY I -"' 'LEL EA_CHACCIDENT 1$1,000,000 6LDISEASE-EAEMPLOYE $1,000,000 E.L.DISEASE-POLICVLIMI $1 000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS REF: N&M#202531001/Haight/Rozbicka v. Estrella Properties. The City of San Juan Capistrano, its elected and appointed officials and employees are additional insureds to general&excess liability. CERTIFICATE HOLDER 1 1 AODMONALINSURED;INSUPERIETnER: _ CANCELLATION Ton Day Notice for Non-Paument of Premium SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION City of San Juan Capistrano DATE THEREOF,THEISSUING INSURERWILLENDEAVORTOMAN$0 DAYSWRITTEN Attn: Mr. Peter Salgado NOTICETOTHE CERTIFICATE HOLDERNAMEDTOTHE LEFT,BUTFAILURE TODOSOSHALL 32400 Paseo Adelanto IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERITS AGENTS O San Juan Capistrano, CA 92675 REPRESENTATIVES. AUT ORI2ED REPRESEN TIVE ACORD 25-S(7197)1 of 1 #10102410 DAC 0 ACORD CORPORATI 1988 Client :704 NINYOMOORI acnRn� CERTIFICA OF LIABILITY INSURANCE 11/17//03°"" PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey,Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.BOX 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland,CA 94604-2675 510 465-3090 Edl Barrow INSURERS AFFORDING COVERAGE INSURED INSURER A:National Surety Corp. NInyO&Moore,Geotechnical Consultants INSURER B:Fireman's Fund Insurance CO. 475 Goddard,Suite 2W INSURER C:AmariCan AIRORIObllG Ins.CO. Irvine,CA 92618 INSURER D:Gre81 American A88UranDS CO. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWrrHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONITR LIMITS A GENERAL LIABILITY MMM18571 10/03/03 10/03/04 EACH OCCURRENCE SI omwo X COMMERCIALGENERALLIABILRY ThISpOIk:y FIREOAMAGE(Anyoneiks $1000_00 CLAIMS MADE OCCUR excludes Claims ME D EXP(Any one person) $10000 X Contractual arising out Of PERSONAL&ADV INJURY $I 000 0_O X RR Cont.OG2417 the performanne GENERAL AGGREGATE oO 00_ GENL AGGREGATE LIMITAPPLIESPER: Of professional PRODUCTS-COMP/OP AGO 12000 000 POLICY X PER_IjX LOC SSIVkSS A AUTOMOBILE LIABILITY M2'X80818571 10/03/03 10/03/04 COMBINED SINGLE LIMIT &1,_00,_00 X ANY AUTO (Eaaccloent) ALL OWNED AUTOS BODILYINJURY = SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY 1 X NON-OWNED AUTOS (Per accldenl) PROPERTY DAMAGE & (Peraccldent) GARAGE LIABILITY AUTO ONLY-EAACCIDENT 1 ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ B ESS LIABILITY XSM00078121813 10/03/03 10/03/04 EACH OCCURRENCE $9000O0_ X OCCUR F1 CLAIMSMADE AGGREGATE =90_0__-0 5 DEDUCTIBLE 1 RETENTION $ $ C WORKERSCOMPENHATION AND YJZPON13783 05/01/03 05/01/04 X WCSTATU- I JOTH- EMPLOYizRS'LIABILITY E.L.EACH ACCIDENT $1 OOOOOO E.L.DISEASE-EA EMPLOYEE $1000000 E.L.DISEASE-POLICY LIM17 $1,000,000 D OTHER Professional EDN320888601 10/03/03 10/03/04 $2,000,000 per claim (Incl.Pollution) $2,000,000 annl aggr. ability DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONSADDED BY ENDORSEMENT/SPECIAL PROVISIONS REF:N&M#202531001/Haight/Rozblokay.Estrella Properties. The City Of San Juan Capistrano,Its elected and appointed officials and employees are additional Insureds to general&excess liability. NOV 1 CERTIFICATE HOLDER ADDmONALINSUEo-Al9AERLETTER CANCELLATION Ton D@X Notion for Non-Payment of Premium SHOULDAWOFTFEABOVE DESONSEDPOLICIESSECANCELLED BEFOIETHE E)CPFATION City Of San Juan Capistrano DATETHEREOF,THE ISSUING INSURER W ILLENDEAVORTO MAIL3ODAYS WRTREN Attn:Mr.Peter Salgado NOTICETOTHE CERTIRCATE HOLDERNAMEDTOTHE LEFT,BUTFAILUFE TO DOHD MALL 32400 Pasao Adelant0 IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER,ITS AGENTS OR San Juan Capistrano,CA 92675 REPRESENTATIVES. AORIZE REPREHEN TIVE ACORD 25-S(7197)1 of 1 #M934.56 ART 0 ACORD CORPORATION 1988 POLICY NUMBER: MZX80818571 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organizatiqn: City of San Juan Capistrano Attn: Mr. Peter Salgado 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II - WHO IS AN INSUREDs amended to (1)AII work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations services, maintenance or repairs) to be performed for that insured. performed on or on behalf of the additional insured(s) at the site of the covered B. With respect to the insurance afforded to these operations has been completed; or additional insureds, the following exclusion is added: (2)That portion of your work" out of which the injury or damage arises has been put 2. Exclusions to its intended use by any person or organization other than another contractor This insurance does not apply to 'bodily in- or subcontractor engaged in performing jury--or 'property damage•occuring after: operations for a principal as a part of the same project. REF: N&M #202531001/Haight/Rozbicka v. Estrella Properties. The City of San Juan Capistrano, its elected and appointed officials and employees are additional insureds to general liability. CG 2010i001