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1997-1110_CAPITAL & COUNTIES USA_Insurance Certificate ACORD CERTIFICA^- OF LIABILITY INSUF - �CkAPIB22 DZlil��97 PRODUCER THIS CERTIFICATE IS i..ucD AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE United Agencies, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 350 W. Colorado Blvd. Ste. 220 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91105 COMPANIES AFFORDING COVERAGE Charlie Russell COMPANY Phone No. 626-792-6158 Fax No. 626-577-1346_ _ A Fireman' s Fund Ins. Companies INSURED COMPANY p B ` •c Capital & Counties U.S.A. , Inc COMPANY �-.� ..,� Kathryn Kearney C >�` ^---? Cm,� 101 California Street, #2525 COMPANY �a �•, N San Francisco CA 94111 p COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI'ERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THEMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER , POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY MXX 80687466 11/01/97 11/01/98 PRODUCTS-COMP/OPAGG $ 2,000,000 CLAIMS MADE OCCUR PERSONAL&ADV INJURY $ 1,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one fire) $ 100,000 MED EXP(Any one person) $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ -+- UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORMWC $ WORKERS COMPENSATION AND I TOY LIMIMITIT •CER- TORY LS � � ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ OTHER * TEN DAYS NOTICE OF CANCEL FOR NON-PAYMENT OF PREMIUM DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS It is agreed that the Certificate Holder is named as Additional Insured with respect to project: Lot 216, Tract 12954. The attached additional insured endorsement applies. CERTIFICATE HOLDER CANCELLATION C ITYSAJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of San Juan Capistrano BUT FAILURE TO MAIL SUCH NOTICE SHAL -=SE s •BLIGATION OR LIAB 32400 Paseo Adelanto OF ANY KIND UPON THE COMPANY,I •AGENT,- -EPRESENTATIVE San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIVE - Charlie Russell ACORD 25-S(1/95) ©AC RD CORPORATION 1988 a v san #o°f4, • DRUG USE ami EI �" MEMBERS OF THE CITY COUNCIL IsCOLLENE CAMPBELL JOHN GREINER ` 11 't:� eusNfo 1 n19P67 E WYATT GIL JONS T • 1776 DAVID M.SWERDLIN • (111, • CITY MANAGER 00444,0444/0 GEORGE SCARBOROUGH October 20, 1997 Capital & Countries USA, Inc. 101 California Street#2525 San Francisco, California 94111 Re: Renewal of General Liability Certificate of Insurance (License Agreement, lot 216, Tract 12954, Wonderyears Preschool) Gentlemen: The General Liability Certificate of Insurance, regarding the above-referenced License Agreement, is due to expire on November 1, 1997. In accordance with your agreement,the insurance certificate needs to be renewed for an additional period of one year. The agreement requires a general liability endorsement form naming the City of San Juan Capistrano as an additional insured. I have included a City approved endorsement form to submit to your insurance company; however, your insurance company may provide their own endorsement form. Please forward the updated certificate and the endorsement form to the City, attention City Clerk's office, by November 11, 1997. If you have any questions, please contact me at(714) 443-6310. Thank you for your cooperation. Very truly yours, /COliqh i&IM4A6iL Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Sam Shoucair, Senior Engineer 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171