Loading...
1998-0504_BOTACO INC._Insurance Certificate I ACORD. CERTIFICA : sOF LIABILITY INSUNC SR Js DATE(MM/DD/VV) TAC-1 05/04/98 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BOSWELL INS AGENCY (#0A96080) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agents & Brokers, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 4648 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Mission Viejo CA 92690 COMPANIES AFFORDING COVERAGE Joe A. Boswell COMPANY Phone No. 714-855-0430 Fax No. 714-837-5528 A CNA Insurance Companies INSURED COMPANY B BotaCo Inc. COMPANY s:3 Attn: Nacho Soto C ` "- 31921 Camino Capistrano, #401 COMPANY San Juan Capistrano CA 92675 - 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 LIMITS= LTR DATE IMM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY 134883700 05/01/98 05/01/99 PRODUCTS-COMP/OPAGG $ 1,000,000 CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $ 1,000,000 X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one fire) $ 50,000 . i MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 600,000 A X ANY AUTO 1073449589 05/01/98 05/01/99 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X 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 $ 2,000,000 A X UMBRELLA FORM 134883714 05/01/98 05/01/99 AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS ER EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE — OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE I$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The City & the Community Redevelopment Agency, its elected or appointed officers, officials employees and volunteers are included as additional insuredsper form G17957C attached. *10 days or non-payment of premium or non-reporting of payroll CERTIFICATE HOLDER CANCELLATION SAN JU9 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING COMPANY WILL MAIL City of San Juan Capistrano *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn: City Clerk 32 400 Paseo Adelanto OUCH NOTICE SHALL-IMPOSE NO OBLIGATION OR LIABILITY - San Juan Capistrano CA 92 67 5 OF ANY KIND UPON- -HE COMPANY,ITS-AGENT-S OR RENES. AUTHORIZED REPRESENTATIVE,-- �/ Joe A. Boswell / ! ")( - ACORD25-S(1/95) ©ACORD C C '.RATION',1988 CNA For All the C.:m nimentsYeaMake BarACO, INC. 134883700 5-1-98/5-1-99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART operations hazard". WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization 2. The Limits of Insurance applicable to the (called additional insured) whom you are required to additional insured are those specified in the add as an additional insured on this policy under: written contract or agreement or in the Declarations for this policy, whichever are less. 1. A written contract or agreement; or These Limits of Insurance are included within and not in addition to the Limits of Insurance shown in 2. An oral contract or agreement where a certificate the Declarations. of insurance showing that person or organization as an additional insured has been issued; but 3. A person's or organization's status as an additional insured under this endorsement ends the written or oral contract or agreement must be: when your operations for that additional insured • are completed. a. Currently in effect or becoming effective during the term of this policy; and The insurance provided to the additional insured does not apply to "bodily injury", "property damage", "per- b. Executed prior to the "bodily injury", "property sonal injury", or "advertising injury" arising out of an damage", "personal injury", or "advertising In- architect's, engineer's, or surveyor's rendering of or jury". failure to render any professional services including: The insurance provided to the additional insured is 1. The preparing, approving, or failing to prepare or limited as follows: approve maps, drawings, opinions, reports, sur- veys, change orders, design or specifications; 1. That person or organization is only an additional and insured with respect to liability arising out of: 2. Supervisory, inspection, or engineering services. a. Premises you own, rent, lease, or occupy: or Any coverage provided hereunder shall be excess b. Your ongoing operations performed for that over any other valid and collectible insurance additional insured by or for you. available to the additional insured whether primary, excess, contingent or on any other basis unless a The insurance provided to the additional insured written contract specifically requires that this does not apply to "bodily injury" or"property insurance be primary. damage" included within the "products-completed G-17957-C (Ed. 07/96) • STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE JANUARY 20, 1998 046-98 UNIT 0007397 POLICY NUMBER: 1-1-9 CERTIFICATE EXPIRES: CITY OF SAN JUAN CAPISTRANO c• BUILDING & SAFETY DEPARTMENT 32400 PASEO ADELANTO . SAN JUAN CAPISTRANO, CA 92675 JOB: ALL OPERATIONS #} " 'z --,,,--1--.4,, ,Tari%.:3'.e,,,,,"".., L. ,. .s ;r.tt a.'.4. ` L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. _ This policy is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer. ',.,, i t ' We will also give you TEN days'advance notice should this policy be cancelled prior to its normal expiration. (c//;' •, y ,�,,,, ;.s- c This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the , °4.`� 1 policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with Ili,..*-_,:' YT ; respect to which this certificate of insurance 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. w.,, 14 "� 77:9—e------, - A./1e • y AUTHORIZED REPRESENTATIVE PRESIDENT ' x , :r ..t,y ' i EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1, 000,000 PER OCCURRENCE „° ',-'" ' �r ....+: f e!i•:, k . h- •,` ,., ,,'m ►. th - " b„,, ,. w," —.41_7,1 ~.101„ a • ” '" ; '�#* . 'Cr"A.. �cif. �Nf �;� � r 4 h ,. � �sde6�+ ,�c� �` at•- ! � .}",, e 4*• g,c ^ ,y �, a c w y ,i. y;1 #.,; 4 ,:.4.>", S . "r �, 'g''c , Sy,S. # ptt v'A. , et ?' :.' ,,'"or,,., e '^s E `. :' . ' s '''.1„''''' :'pa wr..::?' ,4t . - 4 ` kf'''.14 4A,'':„,:7;':;, $ ` ,- .,--','.'1',.' ' :,€' ,i -'Ik'. Fa `1tk,, etil?+ . ,r 14,1-2a. 4i '"c, I.;{r .:'.r ; ,b ,i ti,a fytear „I t:^ '. ,' ,4 r'+, �.t,1',�+ .4; ,- "r^' iIw�* ' ���$ a#. ,'- fr* i's+ * : r ,; . x4'h 1-..f.;';' "!a M, l ^ �rr t .'r^ ,y�::;: r�. f� r {•' � ,om. ' , .'{ y * x rs . r :--,.,‘,. , 1'�c &' , +t r T �is :1,,rtir. ,tC k1 �.h k a,r :..` i P, �,. „ ne• .c• + $ ,x a, 3 a"i, 3��,, t';aav .. K 4 .'y--,.r '' :...Ir . 4.c. �� x °a; a5w..� .,..rww d4,. . ..,„7.., ,,*-'*``,-, .- d ,y,. #, aw• t n ., c.# 7r ¢i tiM,'0,,°' .e' z =.aq;"?, µp�7 ', `k.'3. 3,r ')''''':4,,-',..';',,, ,,,,,,,,;:,. �'a '.:'7 d^ `f..^,yC k.., . f a �• t y 'Ji 5'R K /� ,, ,, �"Z �'fit :``� w' c : � 4 �A.� _4r--.',.,-,". S'�` � .K ':''''...°,4-;:,- s�'� ' t��'t � -1cc +�� �- y bM1�'!• ! (L•"'C,- Ate' �Yt y t W Tt +, ” i. [j] Y l� 1: , • ,est * ' ; r+$.';''+alta c;_ ,- .y: +4 ' EMPLOYER .,y,� P ,,: �, BOTACO INC. 31921 CAMINO CAPISTRANO r ..‘,4',....,,, SAN JUAN CAPISTRANO, CA 92675 � ,., '.,,," =i` .* i „ ,,"* r., `- 1,',i a �'`.,.�'^`yxc��" .�°fi'.",pr v"�"y'��r 1`« ,.., ^';',.,,,t''"r "tet .' .i t, .< „. :,-1.�« _ r.'iw- :e'. `cht..... L THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262(REV.3-95) r ' 32400 PAS EO ADELA NTO MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 _ COLLENE CAMPBELL JOHN GREINER (714)493-1171 çjit;;r-(714)493-1053 (FAX) • ilb • CITY MANAGER May 4, 1998 GEORGE SCARBOROUGH BotaCo Inc. 31921 Camino Capistrano, #401 San Juan Capistrano, CA 92675 Re: Renewal of General Liability and Automobile Liability Certificates of Insurance (Landscape Maintenance - City Sports Park) Gentlemen: The General Liability and Automobile Liability Certificates of Insurance, regarding the above- referenced service, expired on May 1, 1998. In accordance with your agreement, the insurance certificates need 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 certificates and the endorsement form to the City, attention City Clerk's office, by May 15, 1998. If you have any questions, please contact me at(949) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk Enclosure cc: Silvia Cintron, Public Works DRUG USE IS AB St San Juan Capistrano: Preserving the Past to Enhance the Future