1998-0120_BOTACO INC._Insurance Certificate ACORD CERTIFICA OF LIABILITY INSUR ICE CSR Js DATE(MM/DD/YY)
BOTAC-1 01/20/98
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. A
INSURED
COMPANY
B CNA Insurance Companies
COMPANY
BotaCo Inc. C
31921 Camino Capistrano, #401 COMPANY
San Juan Capistrano CA 92675 D
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.
COTYPE OF INSURANCE POLICYNUMBERPOLICY EFFECTIVE POLICY EXPIRATION
LIMITS
LTR I DATE(MM/DD/YY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
B X COMMERCIAL GENERAL LIABILITY 134883700 05/01/97 05/01/98 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
MED EXP(Any one person) $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ 600,000
B X ANY AUTO 1073449589 05/01/97 05/01/98
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 S
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $ 2,000,000
B X UMBRELLA FORM 134883714 05/01/97 05/01/98 AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND O TSIA LI-LIMITS OE
RY I ER
EMPLOYERS'LIABILITY
EL EACH ACCIDENT $
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $
OTHER
I.•
c...
� <n m
c-.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS .. rj r 1,7
*10 day Notice of Cancellation for nonpayment of premium. r"1
All Operations of the Named Insured zz -' --t
FAX 714-493-1053
CERTIFICATE HOLDER CANCELLATION
SANJU9 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of San Juan Capistrano EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL MAIL
Att: City Clerk' s Department *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
(Don) _
32400 Paseo Adelanto . ie4ea+IY
San Juan Capistrano CA 92675 '
AUTHORIZED REPRESENTATIVE
Joe A. BoswellKit.faiZIZZ6
ACORD 25 S(1/95) ®ACORD CORPORATION 198$„I;
•
. r� 1
DRUG USE e 0� MEMBERS OF THE CITY COUNCIL
(S a COLLENE CAMPBELL
JOHN GREINER
it iotORPaeatta WYATT HART
csrenuXto 1961 GIL JONES
1776 ' DAVID M.SWEROLIN
• A1 •
CITY MANAGER
• GEORGE SCARBOROUGH
December 18, 1997
BotaCo Inc.
31921 Camino Capistrano #401
San Juan Capistrano, CA 92675
Re: Renewal of Workers Compensation Certificate of Insurance (Landscape Maintenance,
Sports Park)
Gentlemen:
The Workers' Compensation Certificate of Insurance,regarding the above-referenced service, is due
to expire on January 1, 1998. In accordance with your agreement,the insurance certificate needs to
be renewed for an additional period of one year.
Please forward an updated certificate to the City of San Juan Capistrano, attention City Clerk's
office, by January 9, 1997.
If you have any questions, please contact me at(714)443-6310.
Thank you for your cooperation.
Very truly yours,
/011/01) 0-1
Dawn M. Schanderl
Deputy City Clerk
cc: Cheryl Johnson, City Clerk
Silvia Cintron, Public Works
32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171