1997-0429_BOTACO INC._Insurance Certificate _,
CSR J
A1:11I:I1, CERTIFICA OF INSURANCE BOTACSDATE IMM/DO/YY)
I 04/29/97
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
JOA A. Boswell COMPANY
Phone No. 714-855-0430 Fez No. - A Golden Eagle Insurance Company
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.
CO 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
B X COMMERCIAL GENERAL LIABILITY 134883700 05/01/97 05/01/98 PRODUCTS-COMP/OPAGG $ 1,000,000
CLAIMS MADE X l 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 $
AGGREGATE $
EXCESS LIABILITY ( EACH OCCURRENCE $ 2,000,000
B X UMBRELLA FORM 134883714 05/01/97 05/01/98 AGGREGATE $
OTHER THAN UMBRELLA FORM S
A WORKERS COMPENSATION AND X STATUTORY LIMITS
EMPLOYERS't.1A.BILITV EACH ACCIDENT $ 1,000,000..
THE PROPRIETOR/ INCL NWC29572102 01/01/97 01/01/98 DISEASE-POLICY LIMIT $ 1,000,000
PARTNERS/EXECUTIVE
OFFICERS ARE: 1 X EXCL DISEASE-EACH EMPLOYEE S 1, 000, 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
The City & the Community Redevelopment A ency, its elected or appointed
officers, officials employees and volunteers are included as additional
insuredser form G17957C attached.
*10 days for non-payment of premium or non-reporting of payroll
CERTIFICATE HOLDER CANCELLATION
SANJU9 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
32400 Paseo Adelanto BUT FAH.URS
E-TO-MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
San Juan Capistrano CA 92675 6F AN-V-K. ATIVES.
47.2
AUTHORIZED REPRESENTATIVE /
Joe A. Boswell
ACORD 25-S (3/93) ACORD CORPORATION 1993
.•
CNA
For All the Commitments Yon Melte
BO'I'ACO, INC.
134883700 5-1-97/5-1-98
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)