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1997-0303_BOTACO INC._Insurance Certifcate AIC111:11. CERTIFICA' OF INSURANCE oTAC 1 DATE(MM/DD/YY) PRODUCER • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B0501ELL 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 Golden Eagle Insurance Company INSURED li COMPANY B CNA Insurance Companies COMPANY BotaCo Inc. C Mercury Casualty Company 31921 Camino Capistrano, #401 COMPANY San Juan Capistrano CA 92675 D ` COVERAGES , ,;:g::::: - 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 I POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/W) I r--- GENERAL LIABILITY 1 GENERAL AGGREGATE $2,000,000 B X COMMERCIAL GENERAL LIABILITY 134883700 05/01/96 05/01/97 PRODUCTS-COMP/OPAGG $ 1,000,000 CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $ 1,000,000 X OWNER'S&CONTRACTORS PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one fire) $ 50,000 I MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILITY C ANY AUTO AC11017268 05/25/96 05/25/97 COMBINED SINGLE LIMIT $ 600,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS : (Per accident) 1 PROPERTY DAMAGE $ GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT 1 $ ANY AUTO OTHER THAN AUTO ONLY: ' EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $2,000.000 B X UMBRELLA FORM 134883714 05/01/96 05/01/97 AGGREGATE $ OTHER THAN UMBRELLA FORM $ A WORKERS COMPENSATION AND X STATUTORY LIMITS EMPLOYERS'LIABILITY EACH ACCIDENT $ 1,000,000 THE PROPRIETOR/ INCL I NWC29572102 01/01/97 01/01/98 DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTIVE --- OFFICERS ARE: X EXCL' 1 I DISEASE-EACH EMPLOYEE $ u00,000 OTHER AL z n ri n of--,in m DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS L�3;,k $—' < The Cit & the CommunityRedevelopment Agency, its elected orappointed z�x-"''- m officers, officials, emloyees and volunteers included as aitional 7 - insuredsper form G-17957-u attached. r *10 days or non-payment of premium or non-reporting of payroll **Replaces certificate issued 1/2/97** xxx ce=, CERTIFICATE HOLDER CANCELLATION - ' ........... .. SANJU99 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 San Juan Capistrano CA 92675 AUTHORIZED REPRESENTATIV Joe A. Boswell ( ACORD 25-S(3/93) I/ ©ACORDgRAT CORPION 1993 i i CNA • For A I the Cummkmena You Make' • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (called addition: insured) whom you are required to add as an additional insured on this policy under: 1. A written contract or agreement; or • 2. An oral agreement or contract where a certificate of insurance showing that person or organization as an additions insured has been issued; but: • the written or oral contract or agreement must be: (a) currently in effect or becoming effective during the term of this policy; and (b) executed prior to the "bodily injury," "property damage," "personal injury," or "advertising injury." The insurance provided to the additional insured is limited as follows: 1. That person or organization is only an additional insured with respect to liability arising out of a. Premises you own, rent, lease, or occupy or • • • b. "Your work" for that additional insured by or for you. . 2. The limits of insurance applicable to the additional insured are those specified in the written contract or agreemen or in the Declarations for this policy whichever are less. These limits of insurance are inclusive of and not it addition to the limits of insurance shown in the Declarations. Tne insurance provided to the additional insured does not apply to "bodily injury", "property damage", "personal injury' or "advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render an} professional services including: 1. Tne preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, chantE orders, desicn or specifications; and 2. Supervisory, inspection, or engineering services. • Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. THIS ENDORSEMENT iS A PART OF YOUR POLICY AND TAKES EFFECT ON THE EFFECTIVE DATE OF YOU= POLICY UNLESS ANOTHER EFFECTIVE DATE iS SHOWN BELOW. POLICY =MESE NO. 134883700 EFFECTIVE DATE OF THIS POLICY CHANGE BOTACO, DC- 5-1-96 COUNTERSIGNED DATE _UTHORI FRESENT VE JOE A. BOSWEE I/JS G-17957-B • (ED. 09/92)