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1993-0815_C.B. ELECTRIC_Insurance Certificate ISSUE DATE(MM/DD/YY) PRODUCF.R , + THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND R W TURN: INSURANCE BROKERAGE CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 34071 LA PLAZA SUITE 210 POLICIES BELOW. DANA POINT CA 92629 COMPANIES AFFORDING COVERAGE ( 714 ) 240-8350 ( 714 ) 240-1436 FAX COMPANY A LETTER SAFECO INSURANCE COMPANY COMPANY B INSURED LETTER FINANCIAL INDEMNITY COMPANY C B Electric COMPANY C 114 Avenida Sierra LETTER San Clemente CA 92672 COMPANY D (714 ) 492-3013 LETTER COMPANY E LETTER 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) A GENERAL LIABILITY GENERAL AGGREGATE $1,000, 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $1,000, 000 CLAIMS MADE X1 OCCUR. SL 2285548 07/23/93 07/23/94 PERSONAL&ADV.INJURY $1,000,000 OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $1, 000,000 FIRE DAMAGE(Any one fire) $ 50, 000 MED.EXPENSE(Anyoneperson) $ 5, 000 B AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $250 000 HIRED AUTOS C3822874 06/22/93 11/23/93 BODILY INJURY NON-OWNED AUTOS (Per accident) $500 000 GARAGE LIABILITY PROPERTY DAMAGE $100, 000 EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM / / / / AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS AND / EACH ACCIDENT $ DISEASE--POLICY LIMIT $ EMPLOYERS'LIABILITY — DISEASE--EACH EMPLOYEE $ OTHER / / / / DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ALL OPERATIONS OF THE NAMED INSURED ADDITIONAL INSURED: SEE PAGE TWO (2 ) ATTACHED TO THIS DOCUMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF SAN JUAN CAPISTRANO EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 32450 PASEO ADELANTO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE SAN JUAN CAPISTRANO, CA. 92675 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ATTN: RON S IEVE RS AUTHORIZED REPRESENTATIVE ACORD:25 S ; l ( (( / �►Acl�l�l�:'>��b��c� • • PAGE 2 9-15-93 ' CHARLES D BROWN DBA C. B. ELECTRIC CERTIFICATE TO CITY OF SAN JUAN ET AL ADDITIONAL INSUREDS : The City and the Community Redevelopment Agency, its elected or appointed officers, officials , employees and volunteers are included as insureds with gard to damages . INSURED: CHARLES D BROWN - DBA: C B ELECTRIC §AFECO® POLICY NUMBER: SL 2285548 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. - ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY CATASTROPHE COVERAGE PART SCHEDULE Name of Person or Organization: ** WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. ** CITY OF SAN JUAN CAPISTRANO ATTN: RON SIEVERS 32450 PASEO ADELANTO c - SAN JUAN CAPISTRANO, CA 92675 z''� fir? C30 + v-+ rn -•,S)s,c-, 'tD rn .. m .1it rn z cn w 10/12/93 QN/EC PSWR AC4 ROBERT W. BURNS INSURANCE BROKER 17-7240 Copyright, Insurance ServicesROffice, Inc., 1985 V°Iv r� *Registered trademark of SAFECO Corporation. CG 20 10 11/85 PRINTED IN U.S.A.