1997-0718_CALIFORNIA TRAFFIC MAINTENANCE_Insurance Certificate ..>:;.>::::;> i<i:.>;.::...:i . . D
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Contractors & Manufacturers Insurance Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. 0. Box 7817 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Northridge CA 91327-7817 COMPANY
(818) 368-3561 A GOLDEN EAGLE INSURANCE CO.
INSURED COMPANY
California Traffic Maintenance B co/ APPLEBY & STERLING
1731 N California COMPANY
C NAVIGATORS INSURANCE CMPANY
Burbank CA 91505- COMPANY
(818) 95418772 D GENERALI INSURANCE COMPANY...USA
•
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.
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
TR DATE(MM/DD/YY) DATE(MM/DD/YY)
B GENERAL LIABILITY GENERAL AGGREGATE $2000000
X COMMERCIAL GENERAL LIABILITY 97G2167 07/08/97 07/08/98 PRODUCTS-COMP/OP AGG $1000000
CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $1000000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1000000
FIRE DAMAGE(Any one fire) $50000
MED EXP(Any one person) $5000
D AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO GA10300023 07/08/97 07/08/98 1000000
ALL OWNED AUTOS BODILY INJURY
X 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 $
UMBRELLA FORM / / / / AGGREGATE $
OTHER THAN UMBRELLA FORM $
A WORKERS COMPENSATION AND X STATUTORY LIMITS
EMPLOYERS'LIABILITY NWC 424849 02/05/97 02/05/98 EACH ACCIDENT $1000000
THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT $1000000
PARTNERS/EXECUTIVE
OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE %,1,Q,00000
OTHER r
/ / / / C fV
r*i
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS -
ALL OPERATIONS OF THE NAMED INSURED ON JOB NO. ANNUAL CONTRACT TEN DAY CANCELLATION FOR NON PAYMENT OF PREMIUMS 6
AS RESPECTS GENERAL LIABILITY, THE CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL
INSURED RESPECTING WORK PERFORMED FOR CERTIFICATE HOLDER BY NAMED INSURED.
GA .
ERTWIGATE HQU EA GANG �.L ATI t
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 MAIL
Att: Deputy City Clerk 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Ddawn Schanderi BUT FAILURE TO MAIL SUCH NOTIC ALL IMPOSE NO OBLIGATION OR LIABILITY
32400 Paseo Edelanto OF KIND UPON T E '0' -; Y, ITS ENTS OR REPRESENTATIVES.
San Juan Capistrano CA 92675 AUT,•RI D RESENTATI E
'
ACORD 25-S (3193y •• 1/4004
1983
POLICY NUMBER COMMERCIAL GENERAL LIABILITY
97-G2167
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 10 11 85
ADDITIONAL INSURED -- OWNERS, LESSEES, OR CONTRACTORS
(FORM B)
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
The City of San Juan Capistrano, and the Community Redevelopment Agency, its elected or appointed
officers, officials, employees, and volunteers are included as insureds with respect to damages and
defense of claims arising from (a) actvities performed by or on behalf of the Named Insured, (b) projects
and completd operations of the Named Insured, or (c) premises owned, leased or used by the Named
Insured.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
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.
IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THIS POLICY FOR THE BENEFIT OF THE
ADDITIONAL INSURED SHOWN SHALL BE PRIMARY INSURANCE, AND ANY OTHER INSURANCE
MAINTAINED BY THE ADDITIONAL INSURED(S) SHALL BE EXCESS AND NON-CONTRIBUTORY, BUT
ONLY AS RESPECTS ANY CLAIM, LOSS OR LIABILITY ARISING OUT OF THE OPERATIONS OF THE
NAMED INSURED(S) OR ITS SUB-CONTRACTORS, AND ONLY IF SUCH CLAIM, LOSS OR LIABILITY IS
DETERMINED TO BE SOLELY THE NEGLIGENCE OR RESPONSIBILITY OF THE NAMED INSURED.
IN THE EVENT OF CANCELLATION OR REDUCTION IN COVERAGE, A 30 DAY WRITTEN NOTICE OF
CANCELLATION WILL BE MAILED TO THE CERTIFICATE HOLDER.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984