1998-0814_CALIFORNIA TRAFFIC MAINTENANCE_Certificate of Insurance C',ertificate #2601816,7 Issue Date: 8/12/1998
P.O. Box 13456 CERTIFk-ATE OF INSURANC
Sacramento, CA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
95813-3456 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES rt.• r
(916) 566-1000 BELOW. THIS FORM SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES. `t
<...� c)
Insured: Certificate Holder: ''-'r- �r—n
'ti ti cn 19
Gilbert Apodaca And Cathy Apodaca; DBA: California City Of San Juan Capistrano
Traffic Maintenance ct�
CO
1731 N California Street Attn: City Clerk
Burbank, CA 91505 23400 Paseo Adelanto
San Juan Capistrano, CA 92675
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 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 TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Commercial General Liability CA IC10019294 00 Policy Period: 7/8/1998 to (Continuous until
cancelled)
The Insurance Corporation of New York
Description Limit of Insurance
General Aggregrate Liability Limit (Other Than Products-Completed Operations) $2,000,000
Products-Completed Operations Aggregate Liability Limit $2,000,000
Each Occurrence Limit $1,000,000
Personal And Advertising Injury Liability Limit $1,000,000
Tenant's Real Property Legal Liability $50,000 Any One Occurrence
Medical Expense Limit-Any One Person $5,000
Per Claim Deductible Applies to Property Damage $500/$12,500
Business Auto CA IC10019294 00 Policy Period: 7/8/1998 to (Continuous until
cancelled)
The Insurance Corporation of New York
Covered Auto Coverage Limit of Insurance: The most we will
Symbols pay for any one accident or loss
7,8,9 Liability $1,000,000
7 Uninsured Motorist $100,000
7 Physical Damage Comprehensive Coverage ACTUAL CASH VALUE OR COST OF REPAIR,
WHICHEVER IS LESS MINUS THE SCHEDULED
DEDUCTIBLE FOR EACH COVERED AUTO BUT NO
DEDUCTIBLE APPLIES TO LOSS CAUSED BY
FIRE OR LIGHTNING.
7 Physical Damage Collision Coverage ACTUAL CASH VALUE OR COST OF REPAIR,
WHICHEVER IS LESS MINUS THE SCHEDULED
DEDUCTIBLE FOR EACH COVERED AUTO.
Symbols: 1: any auto; 2: owned auto only; 3: Owned private passenger auto only; 4: owned auto other than private passenger auto
only; 5: owned autos subject to no-fault; 6: owned autos subject to a compulsory uninsured motorists law; 7: specifically described
autos; 8: hired autos only; 9: non-owned autos only.
Certificate #26018167, Page,2
SPECIAL INFORMATION CAN LATION
City of San Juan Capistrano, its elected & appointed officials and employees Should any of the described
are included as an additional insured as per attached form IC CG 21 24 03 97. policies be cancelled, the issuing
RE: Painting operations @ Various citywide locations for City of San Juan company will endeavor to mail 30
Capistrano. P.0># 15582. days written notice to the
certificate holder. But failure
to mail such notice shall impose
no obligation or liability of any
kind upon the company, its agents
or representatives.
(22. )4/
Anne Lehman
Authorized Representative
POLICY NUMBER: CA 1C10019294
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTOMATIC ADDITIONAL INSUREDS - CONSTRUCTION CONTRACTS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Endorsement effective
THE INSURANCE CORPORATION OF NEW YORK
8/12/98 To Continuous Until Cancelled
Named Insured Countersigned by
California Traffic Maintnance )(-{'•
(Authorized Representative)
The following provisions are added:
SECTION I - COVERAGES
Subpart (1) (a) of Exclusion f. of Coverage A. is replaced by the following:
At or from any premises, site, or location which is or was at any time owned or occupied by, or rented or loaned to
the insured;
SECTION II -WHO IS AN INSURED
5. Any person(s) or organization(s) (hereinafter called "Additional Insured") with whom you agree in a written construction
contract to name as an insured is an insured with respect to liability arising out of "your work" for the Additional Insured
on the project specified in the construction contract, including acts or omissions of the Additional Insured in connection
with the general supervision of "your work."
However, the insurance provided to the Additional Insured does not apply to:
a. "Bodily injury," "property damage," or"personal injury," occurring after:
(1) All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the
Additional Insured at the site of the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any
person or organization other than another contractor or subcontractor engaged in performing operations for a
principal as a part of the same project.
IC CG 21 24 03 97 Page 1 of 2
POLICY NUMBER: CA 1C10019294
AUTOMATIC ADDITIONAL INSUREDS - CONSTRUCTION CONTRACTS
(cont.)
b. "Property damage" to:
(1) Property owned, used, or occupied by or rented to the Additional Insured;
(2) Property in the care, custody, or control of the Additional Insured or over which the Additional Insured is for any
purpose exercising physical control; or
(3) "Your work" for the Additional Insured.
c. "Bodily injury," "property damage," or "personal injury," arising out of an architect's, engineer's, or surveyor's
rendering of or failure to render any professional services for you, for the Additional Insured, or for others, including:
(1) The preparing, approving, or failing to approve maps, drawings, opinions, reports, surveys, change orders,
designs, or specifications; and
(2) Supervisory, inspection, or engineering services.
These exclusions apply in addition to those contained in the Coverage Part.
SECTION III - LIMITS OF INSURANCE
The following provision is added:
The naming of one or more Additional Insured's does not increase the limits of insurance.
SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS
For the coverage provided by this endorsement:
a. Subpart (4) (a) of the Other Insurance provision is replaced by the following:
(a) This insurance is primary, and our obligations are not affected by any other insurance carried by such Additional
Insured whether primary, excess, contingent, or on any other basis.
b. Subpart (8) (Transfer of Rights of Recovery Against Others To Us.) is replaced by the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above
because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under
a contract with that person or organization and included in the "products-completed operations hazard." This waiver
applies only to the person or organization shown in the Schedule above.
IC CG 21 24 03 97 Page 2 of 2
1I .30a
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32400 PASEO ADELANTO MEMBERS OF THE CITY COUNCIL
SAN JUAN CAPISTRANO,CA 92675 4 COLLENE CAMPBELL
D JOHN GREINER
(949) 493-1 171 11 h IBOAAaAATIA WYATT HART
(949) 493-1053 (FAX) • ISIAAIISAIA 1961 GILJONES
1776 DAVID M.SWERDLIN
• (I • CITY MANAGER
August 7, 1998 GEORGE SCARBOROUGH
California Traffic Maintenance
1731 N. California
Burbank, California 91505
Re: Renewal of General Liability and Automobile Liability Certificates of Insurance (Pavement
Markings)
Gentlemen:
The General Liability and Automobile Liability Certificates of Insurance, regarding the above-
referenced service, expired July 8, 1998. In accordance with your agreement, the insurance
certificates need to be renewed for an additional period of one year. The agreement requires a
general liability endorsement form naming the City of San Juan Capistrano as an additional insured.
I have included a City approved endorsement form to submit to your insurance company;however,
your insurance company may provide their own endorsement form.
Please forward the updated certificates and the endorsement form to the City,attention City Clerk's
office, by August 21, 1998.
If you have any questions, please contact me at(949) 443-6310.
Thank you for your cooperation.
Very truly yours,
//00-1•6194 461"diAL
Dawn M. Schanderl
Deputy City Clerk
Enclosure
cc: Cheryl Johnson, City Clerk
Jack Galaviz, Superintendent
Silvia Cintron, Public Works
DRUG USE
IS
AB
San Juan Capistrano: Preserving the Past to Enhance the Future
I yr',
32400 PASEO ADELANTOra'a"
MEMBERS OF THE CITY COUNCIL
SAN JUAN CAPISTRANO,CA 92675 PI JO N NE GREIAMPBELL
U JOHN GREINER
(949)493-1 171 mIOIPO IIO WYATTHART
(949)493-1053 (FAX) IS1AVISNIA 1961 GIL JONES
1776 DAVID M.SWERDUN
• I� • CITY MANAGER
July 7, 1998 GEORGE SCARBOROUGH
Mr. Gilbert Apodaca
California Traffic Maintenance
1731 North California Street
Burbank, California 91505
Re: Renewal of General Liability and Automobile Liability Certificates of Insurance (Pavement
Markings Maintenance, Installation and Removal)
Dear Mr. Apodaca:
The General Liability and Automobile Liability Certificates of Insurance, regarding the above-
referenced service, are due to expire on July 8, 1998. In accordance with your agreement, the
insurance certificates need to be renewed for an additional period of one year. The agreement
requires a general liability endorsement form naming the City of San Juan Capistrano as an
additional insured.
Please forward the updated certificates and the endorsement form to the City, attention City Clerk's
office, by July 23, 1998.
If you have any questions, please contact me at(949) 443-6310.
Thank you for your cooperation.
Very truly yours,
/01u . , i
Dawn M. Schanderl
Deputy City Clerk
cc: ��
Silvia Cintron, Public or cs
DRUG USE
IS
AB E
San Juan Capistrano: Preserving the Past to Enhance the Future