1999-0305_CALIFORNIA TRAFFIC MAINTENANCE_Insurance Certificate 03/30/1993 :0:417 818-X954-826E PAGE 132
CERTIFICATE OF LIABILITY INSURANCE DATECMMIDDJrv)
03/05/99
PRODUCER INSURNCE SERVICES INC. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
P.O. $OX 7329 ONLY AND CONFERS NO FIGHTS UPON THE CERTIFICATE
DOES NOT AMEND, EXTEND OR
THOUSAND OAKS, CA 91359 ALLTLER RTHEHIS COVERAGECATAFFORDED BY THE POLICIES BEt.OW.
_____ FAX: 805-494-0781 INSUREPSAFFORDING COVERAGE
INauREo
CALIFORNIA TRAFFIC INSURER SUPERIOR NATIONAL INS CO
MAINTENANCE, INC. INSURER B_.__... _..--_---
17 31 N CALIFORNIA STREET INSURER c
CA 91505 NSURER D.
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BUN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEC. NOTWITHSTANDING
ANY REQUIREMENT, TERM 3R CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT '0 WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 19 SUBJECT TC ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
,NSATl'PE OF INSURANCE i POLICY NUM<ER — 1 POLICY E�rECTIVE POLICY EXPIRATION " .
I
1_DATE I______ DATE IM M______1 LIMITS
GENERAL LIASIUYY
EACH OGGtJRAENCE �$
TCO„
GENERAL UAGUTY FIRE DAMAGE(Ally olio firs) S
CLAIMS MAGE 7 OCCUR -�
MED EXP(Any una porno)
PERSONAL 4 ADV INJURY S
�.,_.,,_.,_ GENERAL AOOREOATE S
OWL AGGREGATE LfMfT APPLIES PER PRODUCTS•COMi'(OP AGO $
t-1►DUCT f7,PIEI" VX 1 L • _-1 .�..�.___.
AUTOMOBILE LIABILITY I COMBINED S MOLE UMiT $
ANY AUTO (j a.4cidan$
ALL OWNED AUTOS —_
BODILY INJURY 3
SCHEDULED AUTOS (Por Foram)
HIRED AUTOS �.
!BODILY INJURY $
...- NON-OWNED AUTOS (PofoKcidsnll tf
PROPERTY DAMALK?yr acodontI
j
SARAAE LIABILITY AUTO ONLY EA ACCIDENT S
ANY AUTO EA AGC
OTHER THAN --'
AUTO ONLY AGO $
OfCESS uABIUTY EACH OCCURRENCE 3
OCCUR [j CLAIMS MADE AGGREGATE $
....— 4'
---DEDUCTIBLE w._._ ...n,.w�.. .
RETENTION 1 , $
A W01lRHS5COMPeNSATIoNAND WDN68153-A 03/01/99101/01/00 'X1,"ogrLIMITS E..1
EMPLOYERS'LIAEILITY
E L EACH ACCIDENT i 10 0 0 0 0 0
f
E L.DISEASE_EAEMPLOYEE $ 1000000 1
f E.L.DISEASE•POLICY UMIT $ 1000000
I OTHER - -- -
I
___J _
DESCRIPTION OF OPERATIONS,LOCATIONS/YEHICLESIEXCWSIQNE AWED EIY ENDORSEMENT/SPECIAL PROVISIONS
PROJECT: PAVEMENT MARKING MAINTENANCE CONTRACT, P.O. 15582
10 DAY NOTICE OF CANCELLATION MAY APPLY FOR NON PAYMENT OF PREMIUM.
L
CERTIFICATE MOLDER i ADDITIONAL INSURED;INSURER LET"'f R: _ CANCELLATION
III SHOULD ANY OF THE AboVE DESCRIBED POLICIES SE CANCELLEOBEFORE THE EXPIRATION
DATE THEREOF,THE'5SUIN0 ENSURER WILL EHOEAVOR TO MAIL 3 0 DAIS WRITTEN
CITY OF SAN JUAN CAPISTRANO
32400 PASEO AD)ELAN'TO NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE"O DO 60 SHALL
BAN JUAN CAPI6TRANO, CA 9267 S IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES. �
AUTHOR'�ZED REPRYBOATI6'C r -
_ ç,/'
. ter_ -�
IATTN I CITY CLEWS OFFICE LOR"7� 1{AI 'Jr� !:
ACM 25-S(7'97) -.1 o ACORD CORPORATION 1988
CERTIFICA _ _ OF LIABILITY INSUR, NCE DATE(MM/DD/YY)
03/05/99
PRODUCER INSURNCE SERVICES INC. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
P.O. BOX 7329 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
THOUSAND OAKS, CA 91359 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE rn
FAX: 805-494-0781 r, , c)
INSURED CALIFORNIA TRAFFIC INSURER A. SUPERIOR NATIONAL INS Co rn
c
MAINTENANCE, INC. INSURER B: W a
1731 N CALIFORNIA STREET INSURER C:
BURBANK, CA 91505 INSURER D:
`o
INSURER E. CZ,
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION LIMITS
LTRDATE(MM DD,YY) DATE(MM/DD/YY)
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABIUTY FIRE DAMAGE(Any one fire) $
CLAIMS MADE OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS-COMP/OP AGO $
POLICY - PRO n LOC
JECT
AUTOMOBILE UABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
(Per accident)
GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGO $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION AND WDN 6 8 1 5 3 -A 03/01/99 ' 01/01/0U X I TORY LIMITS I 1R
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 1000000
E.L.DISEASE-EA EMPLOYEE $ 1000000
E.L.DISEASE-POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
PROJECT: PAVEMENT MARKING MAINTENANCE CONTRACT, P .O. 15582
10 DAY NOTICE OF CANCELLATION MAY APPLY FOR NON PAYMENT OF PREMIUM.
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHEEXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
CITY OF SAN JUAN CAPISTRANO NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES. /
AUTHORIZED REPRESENTATIVE
ATTN: CITY CLERK'S OFFICE LORNC ��� CG�
ACORD 25-S (7/97) 0 ACORD CORPORATION 1988