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1999-0203_CAPISTRANO VALLEY BOBBY SOX_Insurance Certificate
ACORDT. CERTIFICA. - OF LIABILITY INSURE viCE DATE(MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORI3AV Special Markets Insurance Consultants ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 108 McDill Avenue ALTER THE COVERAGE AFFORDED BY THE PIES BELOW. a Stevens Point, WI 54481 INSURERS AFFORDING:COVERAGE 7,3 INSURED INSURER A: . i Prl . Bobby Sox Softball - Teams & Leagues, Cappo Valley INSURERS: -- Bobby INSURER C: Sox , N < 7429 Orangethorp Ave, Suite BINSURER D: 'w `t Buena Park, CA 90622 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. WITHSTANDING 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) I DATE(MM/DD/YYl GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000.00- 1 x 000000.00-- X COMMEERCIAAL GENERAL LIABILITY GL-40-01-13-005-05 1/1/99 1/1X00 FIRE DAMAGE(Any one fire) $ 8-- 50 000.0 CLAIMSMADE X OCCUR MED EXP(Any one person) $ Excluded - PERSONAL&ADV INJURY $ 3,000,000.00 GENERAL AGGREGATE $ 3,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,0e0,000.00 X POLICY PRO- LOC _ JECT AUTOMOBILE LIABILITY 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) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ H- WORKERS COMPENSATION AND • WC STATU- R EMPLOYERS'LIABILITY TORY LIMITS ER ER E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of San Juan Capistrano is added as a named insured for liability arising from the operations of Cappo Valley Bobby Sox. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN 30 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL The City of San Juan Capistrano IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 32400 Paseo Aldelanto REPRESENTATIVES. AUTHORIZED REPRESENTATIVE San Juan Capistrano, CA 92675 e"1/ , ACORD 25-S(7/97) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(7/97) r � cir.a�� 32400 PASEO ADELANTO y0), MEMBERS OF THE CITY COUNCIL COLLENE CAMPBELL SAN JUAN CAPISTRANO,CA 92675 ,� L� JOHN GREINER (949)493-1 171 ` MA110A1110 WYATTHART (949)493-1053 (FAX) • IS�Al11SN11 1961 GILJONES 176 DAVID M.SWERDLIN • (I • CITY MANAGER GEORGE SCARBOROUGH January 14, 1999 Ms. Laurie Menosky, President Capistrano Valley Bobby Sox 24262 DeLeon Dana Point, California 92629 Re: Renewal of General Liability Certificates of Insurance (Concession Stand at Cook Park Cordova Athletic Fields - License Agreement) Dear Ms. Menosky: The General Liability Certificate of Insurance, regarding the above-referenced agreement expired on December 31, 1998. In accordance with your agreement, the insurance certificate needs 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 certificate and the endorsement form to the City, attention City Clerk's office, by January 22, 1999. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. Very truly yours, kat,o-nk .60hfLid&Le___ Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Karen Crocker, Community Services Manager DRUG USE IS San Juan Capistrano: Preserving the Past to Enhance the Future