1999-0317_CHAMBER OF COMMERCE_Insurance Certificate ^C;r. . ..:.:.::..::.....�.:•:>`,,,, .. ::i;:..,:'.;i:::..:::.::C.:: ---.'" '''' ;.i.:.; ''''''i'%>;<: : ;:.::: ,. .:.j< i>. : ,,,, ,,,,, . .i::< : D T _._.. ..
"' ■■ � ■■ _ • : .:'''''''''''''''',11;:.:_ ,; � DATE(MM/DD/YY) �.� •
iiiA CORD <_ ::: ::: � ■■■■ :.. ■■■■ y■■
........... .::..::.:....,.::.::..�:..:..:...�:.:.:::.: :..�::............................................................................. ................ ...........::..::..:..:...::.:.:::::...:.:.::::.:;. 03-17-1999 ::::>
PRODUCER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Allied Specialty of California HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 619034 COMPANIES AFFORDING COVERAGE
Roseville, CA 95661-9034 COMPANY
(800) 434-1110 FAX: (916)773-1590 A T.H.E. Insurance Company
INSURED `--COMPANY
San Juan Capistrano B y,,c� ry
- _ry r1 11)
Chamber of Commerce COMPANY :, rrnn
�
P.O. Box 1878 C _
,n
San Juan Capistrano, CA 92693-1878 COMPANY , rn
D
::..:....:........:.w..:...:..::::.�:.�::.: ::;:�h:�:v:v0::::::::.:�:::::::::.:�:::::::::::::•:::w:::::.�:::::: :::.::::::::::nom::::::::n::::n�n�.;n�;:.:::v:::r;{::::::::.�::.i:ii::ii ii;::•;•r,..•1.v}:.�mn�nii}ii:iii::Li::•ifi:!iiiii:i>:i i;i>iiiii}iih.%n;.;:v'vv:;:;::i+:y iii::: ...v:<::}Y::jii:ii::::it::ii:vn::i:$i:is
:...:..:..l..�n�:.�:.�::.:::ni:n::.�::::::.�:n�:.�:::nom::;•:::•;..:.�:::::n�::.�.:..::v.�:.. ..:.......:::•v;:•:::v.�::::::::n�:::
�I i::::::: 11�•::^?::i:ii?i::::::::::::::::::::::::::
�' '�:':!i;.;i::%tv::j;;;ry:.;i;ii:::ii::h:+:::i;:i� :::::jjjj$::ii;;i:;j;i::i:i:vi:i;:jii;iyY<::;:i:;::iiii.:i:::::`isj':5>i>iiiii:ivi:ii:::%'^.:::2;;iiii.?:i:ij i:::!:::i:iii:>'{<jl�;i:::v:ivi:i:��:::::i::i iii::+.i'.::?::::.::::::jj:�: ii: ::i:<jtjs�;::<Ji%:;:;i';_:::;:::i:i':::::::!!!c::!.�:c;::::i::i:b:;.i;::::.�t::
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH- ItaLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEC ANA 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.
T TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR I DATE(MM/DDNY) DATE(MM/DDNY)
GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000.
X COMMERCIAL GENERAL LIABILITY 99LC1958 Q3-15-1999 03-15-2000 PRODUCTS-COMP/OPAGG $ 1,000,000.
A ::i'imi CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $ 1,000,000.
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE .$ 1,000,000.
X D & 0 Coverage FIRE DAMAGE(Any one tire) $ N/A
MED EXP(Any one person) $ N/A
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
(Per accident) $
NON-OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTOOTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND n 'vBC STA i U- yy0Tl-'
TORY LIMITS� I^ER
EMPLOYERS'LIABILITY
EL EACH ACCIDENT $
THE PROPRIETOR! R INCL EL DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $
OTHER
DESCRIPTION OFOPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Additional Insureds: CITY OF SAN JUAN CAPISTRANO.
,.;. C :::':::':: i:'3'i:::ii:::`:':::::':::j:i;:;:i:.i:::.i: :;;::::r;;�iiY:3:::::::::::::::`:iii:;i<:::: :':;i;.:i:: :si::::::::i:';:;i:::::ii:is::::::�:i':::i:iiii:::::i:'ii:'
./v trhh '.::: ::}�:.tt'��{+yy .::i::::::;:j:.:;:i;:i;: :: :::i::i:: ::::ji::::::ji::::ii;•j::j?;;i::j;:3;i:::".;:::::::::i:::::i::isj.iiii::is�::� :%ii3j:::;::;.;.:............................................... : .:. ....:. :::::.�:::.�::::.�:..:�.::: :::.::. +:� :::�:::: ::
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CINDY PANDELTON EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
CITY OF SAN JUAN CAPISTRANO 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
32400 PASEO ADELANTO BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
SAN JUAN CAPISTRANO, CA 92675 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
I ' - ..1,..4,4:°(
:; 004La '+.:..:::1:. ..:.::.:::i;;.i:n:ii:<i;i::.::;iing.:::::i:::;..�::.isi:::::::.a:i:.<.::.:.::.i:.».:::.:: :::.moi.iii:;.. :::::.;,:;;::.::.;::.;:.::;.;::::::::<:::::,:.>::..;.:::.:::.:i;.:: :<.;: ,;:.,:;:<.;:::.::;..:...:.....:..
MAY-25-1999 09:51 FROM I u 1y4'i4 .31e.o.3 r.oz
AH 1/V T7 L ii Nil t ,. y 7 r fes•. t
—,. llii1k117iIksl!�1 ' I� t, Ilr}lH I �wlj.6e""t�hnee f;rtRsrerss nr
1.4ar,,,...+a' ,,-,;.-.awie.....r u.....u..4,4 .....1.«. n ?tM?, iRu.. Ms °>. • • �t.1ta. si;xAr/KlieaavtuiN 03'17-1999
PRODUCER THIS CERTIFICATE IS I :D AS A MATTER OF INFORMATION
ONLY AND CONFERS RIGHTS UPON THE CERTIFICATE
Allied Specialty of California HOLDER. THIS CERTIFICATE DOES NOr AMEND, EXTEND OH
Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
p.O. Box 619034 COMPANIES AFFORDING COVERAGE _
Roseville, CA 95661-9034 COMPANY
(800)434-1110 FAX: (916)773-1590 A T.H.E. Insurance Company
INSURED
COMPANY
San Juan Capistrano B
Chamber of Commerce COMPANY
P.O. Box 1878 I C • _
San Juan Capistrano, CA 92.693-1878 COMPANY
D
Tttit5�Iii n K ,s•,< e.r•+ i il7s3kll(E'•11 r►: !N•'!. ` nn, ° - IN1io}!!)�tsrEMseYsr•s.e •s.;.._< a. r.c,
IRA'tI 4 'B slt'74,t ti ssSO.,7irs>is•t Els,(£,;I I r..E aimila l: 441174 kJiN*1 i,...2* . lf kw1.64a#Tt3.noif►ji—. 7.-».-,!4.isii.,„ iVYut,=»z at r.Ir.€Sia<>Kis�rds r.e
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.
1
CO TYPE OF INSURANCE i POLICY NUMBER >O-1'EFFECTIVE POLICY EXPIRATION
LM/
TR DATE(MM/DD/YY) DATE tmoo/oWI'r) I LIMITS
GENERAL LIABILITY II GENERAL AGGREGATES 1,000,000_
X ICOMMERCIAL GENERAL LIABILITY I 99LC1958 3-15-1999 133-15-2000 1 PRODUCTS-COMP/OPAG(; S 1,000,000.
A ,IdaJ. ,CLAIMS MADE X I OCCUR I PERSONAL A AM/INJURY S 1,000,000.
— OWNERS&CONTRACTOR'S PROT I II EACH OCCURRENCE _ $ 1,000,000-
1( D SO Coverage i . FIRE DAMAGE(Any one ere)~ S N/A
1 - ._. I _
MED EXP(Any one person) S N/A
AUTOMOBILE LIABILIT/ 1
ANY AUTO i COMBINED SINGLE LIMIT 1 S
I Alt OWNED AUTOS BOD1LY INJURY
�SCHEDULED AUTOS i IPer peron) S
HIRED AUTOS
BoolLY INJURY S
f NON-OWNED AUTOS - (Per accn:ani)
- I J PROPERTY DAMAGE S
~
GARAGE LIABILITY
I !AUTO ONLY-EA ACCIDENT S
ANY AUTOI OTHER THAN AUTOY: **Iies:,x,tiEt<s eFsx as•`i'sett
I EACH ACCIDENT S
—I
AGGREGATE S
EXCESS LIABILITY EACH OCCURRENCE S
UMBRELLA FORM 'i I AGGREGATE S
OTHER THAN UMBRELLA FORMS— ,I - _
i WCSTATU- MU I'.e �fK ••su«s•r..s,xar,,
WORKERSCOMPENSATKMiANO 1i•`'•" .,
i i I.IORY IMTt <f_ •,
EMPLOYERS'LUeILTTY I EL EACH ACCIDENT S
THE PROPRIETOR/ 7 '
PARTNFRSIEXECUTIVE INCL I EL DISEASE-POLICY LIMIT S
_
OFFICERS ARE: EXCL I I EL DISEASE EA EMPLOYEE s
OTHER
I i
A HOST..)LIQUOR LIABLT4Y 99LC1958 05-25-1999 03-15-2000]
H
DESCRIPTION OF OPERATIONS/LOCATIONS/VENICLESAPECIAL/TENS Additional Insureds: CITY OF SAN JUAN CAPISTRANO_
j��'u�'. -"'R rf_ i �s .,..;•s t:.�. �{SIS r- l . --- ..:<, ..
.., s .�. .. ... ��� � �+��sy� l�I�c�tplifNieYM.•R "sSEii(tsftttt `' 1M s1e< tl EMYi 1K
IVO! y YID �`pit»is;I.j.�:����i',�Itewll � I"F.i�F+�.lug...�.� es�tt(sth'i',:�::.'��....Es3il�'f?�+�«�.`ia'�i� 1�.1'�uF»iu�>tihl>'1`M'$' �
SHOULD ANY OF THE ABOvE DESCRIBED POLICIES BE CANCELLED BEFORE THF
CINDY PANDELTON EXPIRATION DAD THEREOF, THE ISSUING COMPANY MnLl. ENDEAVOR YO MAIL
CITY OF SAN JUAN CAPISTRANO 30 DAYS warn-EN NOTICE To THE CERTIFICATE HOLDER NAMED to THE LEFT.
32400 PASEO ADELANTO BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOse NO OBLIGATION OR LIABILITY
SAN JUAN CAPISTRANO, CA 92675 of ANY FIND UPON THE COMPANY. S AGENTS OR REPRESENTATIVES
��� y% y���.++ t�l�:.,, AUTHORIZED REPRESENTATIVE '"
'[..�i>'t�.,s II .:,�.I(i{. ' `�t o .ii..i.rA �. "- tib"">""W`w'<a,1+o.rt'e'YT" o•. w»•--r R "T `/liG•. :Yc'?" �. -fir - ,+i.
. iSe� ..i;r.i -, : n „ .,•,. ,w,�.ixis i H.4u. ,s+ii!t! 'P"..avY?ri. ...•,,.. 17.ii''' ' 0 1 :flieLM . ,. if '',1 �4.!. ..V r.,A.11"a.-Si..
MAY-25-1999 09:50 FROM I0 194949.3105.3 F'.01
FAX NUMBER
19421 493-1053
ALLIED-SPECIALTY OF CALIFORNIA
INSURANCE AGENCY, INC.
1699 EAST ROSEVILLE, SUITE # A
ROSEVILLE, CA 95661-9034
TELE. (916) 773-1996 - - (800) 434-1110
FAX (916) 773-1590
filli _WyER SHEET
Date: May 25. 1999
No. of Pages: 2
(including this page)
Attention: -Pawn_
From: A,iefa ldra E. Hess
Re: _.ztificate of Liability .fQ.X
San Juan Capifrano Cham, of Comm,
Message: „Attached please find the Ceriti.o to that. p_h_a_v_e_
requested. the oricxingl was sent out to you by mail .
1Xa't hmitate to call if any questions.
Thank you,
Alejandra
moo)