1998-0223_CHAMBER OF COMMERCE_Insurance Certificate 134/143/1998 11 : 32 7144892695 SJCCHAMBE RUF Cr IMlinr-1.'I.I
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Allied Specialty of California ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTENT) OR
Insurance Agency, Inc, ALTER THE COVERAGE AFFORDED BY THE POLICIES ULLOW
P 0 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 CapistranoB
Chamber of Commerce COMPANY
P 0 Box 1878 _ C
San Juan Capistrano CA 92693- 1878 COMPANY
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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"
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PotICY EXPIRATION
LYR DATE(MM/DD/YY) DATE(5141/DO/YY)
GENERAL LIABILITY GENERAL AOOREGATE $ 1,000,-000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG+f 1,060,000
A '':.L%%`L, CLAIMSMADE 1 XIDCCUR 98LC9138 03/15/98 03/15/99 PERSON...aACVIWURY s 1,000,000_
I. ! .....CLAWS
OWNER'S II CONTRACTOR"S PROT EACH OCCURRENCE s1,000,000
X D b 0 Coverage FIRE DAMAGE(Any ons fire) $ N/A
MED EXP(My one person) ,S NTA
AUTOMOBILE UABILFf,I
COMBINED SINGLE LIMIT f
ANY AUTO _______`
ALL OWNED AUTOS
,---- BODILY INJURY S
SCHEDULED AUTOS (Par person)
HIRED AUTOS
90PILY INJURY S
NON-OWNED AUtOS (Por accident)
PROPERTY DAMAGE S
I
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN AUTO ONLY e r ,; • I Ts'
--
EACH ACCIDENT S _
_ 1 t _ AGGREGATE '
F r ExCeSS LABILITY EACH OCCURRENCE f
--
UMBRELLA FORM AGGREGATE S
OTHER THAN UMBRELLA FORM S
•WORKERS COMPENSATION AND T` WC STATU 10TH-H{ 5 jL`e
TORY IJMIt EA .:,;� ;,. .:.
EMPLOYERS LIABILITY
EL EACH ACCIDENT S __
THE PROPRIETOR/PARTNERSIEXECUTIVE INCL EL DIS *SE•POLICY LIMIT J S
OFFICERS ARE: E..CL EL DI ASE-EA EMPLOYEE S
OTHER _
DESCRIPTION OF OPERATIONSA.00ATIONSNENICLES/SPECIALITEMS Additional Insured: City of San Juan Capistrano
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
'" EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City of San Juan Capistrano _1(1_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED YO THE LEFT
32400 Paseo Adelanto BUT FAILURE YO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
San Juan Capistrano CA 92675 _ OF ANY K,ND PON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
�+���)�y�y((7� � AUTHORIZED NT E '
AarAKa'tWitiLae.4,00 >� W,'Ner, 4g ,.� >t ' s,h.p?U :•.:,`.4; •'j...>.... .k.re•. ..if:'''V iNAii Ata?' " &r' •'1Y.'t'41 '�Ay0 2NMM
OCT-21-1998 07: 15 FROM IH 19494931053 P.01
714493105 !TY OF SAN I l 1F cylP 544 P02 SEP 23 '96 14:26
LIABILITY ENDORSICMb NT
CITY OF SAN JUAN CAPISTRANO
COMMUNITY REDEVELOPMENT AGENCY
32400 Paseo Adelanto
San Juan Capiatrtano,California 92675
ATTN: DAWN SCHANDERT,
A. POLICY INFORMIJQN Endorsement*
1. InsursnceCompany..H_ ��Lri�ANCE COMPANY ;PolicyNtiunber 98LC9.L18
2. POlicyTerm(from) 03-05 28 (To) 02-15-99 ;Rndorsement&ffectiveDate 09-01-98
3. NamedInsured SAN JUAN CAPISTRANO CHAMBER OFF
4. AddressofNamodlnsured 0. BOX 1878 SAN JUAN CAP,LSJMN01 CA 9267
S. Limit of Liability Any One Decurrerfoe'Aggregate 3 1 ,000,000
General Liability Aggregate(Check osier)
Applies "per locstinniprQjcct" _Is twice the occene:we limit
6. Deductible or Self-insured Retention(Nit unless otherwise specified): S 500.00
7. Coverage is equivalent to;
Comprehensive General Liability form(11.0002(Ed 1173)
Commercial General Liability"claims-made"form CG0002
8. Bodily Injury and Property LYartiage Coverage is:
"class-trade"
"occurrence"
If claims-made,the.retroactive date is
R. MUCK AMENDMENTS
This endorsement is issued in consideration of the policy premium. Notwithstanding any inconsistent statement in the policy to which this
endorsement is attached or any other endorsement attached thereto, it is agreed as follows:
1. INSURED The City and the Community Redevelopment Agency,its elected or appointed officers,officials,employees
end volunteers are included as insureds with regard to damages and defense of claims arising from, (a) activities
performed by or ort behalf of the Named Insured,(b)projects and completed operations of the Named Insured,or(c)
promise owned, leased or used by the Named Insured.
7. CONTRIBUTION NOT REQUIRED. As respects_(a)work performed by the Named insured for or on behalf of the
City;or(b)projects sold by the Named Insured to the City;or(c)premises leased by the Named Insured from the City,
the insurance afforded by this policy shall he primary insurance as respects the City, its elected or appointed officers,
officials,employees or volunteers,or stand in an unbroken chain of coverage excess of the Named Insured's scheduled
underlying primary coverage. In either event, any other insurance maintained by the City, its elected or appointed
officers, officials,employees or volunteers shall be in excess of this insurance and shall not contribute with :t.
3- SCOPE OF COVERAGE. 'Phis policy,If primary,affords coverage at least as broad as:
(I) insurance Services Office form number(31,3002(Rd. 1/73),Comprehensive General Liability Insurance and
Insurance Services Office form umber GL0404 Broad Form Comprehensive General Liability endorsente,it,
11,
(2) Insurtsnce Services Office Commercial General I-lability Coverage, "ocxurrence" form 000001 or"claims
made''form CC0002; or,
U I-G l 1 r- l b r KUrl H1 19494931053 P.02
'71449311453 Py' (F N .Tl IAN i44 P03 SEP 23 '98 14:26
6
(3) If excess,affords coverage which is at least as broad as the prunary insurance torms referenced in the preceding
sections(I)and(2).
4 SEVERABII.4TY OF INTEREST. The insurance afforded by this policy applies separately to each insured who is
seeking coverage or against whom a claim is made or a suit is brought except with respect to the Company's limit of
liability.
5. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply
with repotting provisions of the policy shall not affect coverage provided to the City and the Community Redevelopment
Agency,its elected or appointed officers,officials.employees or volunteers.
6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be,suspended.voided.cancelled,reduced
m coverage or limits except after thirty(30)days'poor written notice by certified mall return receipt requested has been
given to the City. Such notice shall be addressed as shown In the heading of this endorsement
Incidents arid claims are to be reported to the insurer at
ATTN:
(Title) (Department)
ALL RISK CLAIMS SERVICE
(Company)
(Street Address)
(City) (State) (Zip code)
(813) 367-6700
(Telephone) —
D.
bititiALLB.K.OF INSURER OR.AL tiJLM1 EPR iN TATTVE OF TH ; JRER
„(print/type name), warrant that I have authority to bind the below listed
Insuranbe company and by my signature hereon do so bind this company,
...vriaires44
SIGNATURE OF AUTHORIZED RiPRBSENTATIVF
(Original signature required on endorsement furnished to the City)
ORLIANIZATION:_ ALLIED SPF:(_IA'pry QF.leLT�net��,A TITLE
ADDRESS- "TELEPHONE: (800) 237-335
32400 PASEO ADELANTO
MEMBERS OF THE CITY COUNCIL
COLLENE CAMPBELL
SAN JUAN CAPISTRANO, CA 92675 i � JOHN GREINER
(949) 493-1171 f" 1 imouo�wI WYATT HART
(949) 493-1053 (FAX) • uellISNf 1961 GIL JONES
1776 DAVID M.SWERDLIN
• � •• CITY MANAGER
GEORGE SCARBOROUGH
September 4, 1998
Mr. Tom Facon
Executive Director
San Juan Capistrano Chamber of Commerce
P. O. Box 1878
San Juan Capistrano, California 92693
Re: Visitor Services
Dear Mr. Facon:
At their meeting of September 1, 1998, the City Council of the City of San Juan Capistrano
approved a Memorandum of Understanding with the Chamber to provide visitor services
during Fiscal Year 1998-99, with the City contributing $25,000 to the program.
A fully-executed copy of the MOU is enclosed for your files. The required insurance is on
file with the exception of the General Liability Endorsement form. Please forward the
required endorsement form to the City Clerk's office as soon as possible.
Thank you for your cooperation. Please feel free to contact Mechelle Lawrence if you need
any further information.
Very truly yours,
GYM
Cheryl Johnson
City Clerk
Enclosure
cc: Mission Inn Motel
Best Western Capistrano Inn
Mission San Juan Capistrano
Mechelle Lawrence (with enclosure) DRUG USE
IS
AB
San Juan Capistrano: Preserving the Past to Enhance the Future