1999-0629_COMPUTER SERVICE COMPANY_Insurance Certificate +.. LIABILITY i �+ p / DATE(MM/DD/YY)
ACORD ' ,�I� � OF 1 tiTUflfi" "C PAGE 1 OF 2 29-JUN-1999
PRODUCER 98377 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Willis Corroon Corporation of Los Angeles ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
801 N.Brand Blvd. #400 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CA Dept.of Ins. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License#0507516 COMPANIES AFFORDING COVERAGE
Glendale CA 91203
(818) 548-7500 COMPANY Steadfast Insurance Company
Tara Stanbridge,ARM A
INSUREDCOMPANY SAFECO Insurance Company of America
B
Computer Service Company Fremont Industrial Indemnity Company
P.O. Box 8100 COMPANY
12907 E. Garvey Avenue
Baldwin Park CA 91706-0093 COMPANY
D
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' ERAGES
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.
POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE
coI POLICY NUMBER LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
A GENERAL LIABILITY SCO215933804 01-JUL-1999 01-JUL-2000 GENERAL AGGREGATE $ 2.000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGO $ 1.000.000
CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $ 1.000.000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1•000,000
X $10,000 SIR
FIRE DAMAGE(Any one fire) $ 50,000
MED EXP(Any one person) $ 5,000
B AUTOMOBILE LIABILITY 1BA8249066 01-JUL-1999 101JUL-2000
COMBINED SINGLE LIMIT $ 1 ,000.000
X ANY AUTO
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA"'ORM $
C WORKERS COMPENSATION AND LIY524943 i 0IJUL-1999 01-JUL-2000 X TORYT LIMITS 211:1-H
-
EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 1.000.000
THE PROPRIETOR/ X INCL ELDISEASE-POLICY LIMIT $ 1.000,000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCLI ELDISEASE-EA EMPLOYEE $ 1.000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
SEE ATTACHED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL 45441AANZIX}tl4 MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of San Juan Capistrano 81XIXIFXNXJXIXX1(Ol&K 4KX K N CD T CCXXSB(XMXWXptX N(liXXf&NKOG}QXK)XXX X= XX)
32400 PaseoAdelanto OFXX NXX NO XTIX@fXrib.M.M14.11X XAdEN"Kg XMUXF(&AalVEAAITM76/tg1XX}
San Juan Capist CA 92675 AUTHO ENTATIVE
'... .:. .Fi�1'f701V 1988
V�/IIc � [
IS , , J�H r�AGE 20F 2 ____SSUE DATE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURED 98377 PRODUCER
Willis Corroon Corporation of Los Angeles
801 N. Brand Blvd. #400
Computer Service Company CA Dept.of Ins.
P.O. Box 8100 License #0507516
12907 E. Garvey Avenue Glendale CA 91203
Baldwin Park CA 91706-0093 (818) 548-7500
Tara Stanbridge,ARM
GOV RAtGES REPOR E 'R r O C IVL 1999
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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
TYPE OF INSURANCE DATE(MM/DD/YY) DATE(MM/DD/YY)
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
The certificate holder is named as additional insured under the General
Liability policy per the attached endorsement and under the Automobile
Liability coverage per the policy form.
This insurance is primary on both the General Liability and Automobile
Liability per the policy forms .
Cross Liability and Severability of Interest applies per the policy forms .
Re : Computer Service Job No . 9116
Downtown Lighting Phase I ( CIP No . 118)
•
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL CIA:C4X/t41X414 MAIL
30- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT;
City of San Juan Capistrano 9AXE(TFlfKpkEXTOCNAM kiiLK;IVWoXMX50140)1XIMMIX ION OlitIOppAIO (lQFD(KM .II XX)
32400 Paseo Adelanto CCFX • :I AX •• ?OXtfXX M%XIa76 .• ✓�XAtAO ?JOXSTIWKSXXXXXX)
San Juan Capist CA 92675 AUTHO I I • �SENTATIVE /
; 1�llE.US'It9�
POLICY NUMI3ER: SC0Z15933804 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
All entities and/or persons for whom the named insured, under written contract,
has agreed to provide coverage as an additional insured.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of "your work" for that insured by or for you.
CG 2010 11 85 Copyright, Insurance Services Office, Inc., 1984 0
1 1S
June 29 , 1999
Telephone: (818)548-7500
Fax: (818)552-2031
Website: www.willis.com
City of San Juan Capistrano CA Dept.of Insurance
32400 Paseo Adelanto
San Juan Capist, CA 92675 Lic.#o507s1s
Dear Certificate Holder :
Enclosed is the Certificate of Insurance issued on behalf of
Computer Service Company .
Should you have any questions please feel free to call .
Sincerely yours,
Willis Corroon Corporation of Los Angeles
Enclosure
cc : Computer Service Company
Steadfast Insurance Company
SAFECO Insurance Company of America
Fremont Industrial Indemnity Company
Willis Corroon Corporation
of Los Angeles
801 N.Brand Blvd.Suite 400
Glendale,CA 91203-1234