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1998-1117_COMPUTER SERVICE COMPANY_Insurance Certificate ACORDM CERTIFICAT )F LIABILITY INSURA E PAGE 1`OF 2` 17-NOV-1998 PRODUCER 92485 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 INSURED COMPANY Continental Casualty Company B Computer Service Company P.O. Box 8100 COMPANY 12907 E. Garvey Avenue Baldwin Park CA 91706-0093 COMPANY .COVERAGES 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 POLCY AFFECTIVE POLI:Y EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE‘MM/DD/YY/ A GENERAL LIABILITY SCO215933803 01-JUL-1998 01-JUL-1999 GENERAL AGGREGATE $ 3.000.000 X COMMERCIAL GENERAL LIABIUTY 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 FIRE DAMAGE(Any one fire) $ 50,000 MED EXP(Any one person) $ B AUTOMOBILE LIABILITY BUA191247737 01-JUL-1998 01-JUL-1999 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 $ GAR AGE 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 $ B WORKERS COMPENSATION AND WC191247706 01-JUL-1998 01-JUL-1999 X TpRYLIMITS I _ ER EMPLOYERS'LIABILITY EL EACH ACCIDENT _$ 1,000,000 THE PARTNERS/EXECUTIVE INCL EL DISEASE-POLICY UMIT $ 1.000.000 NERS/ ECU ,-. OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 1 ,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS SEE ATTACHED CERTIFICATE HOLDER CANCELLOMOW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL *J1CDILA?V (VS MAIL • D• S W ITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of San Juan Capistrano A iX„y4 E>SUMHST)0011 p1 NOUSE(1U IONGOTVKIX1(V(XX), 32400 Paseo Adelanto cox X�• �X •• XX 6fX a ••• GEN LXX) San Juan Capist CA 92675 AUTH.i ZE E•y • • ............................................................................................................................................................................. ......................................................................................................................... Ai�.111�1�G0IRPOEiA'1'10?f�::19&8.: • CORROON RTIF1 > E OF INSURANCE , 2oF issu17 NOV-1998 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 92485 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 COVERAGES 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS 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 coverage per the attached STF22300F and under the Automobile Liability coverage per the attached G39543A. This insurance is primary on both the General Liability and Automobile Liability per the policy forms . Re : Computer Service Job No . 9116 Downtown Lighting Phase I ( CIP No . 118) >cEAT�c,�€e�loco�::: >: :>;.: :> > ;>•:>:::: <:::<.«:<;.:<:::<::;:<:::�<<:<:<:<::>::: :�:::<:<:<:<::::: : c;�NCEu�Tt�N.; .. <>::;::>::«.;;: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL XX/ 1X XI4 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT; Cityof San Juan Capistrano ' ,` b , tOSCRAtt<N4�1<OCf:MN M�IM7(9QS(�IlDXI4RKIVATION(K (K ARCXX) P cC•� AK10 •• 32400 Paseo Adelanto '..I * • !.u:;:...v l:. • :.......' Vii.:?...... San Juan Capist CA 92675AUTH•,1' �p91 ESEN ATIV• wlLLlSVORRcOly a5wCI <:>:>:::>::::>::: CaMwUTRs V. . Date Prepared Endorsement No. Non-Premium En Jrsement 8/25/98 6 Issued by ® Steadfast Insurance Company Policy Number Certificate Number Named Insured SCO 215933803 Steiny and Company, Inc. and Computer Service Company Producer Producer No. -OPC Glendale Specialty Risks Insurance Services, Inc. 75409000 Inception(Month-Day-Year) Expiration(Month-Day-Year) Effective Date and Time of Endorsement Policy Period: • 7/1/98 7/1/99 7/1/98 It is agreed that this policy is hereby amended as indicated. All other terms and conditions of this policy remain unchanged. BLANKET ADDITIONAL INSURED ENDORSEMENT It is agreed that the Persons Insured (Section II) is amended to include the entities named below as an additional insured under this policy, but only as respects liability arising out of work performed by or for the named insured on behalf of the additional insured. It is further agreed that naming the below individual(s) as an insured does not serve to increase the Company's Limits of Liability as specified in the Declarations of this policy. Name of Additional Insured: All entities and/or persons for whom the named insured, under written contract, has agreed to provide coverage as an additional insured. Signature of Authorized Representative STF22300F(ST)11/81 Steadfast Insurance Company AMENDATORY ENDORSEMENT (PRIMARY INSURANCE ENDORSEMENT) THIS INSURANCE COVERAGE SHALL OPERATE AS PRIMARY INSURANCE WITHOUT CONTRIBUTION BY THE CITY OF COSTA MESA'S INSURER BUT ONLY IF A WRITTEN CONTRACT REQUIRES THAT THIS INSURANCE BE PRIMARY. This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ENDT. NO. POLICY NO. ISSUED TO: EFFECTIVE DATE OF THIS Steiny and Company, Inc. ENDORSEMENT 13 BUA 1 91247737 Computer Service Company 7/1/98 ;NA For All The Commitments You Make 8 e �+ Countersigned by a • ti Authorized Representative BJP/M51 BA8 G-39543A 11/17/98 12:05 FAX 818 548 6254 WILLIS CORROON CONST __, LJ 002 Lll16i88" 17:02 FAX 626 337 884 STEINY & CO. , INC. __FIA W/C �l004 L1ABIL TY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO 32#OO Paseo Adelanto San Juan Ca$stranq,California 92673 ATTN: A. POLICY INFORMATION Endorsement fi 1. Insurance Company Steadfast Ins. Co_l_i Policy Number SCQ.1593j803 _ 2. Policy Term (From) 7-198 To) 7-199 )Endorsement Effective Date f-1-96 3. Named Insured�,,� r rvi ----Coll en _ 4. Address ofNameFred 129117 F. �.rvev 'Venues :a .Win •.7-K;'c",q"_1/Ud 3. Limit of Liability Any One Occurrence/Aggregate $ ,Q0Q.006- r3,000,000 General Liability Aggregate (check one:) Applies "per location/project" Is twice the occurrence limit 6. Deductible or Self-Insured Retention Nil unless otherwise specifiedk S 10' SIR 7. Coverage is equivalent to: Comprehensive General Liability form CL0002 (Ed 1/73) X Commercial General Liability "claims•made" form CG0002 ______ S. Bily Injury and Property Damage Coverage is: "claims-made" X Il occur rence" • If claims-made, the retroactive date is B. POLICY AMENDMENTS This endorsement-is is:saed in consideration u; the ;Jokey premium. Netwithsttnuing r.ny incons:,stent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows L INSURE. The City, its elected or appointed officers, officials, employees and volunteers are included as insureds with regard to damages and defense of claims arising from: (a) activities performed by or on behalf of the Named Insured, (b) products and completed operations of the Named insured, or (c) premises owned, leased or used by the Named Insured. 2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insured for or on behalf of the City; or (b) products 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 be 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 Insureds 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 it tnvun 11/17/98 12:05 FAX 818 548 6254 WILLIS CORROON CONST 14003 - 11/16�i8 17:02 FAX 626 337 68 STEINY & CO. , INC. TARA o W/C 41005 3.• SCOPE OF COVERAGE. This policy, if primary, affords Coverage at least as broad as; (U Insurance Services Office form number GL 0002 (Ed. 1/73), comprehensive Genera . Liability Insurance and Insurance Services Of fie, form number GI. 0404 Broad Farr, comprehensive General Liability endorsement; or (2) Insurance Services Office Commercial General Liability Coverage, "occurrence' form CG 0001 or"claims-mads" form CG 0002; or (3) If excess, affords coverage which is at least as broad as the primary insurance forms referenced in the preceding sections (1) and (2). a. SEVERAi3ILITY OF INTEREST. The insurance afforded by this policy applies separately ter 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. PROYISION.S REGARDING THE INSURER'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply with reporting 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. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspended, voided, cancelled, reduced in coverage or in limits except after thirty(30) days' prior written notice by certified mail return receipt requested has been given to the City. Such notice shall be addressed as shown in the heading of this endorsement. C. INCIDENT AND CLAIM REPORTING PROCEDURE Incidents and claims are to be reported to the Insurer at: ATTN: )1)10.5 Col den , (Tire)Supery i soKIDepartment)Claims • Willis Corroon Administrative Services Company (Company) p f. btu 88033] (Street Address) San Diego, CA 92168 (CI t y •Zipp �:.aci72 ((619 2.99-7821 (Teleple) — D. SIGNATURE OF INSURER 0' UTHORIZF.D REPRESENTATIVE OF THE INSURER • -req Perry (print/type , that I have authority to bind the below listed insurance company and by my signature do sol this company. SIGN► - OF A • - ESENTATIVE (original signa • required on e • - furnished to the City) - izgrIctit Steadfast Ins. Co. ,q[YI .SS: 801 N. Brand #PH, en a e, lEUZVIZE: '(81$1 50074701