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