1993-0528_EMPIRE PIPE CLEANING & EQUIPMENT_Insurance Certificate CERTIFICAT . DF INSURANCE CSR EF ISSUE DATE(MM/DD/YY)
EMPIR-1 05/28/93
PRODUcAR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
BOSWELL INSURANCE AGENCY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
Agents & Brokers, Inc. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
P.O. Box 4648 POLICIES BELOW.
Mission Viejo CA 92690
COMPANIES AFFORDING COVERAGE
Joe A. Boswell
714-855-0430 COMPANY FJUN 0 2 1993
LETTER A Golden Eagle Insurance Company
COMPANY B
INSURED LEITER
COMPANY G.
LETTER
Empire Pipe Cleaning & COMPANY
Equipment, Inc. LETTER D
P.O. Box 8035
Anaheim CA 92802 SER Y E
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 POLICY EFFECTIVE POLICY EXPIRATION UNITS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $2,000,000
A X COMMERCIALGENERALUABILTTY CCP220480 04/07/93 04/07/94 PRODUCTS-COMP/OPAGG. $2,000,000
CLAIMS MADE X OCCUR. PERSONAL&ADV.INJURY $1,000,000
X OWNER'S&CONTRACTORS PROT. EACH OCCURRENCE $1,000,000
FIRE DAMAGE(Any one fire) $ 50,000
MED.EXPENSE(Any one person) $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE
ANY AUTO $1,000,000
CCP220480 04/07/93 04/07/94 LIMIT
ALL OWNED AUTOS
BODILY INJURY
A X SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) $
GARAGE LIABILITY
PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURRENCE $3,000,000
A UMBRELLA FORM EXC220481 04/07/93 04/07/94 AGGREGATE $3,000,000
X
OTHER THAN UMBRELLA FORM
A WORKER'S COMPENSATION PWC207322 11/01/92 11/01/93 X STATUTORYUMITB
EACH ACCIDENT $1,000.000
AND
EMPLOYERS'LIABILITY DISEASE—POUCYUMIT $1,000,000
DISEASE—EACH EMPLOYEE $1,000,000
OTHER
DESCRIPTION OF OPERATIONS;LOCATIONSiVEHICLES/SPECIAL ITEMS
*Except 10-days for nonpayment
The City and the Community Redevelopment Agency, its elected or appointed
officers, officials, employees and volunteers are included as additional
pri arry pendors
ement hetome issue cygwoidd e nIahge o.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL
MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
City Of San Juan Capistrano
LEFT,R3tTf'AI {T'RXMe*- F M1RT4 {EWXt{I ft j{iP} IJ ARWX§O{X
Community Redevelopment Agency
32400 Paseo Adel anto LIKARK2KAYA1188e9YRIA5Mmilwis(m-§kRff§RJUKtffft5441ANYffx
San Juan Capistrano, CA 92675 AUTHORIZED REPRESENTATIVE
Joe A Boswell.... . 1l. . 0,..wier,
ACORD 25-S(7/90) :.;.>:.;.:::;:::;:::;::. !: o I�; aT ION 1990
P . +a2
hl Ci `f - 1 2 - '93 k.JED 10
3. SCOPE OF COVERAGE. This policy, if primary, affords coverage at least as broaa 35;
(1) insurance Services Office form number GL. 0002 (Ed. 1/73), Comprehensive ,:e-•
Liability Insurance and Insurance Services Office form number GL 0404 3roato :=
comprehensive General Liability endorsement; or
(2) Insurance services Office Commercial General Liability Coverage. "Occur
form CG 0001 or "claims-made" form CC 0002; or
(3) if excess, affords coverage which is at least as broad as the primary Lnsur-,
forms referenced in the preceding sections (1) and (2).
a. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separatek
each insured who is seeking coverage or against whom a claim is made or a suit is ..)rev.
except with respect to the Company's limit of liability.
S. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS.
failure to comply with reporting provisions of the policy shall not affect coverage drovi(
to the City and the Community Redevelopment Agency, its elected or appointed oUfcE
of fidals, employees or volunteers.
6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspen
voided, cancelled, reduced in coverage or in limits except after thirty (30) days' prior writ
notice by certified mail return receipt requested has been given to the City. Such nor
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 au
A"rTN; Elizabeth Franks
T tie: (bepartmentf "..
Boswell Insurance Agency
Companyr
P 0 Box 4648
treet Address
Mission Viejo, CA 92690
Ity) tate (Zip Cade)
j�7l 855-0430
11¢lep n�
D. SIGNATURE OP INSURER OR AUTHORIZED REPRESENTATIVE OP THE INSURER
i., (print/type name), warrant that I have authority to bind the below lis.
insurance company and by-tiyiiiinature hereon do so bind this company.
$ G TUR 5-0F +t • 7 a• :1-'a• : .- • -IV (original
signiiture required on endorsement turn ed to the City)
1I2e+,Tlalt Boswell Insurance Agency TITLE: President
p „SS; P 0 Box 4648 I.7€t 714 855-0430
---a-77717:7-7=7:77"7"1777717"----
1.1r=iY - 1 1 - 93 TlJE 1 ' - 3 1 P . 02
•
LIABILITY ENDOP.SEMEN';
CITY OF SAN JUAN CAPISTRANO
COMMUNITY REDEVELOPMENT AGENCY
• 32400 PaLs+eo Adelardw
' San 3uan Capistrano, California 92673
ATTN:
A. POLICY INFORMATION Endorsement .1
1. Insurance Company Golden Eagle • policy Number CCP220480
2. Policy Term (From) 7- 3__iw Endorsement Effective Date 5-28-93
3. Named Insured Em.ire -Pile Cleaning' and Equipment, Inc.
4. Address of Named Insured P 0 Box 803 , Anaheim, CA 92802
5. Limit of Liability Any One Occurrence Aggregate 1,000,000 S2,000,000
General Liability Aggregate (check one:)
Applies"per location/project"
Is twice the occurrence limit X
6. Deductible or 5e1f-Insured Retention(NU unless otherwise specified): nil
7. Coverage is equivalent to:
Comprehensive General Liability form GL0002 (Ed 1/73) X
Commercial General Liability "claims-made" form CG0002
8. 5odily Injury and Property Damage Coverage is:
"claims-mead err
x "occurrence"
II claims made, the retroactive date is
•
B. POLICY AMENDMENTS
This endorsement is Issued In consideration of the policy premium. Notwithstanding any inconsist :•
statement in the policy to which this endorsement is attached or any other endorsement att%ch:.
thereto, it is agreed as follows:
I. INSURtED. The City and the Community redevelopment Agency; its elected or appoint
of ficers, officials, employees and volunteers are Included as insureds with regard to darn a;
and defense of claims arising from: (a) activities performed by or on behalf of the Nary
Insured, (b) products and completed operations of the Named Insured, or (c)premises own,,,
leased or used by the Named Insured.
2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insure
for or on behalf of the City; or (b) products sold by the Named Insured to the City; or
premises Ieaserd by the Named Insured from the City, the insurance afforded by this poli:
shall be primary Insurance as respects the City, its elected or appointed officers, official
employees or volunteers; or stand in an unbroken chain of coverage excess of the Nam::
Insuredrs scheduled underlying primary coverage. In either event, any other insurar.;
maintained by the City, Its elected or appointed officers, officials, employees or voluntec::
shall be in excess of this insurance and :Nall not contribute with it.
(OV.R)