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1997-0709_HOLLAND-LOWE CONSTRUCTION, INC._Insurance Certificate ACORD CERTIFICA' OF LIA,,QIL1TY INSUR CE CSR SS DATE(MM/DD/YY) HOLLA 1 07/09/97 ORODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Wood-Gutmann Insurance Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3100 Bristol Street, Suite 390 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Costa Mesa CA 92626 COMPANIES AFFORDING COVERAGE Scott M. Milne, CPA COMPANY PnoneNo. 714-557-0800 FexNo. 714-557-4132 A Transporation Ins Co (CNA) INSURED-----.. ... _ COMPANY B Golden Eagle Insurance Co. COMPANY Holland-Lowe Construction, Inc C 541 N. Main St. , #104-350 COMPANY Corona CA 91720-2043 D 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 I POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE IMM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY C143004459 10/10/96 ! 10/10/97 PRODUCTS-COMP/OPAGG $ 2,000,000 CLAIMS MADE X OCCUR PERSONAL&ADV INJURY S 1,000,000 X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 X X,C, & U FIRE DAMAGE(Any one fire) S 50,000 X $1,000 PD Ded. MED EXP(Any one person) S 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO C136665379 10/10/96 10/10/97 _ X ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM g WORKERS COMPENSATION AND WC STATU- OTH TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 1,000,000 B THE PROPRIETOR/ INCL NWC42247000 01/01/97 01/01/98 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 1,000,0 00 OTHER A Leased & Rented C143004459 10/10/96 10/10/97 Limit: $150,000 Equipment Ded: $ 500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS *10 days notice of cancellation in the event of nonpayment of premium. rr - City of San Juan Capistrano, its elected or appointed officers, officials, employees and volunteers are included as an additional insured per the c _ attached G17957B form. Re: City of San Juan Capistrano Del Obispo Street Rehab. -r"-- CERTIFICATE HOLDER CANCELLATION • SANJU-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH£ ��ffyyyy�w�iy � EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL Mt dL 30*DAYS WRITTEN NOTICF.TO THE CERTIFICAYE HOLDERNAMED9O THE LEFT, City of San Juan Capistrano B i >icK `�� YL � 32400 Paseo Adelanto �y San Juan Capistrano CA 92675 =' " i(eYA " "� •v`'"� X AUTHORIZED RE•- Scott M. Silne, 4 . '`, ACORD 25-S (1/95) - ©ACORD:;CORPORATION 1988 CNA G-17957-3 (Ed. 09/92) For ALL one Commitments You Stake. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (Section II) is amended to include 2. The Limits of Insurance applicable to the additional as an insured any person or organization (called additional insured are those specified in the written contract or insured) whom you are required to add as an additional agreement or in the Declarations for this policy, • insured on this policy under: whichever is less. These Limits of Insurance are in- t. A written contract or agreement; or ciusive and not in addition to the Limits of Insurance shown in the Declarations. 2. An oral agreement or contract where a certificate of The insurance provided to the additional insured does not insurance showing that person or organization as an apply to "bodily injury", "property damage', "personal additional insured has been issued; but injury", or "advertising injury" arising out of an architect's, the written or oral contract or agreement must be: engineer's, or surveyor's rendering of or failure to render any professional services inducing: a. currently in effect or becoming affective during the term of this policy; and 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, b. executed prior to the "bodily injury'. "property change orders, design or specifications; and damage', "personal injury'', or"advertising injury'. The insurance provided to the additional insured is limited 2. Supervisory, inspection, or engineering services. as follows: Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the 1. That person or organization is only an additional in- additional insured whether primary, excess, contingent or sured with respect to liability arising out of: on any other basis unless a contract specifically requires a. Premises you own, rent, lease, or occupy; or that this insurance be primary or you request that it apply on a primary basis. b. "Your work" for that additional insured by or for you. G-17957-8 Page 1 of 1 (Ed. 09/92) LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO 32400 Paseo Addanto San Jean Capistrano, California 92675 ATTN: A. POLICY INFORMATION Endorsement I. Insurance Company Transportation (CNA) policy Number 1043004459 2. Policy Term (From) 10-10-96 (T0)10-10-9/ ;Endorsement Effective Date 3. Named insured Holland-Lowe Construction, Inc. 4. Address of Named Insured 541 N. Main Street Ste 104-350 Corona, CA 91 ILU-1043 5. Limit of Liability Any One Occurrence/Aggregate $ 2.000,000 ,/ 1 ,000,0-00 General Liability Aggregate (check one:) X Applies "per locations project" Is twice the occurrence Limit 6. Deductible or Self-Insured Retention (Nil unless otherwise specified): 5 1 ,000 7. Coverage is equivalent to: Comprehensive General Liability form GL0002 (Ed 1/73) X Commercial General Liability "claims-made" form CG0002 8. Bodily Injury and Property Damage Coverage is: "claims-made" X "occurrence" If claims-made, the retroactive date is B. POLICY 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, its elected or appointed officers, officials, employees and volunteers are included u 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. (rw • 3. SCOPE OF C RAGE. This policy, ii primary, of s coverage at least as broad as: (1) Insurance Services Office form number GL 0002 (Ed. 1/73), Comprehensive Gener Liability Insurance and Insurance Services Office form number GL 0404 Broad For comprehensive General Liability endorsement; or (2) Insurance Services Office Commercial General Liability Coverage, "occurrenc form CG 0001 or "claims-made" form CG CCU; or (3) If excess, affords coverage which is at least as broad as the primary insuranc forms referenced in the preceding sections (1) and (2). SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately t each insured who is seeking coverage or against whom a claim is made or a suit is brough: except with respect to the Company's limit of liability. S. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS An- failure to comply with reporting provisions of the policy shall not affect coverage provide•:. 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 suspende± voided, cancelled, reduced in coverage or in limits except after thirty (30) days' prior writ ter notice by certified mail return receipt requested has been given to the City. Such notic= 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: Fung Louis Claims Mgr (Title) (Department) Wood-Gutmann Insurance Brokers (Company) 3100 Bristol Street Ste 390 CS treet Address) Costa Mesa, CA 92626 (City] (State) (Zip Cade) (714)557-0800 (Telephone) D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER I, Scott M. Milne, CPA (print/type name), warrant that I have authority to bind the below lister insurance company and by my signae hereon do so bind this company. SIGNATURE OF AUTHORIZED REPRESENTATIVE (original signature required on endorsement furnished to the City) Wood-Gutmann Insurance Brokers g A ent TITLE: A� .ESS: 3100 Bristol Street Ste J9U costa Mesa, CA +14 557 0800 TFlFPI-CbE: ( )