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11-0401_ANDERSON-PENNA PARTNERS, INC._Insurance'POLICY NUMBER, BA3053LS56 COMMERCIAL AUTO CA. 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement Identifies person(s) or organization(s) who are "insureds" under the Who is An Insured Prov[sior of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsernen, effective 07/20/2010 Named Insured AndersonPe_.na Partners, =nc. Name of Persons) or Organization(s): City of San.J'uan Capistrano Attn: Bret Cau].der 32400 Paseo Ade].ar:to San Juan Capistrano, CA 92675 SCHEDULE Re: All Operations as pertains 110 named insured. The City of San Juan Capistrano (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" wider the Who is An Insured Provision contained in Section Il of the Coverage Form GA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 'I of 1 COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED (Section 1I): Any person or organization that you agree in a "contract or agreement requiring insurance" to in- clude as an additional insured on this Coverage Part, but only with respect to liability for "bodily in- jury" "property damage" or "personal injury," caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products -completed operations hazard". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. The insurance. provided to such additional insured is limited as follows; d. This insurance does not apply on any basis to any person or organization for which cover- age as an additional insured specifically is added by another endorsement to this Cover- age Part. e. This insurance does not apply to the render- ing of or failure to render any "professional services". f. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section 111) for this Coverage Fart, B. The following is added to Paragraph a. of 4. Otter Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Cov- erage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such addi- tional insured as a named insured, and we will not share with the other insurance, provided that. (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury," for which coverage is sought arises out of an offense committed; after' you have entered into that "contract or agreement requiring insurance", But this insur- ance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured 'under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL: LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury""property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with such person or organization entered into by you before, and in effect when, the "bodily CG D3 81 09 07 Co, 2007 The Travele,s Companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office. Inc„ with its permission. COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. R. The following definition is added to DEFINITION$ (Section V): "Contract or agreement requiring insurance," means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured on this Cov- erage Fart, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense cornmitted: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 C) 20D7 The Travelers Companies, Inc. CG D3 81 OS 07 (ncEudes the copyrighted material of insurance Services Office, Inc.. with its permission. CERTHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807• CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-19-2090 CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANTO SAN JUAN CAPISTRANO CA 92675-3603 GROUP: 000092 P OLiCY NUMBER: 0000754-2009 CERT 1=IGATE ll): 9 CERTIFICATE EXPIRES: 06-01-2011 05-01-2010/05-01-201t SC JOB:ON-CALL CODE ENFORCEMENT This is to certify that we have issued a valid Workers' Compensation insurance policy in a for€n approved by the California Insurance Comrnissioner to the employer named betovv for the policy period indicated. This policy is not subject to cancellation lay the Fund except upon 30 days advance written notice to the employer, We will also give You 30 days advance notice should this policy roe cancelled prior to its normal expiration_ This certificate of insurance is not an insurance poticy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be, issued or to which it may pertain, the insurance afforded by the policy described herein is subiect to all the teras, exclusions, and conditions, of such poiicy. VM thorized Representative Interim President and CEC EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE_ ENDORSEMENT #1600 - ANDERSON, DAVID EXECVP - EXCLUDED, ENDORSEMENT #1600 - PENNA, LISA EXECVP - EXCLUDED. ENDORSEMENT #1600 - MCCARMANT, L MALLORY PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - ANELICIUE, LUCERO SECRETARY TREASURER - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE MOLDERS' NOTICE EFFECTIVE 10-15-2090 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER ANDERSONPENNA PARTNERS, INC. 309 AGATE ST LAGUNA BEACH CA 92651 Sc M0409 REv,1-20107 PRINTED : 10-20-2010 SC Company ID Number. 366635 To be accepted as a participant in E -Verify, you should only sign the Employer's Section of the signature page. If you have any questions, contact E -Verify at 888-464-4218. . .... .. ..... .... . .... .... . .. .... ... ........ ....... . .... . . ...... . .. . . Employer AndersonPenna Partners, Inc. ueLucero .... ..... . -1-111— - $Se TyPe or Print) /2010 Department of Homeland Security — Verification Division WIS Verification Division ..... . .... - -- ame se Type o� Print) ned :10121/2010 ............. ....... .. ... Information Required -Verify Or--66-ra-m- Information relatinq to your Companv.- Name:AnderscnPenna Partners, Inc. Camparsy Facility Address:,109 Agate St :Laguna Beach, CA 92651 Page. 12 of 13 1 E -Ver Nf MOU for Employer I Revision Date 09/01M www.dhs.gov/E-Verify Company ID Number: 366636 North American Industry Classification Systems Code: $41 . . . .............. . Administrator: Number of Emnlovees-, 0 to 19 Number of Sites Verified for .... ....... ...... ire you verifying for more than I site? If yes, please provide the number of sites verified for n each State: R CALIFORNIA I site(s) Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Nwnt� Tel,phonv Number: (71:4) 504 , 2 753 F - m a; I Address: a In c c ro ii. a n d p c n, c o w Name: Mallory McCamw Tek�,Pholle Numb�;r: (714) 313 -3430 13 -Trail Address: malloryf andpen.conz Fax Number: (949) 376 - "'if I Fax Nomben (949) 376 - 7511 Page 13 of 13 1 E -Verify MOU for Employer I Revision Date 0910VO9 www.dhs,govfE-Verify Chris Jak[ From. Christy Jakl Sent. Thursday, March 17, 2011 12;56 PM To; Bret Caulder; Ayako Rauterkus Subject. Anderson -Penna Agreement Hello, I've looked over the Anderson -Penna agreement. Before our office fully executes the agreement, we will need two copies of Exhibit's A & B. They are missing with the originals. Otherwise, insurance is all up to date. They will need to provide E -verify but they have 16 days from the date of the contract to provide the certificate. Please let me know if you have any questions. Kindest Regards, Christi RAI Deputy City Clea City of San .Tuan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (949) 443-6310 1 (949) 493-1053 fax Client#: 1296! AN 'PART COVERAGES l LI'- I g_.,, �—'L k_- s , THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING DATE (MMi0DJYY) AGOR :,. CERTIFICATE OF LIABILITY Y NSUR NCE 07/2012010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LIMITS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. O. Box 10550 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana, CA 92711-0550 EACH OCCURRENCE 714 427-6810 INSURERS AFFORDING COVERAGE INSURED INSURERA; Travelers Indemnity Co. of Connectic AndersonPerma Partners, Inc. _-� INSURER e: Travelers Property Casualty Co of Am 3125 Frye Street INSURER C: U.S. Specialty Insurance Company • Oakland, CA 94602 INSURER D:°% /L NSURER E COVERAGES l LI'- I g_.,, �—'L k_- s , 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 0TH 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 CONDITfONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCE© BY PAIN CLAIMS. INSRTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MMI DtYY LIMITS A GENERAL LIABILITY 6803052L77A 08/01/10 08/01/11 EACH OCCURRENCE S1000000 FIRE DAMAGE (Any one fire) $1,000,000 }( MERCIALGENERALLIABILITY General liability 71MCLAIMS MADE 7 OCCUR excludes Claims MED rXP(Any one parson) $10,000 PERSONAL. & ADV INJURY $1 000 000 rising out of the GENERAL AGGREGATE s2,000,000 �.-__-___-_... .._........ .....m.m.._.._.._...... performance of PRODUCTS -COMPIOPAEG 52,000,000 GEN'LAGGREGATE L.IM7APPLIES PER: professional 1-7 POLICY PRO- JECT LOC services B AUTOMOBILE LIABILITY BA30531-556 08101110 08101/11 COMBINECi SINGLE LIMIT ANY AUTO (Faamdentj S1,Q00,0©0 BODILY 3NJURY S ALL OWNED AUTOS SCHEDULED AU70S (Per person) BODILY INJURY iHtREi3 All765 X NON-OWNEDAUTOS (Peraccident) AROPER7Y DAMAGE $ (Per accident) GARAGE LIABILITY f AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ - AUTO ONLY; AGG B EXCESSLIA$ILITY CUP6874Y728 08101/10 08101111 EACH OCCURRENCE S1 000.,000 X OCCUR � CLAIMS MACE Umbrella Form AGGREGATE S1 000 000 ; $ Following Form S DEDUCTIBLE Excludes Prof] $ RETENTION 5 Lability WORKERS COMPENSATION AND 1 'PdC 8TAT T O R TOR. LIMITS ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY 3 E L DISEASE - EA EMPLOYEE S ' E.L. DISEASE - POLICY LIMIT S C OTHER ProfT Liab USS1020693 08101110 08/01111 $1,000,000 per claim Claims Made $1,000,000 anni aggr. Retro: 8/1105 $35,000 Ded per claim DESCRIPTION OF OPERATIONStLOCATIONSIVEHICLESIEXCLUSiONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: All Operations as pertains to named Insured. The City of San Juan Capistrano is Additional Insured as respects to General and Auto Liability coverage as required by written contract. (General Liability Endorsement CG D3 81 09 07) (See Attached Descriptions) City of San Juan Capistrano Attn: Bret Caulder 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WIWXW%ftY tIY TO MAI L3-0_DAYSWRITTEN NOTICE TO THE CERTIFICATE H 0 LD E R NAM E 0 TO TH E L E FT,X=7jVX Ix REPRESENTATIVE ACORD 25-S (7197)1 of 2 #S275616/M269914 TMN Q ACORD CORPORATION 1988 � III�f•- This certificate voids and supersedes the certificate issued on 10119110. anus 2 5. 3 (OT197) 2 of 2 #S275616/M269914 POLICY NUMBER: BA3 053 L- � 6 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective 07/20/2010 Named Insured AndersonPenna ?partners, Inc. Marne of Person(s) or Organization(s): City of San Joan Capistrano Attn: Bret Caulder 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SCHEDULE Re: All Operations as pertains to named insured. The City of San Juan Capistrano (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who is An Insured Provision contained in Section II of the Coverage Form CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURE© (Section 11). Any person or organization that you agree in a "contract or agreement requiring insurance" to in- clude as an additional insured on this Coverage Part, but only with respect to liability for "bodily in- jury" "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "Your work" and included within the "products -completed operations hazard". Such person or organization does not qualify as an additional insured for "bodily injury" "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. INSURANCE (Section 111) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV). However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Cov- erage Part must apply on a primary basis, or a primary and. non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such addi- tional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; The insurance provided to such additional insured is limited as follows: d. This insurance does not apply on any basis to any person or organization for which cover- C. age as an additional insured specifically is added by another endorsement to this Cover- age Part. e. This insurance does not apply to the render- ing of or failure to render any "professional services". f. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured; or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF after you have entered into that "contract or agreement requiring insurance". But this insur- ance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured under any other insurance. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury" "property damage" or "personal injury" arising out of "your wort[" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with such person or organization entered into by you before, and in effect when, the "bodily CG D3 81 69 07 � 2007 The Travelers Companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission. COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V), "Contract or agreement requiring insurance" means that part of any contract or agreement un-. der which you are required to include a person or organization as an additional insured on this Cov- erage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 G 2007 The Travelers Companies, Inc. CG DS 81 09 87 Includes the copyrighted material of Insurance services Office, Inc., with its permission. ACORD.. CERTIFICAT7 OF LIABILITY INSUR/ ICE 1DATE 0119110DYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates P. O. BOX 10550 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana, CA 92711-0550 COMM ERCIAL GENERAL T i LIABLIY PIREDAMAG(Anyne�rejX 714 427-6810 CLAIMS MADE f j OCCUR excludes claims INSURERS AFFORDING COVERAGE INSURED AndersonPenna Partners, Inc. NSURER A: IN €NsuR1=R B: _,_...... _... Travelers Indemnity CO of ConnectiC y __:_... Travelers Property Casualty Co of Am -3125 Frye Street INSURER C: __........_.__._ � __ U.S. Specialty Insurance Company Oakland, CA 94602 INSURER D: -_ $2,000000____..,,, INSURER E: r_nVFRnrt=.q 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE PDLICY NUMBER POLICY EFFECTIVE L.IR DATE MMIDDNY POLICY EXPIRATION LIMITS DATE MMIDDNY A GENERAL LIABILITY 68030521-77A 08101110 08/01111 EACH OCCURRENCE s1OdD,000, COMM ERCIAL GENERAL T i LIABLIY PIREDAMAG(Anyne�rejX $1 000000 CLAIMS MADE f j OCCUR excludes claims MED EXP (Any one Person) $10 000 $1,000,000 rising out Of the PERSONAL & ADV INJURY s2,000,000 performance of GENERAL AGGREGATE GENI'LAGGREGATELIM€TAPPLIES PER: professional Ipp PRODUCTS-COMPIOPAGO $2,000000____..,,, -- '- JECT F LOC services POLICYPRO B AUTOMOBILE LIABILITY BA3053L556 08/01110 08101/11 COMBINED SING: LIMIT ANY AUTO -E (Ea accident} x1,000,000 $ ALL OWNED AUTOS BODILY INJURY I SCHEDULED AUTOS (Per person) $ X HiREDAUTOS BODILY INJURY ( 6- X NON -OWNED AUTOS (Per accident} $ �...._ I PROPERTY DAMAGE (Per accident) I j $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO `' OTHER THAN EA ACC $ ! AUTO ONLY: AGO B EXCESSLIABILITYCUP6874Y728 ;08/01/10 08101/11 EACH OCCURRENCE $1000000 X OCCUR CLAIMS MADE Umbrella Form AGGREGATE $1 1000YO00 Following Form DEDUCTIBLE Excludes Prof I $ _ I RETENTION $ Lability$ WORKERS COMPENSATION AND LpRy MI ; OFIR ' EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE .$ E.L. DISEASE -POLICY LIMIT $ C i OTHERPraf I. L.iab USS1020693 08/01/10 08/01/11 $1,000,000 per claim Claims Made I $1,000,000 anni aggr. ;Retro: 811/05 E $35,00 Ded er claim DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Re: All Operations as pertains to named insured. ; w` ' CERTIFICATE HOLDER 1 1 ADDRIONALINSURED ; INSURER LETTER: UAINUti-I.AIIUN Ion Day Notice tor NQn-pagmaing—Ermiurn SHOULD ANYOFTHEABOVEDESCRIBEDPOLICII;SBECANCOLEDBE;OIETHEEXPIRAMON City of San Juan Capistrano DATE THEREOF, THE ISSUING INSURER WIMAIL 30DAYSWRITTEN Attn: Bret Caulder NOTICETOTHE CERTIFICATE HOLDER NAMED TOTH E LEFT,X k 32400 Paseo Adelanto �X�ACGrCdDtXi# lc�scx�t�c San Juan Capistrano, CA 92675 xxKRWXX REPRESENTATIVE ACORD 25-S (7197)1 Of 1 #S275413/M269914 TMN 0 ACORD CORPORATION 1988 Client#; 12965 ANDERPART ACORII CER t IFICAT OF LIABILITY NSUR ICG DATE (MMIDOff 0712012010 I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates P. D. Box 10550 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana, CA 92711-0550 714 427-6810 R � C p:m I �� ;-. INSURERS AFFORDING COVERAGE .. INSURED .W.W.�.... _ ._............................_. INSURER A: Travelers Indemnity Co. of Connectie AndersonPenna Partner 2610c � ��� 25 A 10.1 I 5, 3125 Frye Street Oakland, CA 94602 _.�.._.._.�...._.........._�� ............................._ INSURER B: Travelers Property Casualty Co of Am INSURER G: U.S. Specialty Insurance Company INSURER D: INSURER E C P 1t ,.I I - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE ICOR THE POLICY PER;OD 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 AFF=ORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR = TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE , DATE MMFDDfYY POLICY EXPIRATION DATE MMIDD/YY LIMITS A ` GENERAL LIABILITY 6803052L77A 08101110 08/01111 ; EACH OCCURRENCE 51 000,000 X GOMMERGIALGENERAL LIABILITY General liability FIRE DAMAGE (Any one fre) 151,000,000 CLAIMS MADE Fx_1 OCCUR excludes claims MED EXP (Any one Person) 1510000 PERSONAL & ADV INJURY I s1 000000 rising out of the GENERAL AGGREGATE S2,000,000 performance of Iprofessional GEIAGGREGATE LIM, ITAPPLIES I R PRODUCTS-COMPiOPAGG �S2,000,000 POLICY F-] PRO -SECT Pf, LOG services 13 AUTOMOBILE LIABILITY BA3053L556 08101/10 08/01111 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 I ANY AUTO BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS {Pe, Person} BODILY INJURY $ X HIRED AUTOS X NON -OWNED AUTOS {Peraccidant) PROPERTY DAMAGE $ �......_..._._. (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG LIABILITY CUP6874Y728 ! 08/01110 0$/01111 EACH OCCURRENCE S1 000 000 .,—E�XCC�ESS OCCUR CLAIMS MADE Umbrella Form AGGREGATE $1,000,000 I Following Form DEDUCTIBLE Excludes Prof l RETENTION 5 Labilitys -SNC STATU- OTH- WORKERS COMPENSATION AND TORY UMITS t ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY E.L. DISEASE - EA EMPLOYEE S j E.L. DISEASE -POLICY LIMIT $ C OTHER Prof'l. Liab USS1020693 08/01/10 08/01111 $1,000,000 per claim Claims Made $1,000,000 annl aggr" Retro: 811105 i $35,000 ©ed per claim DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLEStEXCLUS[ONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Re: All Operations as pertains to named insured. The City of San Juan Capistrano is Additional Insured as respects to General and Auto Liability coverage as required by written contract, (General Liability Endorsement CG D3 81 09 07) (See Attached Descriptions) CERTIFICATE HOLDER City.of San Juan Capistrano Attn.rBret:Caulder 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WIIk(k3V4)i TOMAIL30 DAYSWRITTEN NOTICETOTHECERTIFICATE HOLDER NAMED TOTHELEFT, Xjd p( REPRESENTATIVE ACORD 25-S (7197)1 of 2 #S275616/M269914 TMN a ACORD CORPORATION 1988 ®ESC' '°TIONS (Continued from Pa" 9 } This certificate voids and supersedes the certificate issued on 10119/10. AMS 25.3 (07197) 2 of 2 #S275615fM269914 'POLICY NUMBER: BA3 0 53 L5 '; 6 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who is An Insured Provision of the Coverage Form. This endorsement does not after coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective 07/20/20101 Named Insured AndersonPenna Partners, Inc. Name of Person(s) or Organization(s): City of San Juan Capistrano Attn: Bret Caulder 32404 Paseo Adelanto San Juan Capistrano, CA 92675 SCHEDULE Re: All Operations as -pertains to named insured. The City of San Juan Capistrano (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who is An Insured Provision contained in Section II of the Coverage Form CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 COMMu_,lICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED (Section II): Any person or organization that you agree in a "contract or agreement requiring insurance" to in- clude as an additional insured on this Coverage Part, but only with respect to liability for "bodily in- jury" "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products -completed operations hazard". Such person or organization does not qualify as an additional insured for "bodily injury" "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply on any basis to any person or organization for which cover- age as an additional insured specifically is added by another endorsement to this Cover- age Part. e. This insurance does not apply to the render- ing of or failure to render any "professional services". f. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section 111) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Cov- erage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such addi- tional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance". But this insur- ance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured 'under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury" "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with such person or organization entered into by you before, and in effect when, the "bodily CG D3 81 09 07 O 2007 The Travelers Companies, Inc. Page 1 of 2 Includes the copyrighted material of insurance Services Office, Inc., with its permission. COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured on this Cov- erage Pari, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 Q 2007 The Travelers Companies, Inc. CG D3 81 09 07 Includes the copyrighted material of Insurance services Office, Inc., with its permission. CERTHOLDER COPY. P.Q. BOX 420807, SAN FRANCISCO,CA 94142---0807 CERTIFICATE OF WORKERS` COMPENSATION INSURANCE ISSUE DATE: 10-19-2010 CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANTO SAN JUAN CAPISTRANO CA 92675-3603 GROUP: 000092 POLICY NUMBER: 0000754-2009 CERTIFICATE ID) 9 CERTIFICATE EXPIRES: 06-01-2011 06-01-2010/06-01-2011 SC JOB:ON-CALL CODE ENFORCEMENT This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subjecL to all the terms, exclusions, and conditions, of such policy. tth,r,zed Representative Interim President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - ANDERSON, DAVID EXECVP - EXCLUDED. ENDORSEMENT #1600 - PENNA, LISA EXECVP - EXCLUDED. ENDORSEMENT #1600 - MCCARMANT, L MALLORY PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - ANELIQUE, LUCERO SECRETARY TREASURER - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-15-2010 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER ANDERSONPENNA PARTNERS, INC. 309 AGATE ST LAGUNA BEACH CA 92551 SC M0408 {REV.T-2010} PRINTED : 10-20-2010 SC Company ID Number: 366635 7o be accepted as a participant in E -Verify, you should only sign the Employer's Section of the signature page. If you have any questions, contact E -Verify at 888-464-4298. Company I© Number: 366635 North American Industry Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name: Angelique M Lucero Telephone Number: (714) 504 - 2753 Fax Number: (949) 376 - 7511 E-mail Address: aluccro!u?andpenxoin Name: Mallory Mccamant "Telephone Number: (714,) 313 - 3430 Fax Number: (949) 376 - 7511 E-mail Address: mallory'rUandpenxoin Page 13 of 13 1 E -Verify MOU for Employer I Revision Bate 09/01/09 www,dhs.gov/E-Verify