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04-0517_BUTIER ENGINEERING INC_Insurance
32400 PASEO ADELANTO �% F� MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 ��i `4�P SAM ALLEVATO (949)493-1171 In[BAPORAIfo DIANE L.BATHGATE (949)493-1053 FAX (SIR LISU4 I (A6( WYATT HART www.sanjuancapistrano.org 1776 JOE SOTO • • DAVID M.SWERDLIN May 17, 2004 Butier Engineering 17782 E 17th Street Suite 107 Tustin, CA 92780 RE: Compliance with Insurance Requirements — Construction Management Services for SC-04 South Connectors Pipeline I & II Project The following insurance documents are due to expire: ✓ General Liability Certificate 06/25/2004 ✓ General Liability Endorsement Form naming the City of San Juan Capistrano as additional insured. ✓ Automobile Liability Certificate 06/25/2004 ✓ Professional Liability Certificate 06/25/2004 J Workers Compensation Certificate 07/01/2004 Please submit updated documentation to the City of San Juan Capistrano, attention City Y e, 324 0 Paseo Adelanto, San Juan Capistrano, CA 92675 by the above ate you have any questions, please contact me at (949) 443-6309. ara cc: Michelle Perea, Administrative Assistant Peter Salgado, Associate Engineer San Juan Capistrano: Preserving the Past to Enhance the Future Client : 1513 BUTIEENGI ACORnN CERTIFIC OF LIABILITY INSUSNCE 07/15/M2003Yn PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey,Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.0!Box 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland,CX 946042675 510 45-3090 INSURERS AFFORDING COVERAGE INSURED INSURER A:Americari Iris.Co. Butler Engineering,Inc INSURER B Amerk:an Automobile Iris.CO. Meredith Financial Center INSURER c.Zurich American Insurance Co. 17782 E 17th St Suite 107 INSURER D: Tustin,CA 92780 INSURER E: COVERAGES 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 UMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSFiAM TYpE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY MZX80815501 06/25/03 06/25/04 EACHOCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE!Any one tire) S1 ODOD00 CLAIMSMADEI OCCUR ME D EXP(Any one person) $10000 PERSONAL&ADV INJURY $1000000 GENERALAGGREGATE $2000000 rGENIGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGO 52000000 ICY PRO LOC A AUTOMOBILE LIABILITY MZX80815501 06/25/03 06/25/04 COMBINED SINGLE LIMIT X ANYAUTO (Eaaccldent) $1,1300,000 ALL OWNED AUTOS BODILY INJURY SCHE DULEO AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Drive Other Car PROPERTY DAMAGE $ (Par accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGO $ IE EXCESS LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ B WORKERSCOMPENSATIONAND WZP80915573 07/01/03 07/01/04 X WOSTATU 0ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1 OIXI DOD E.L.DISEASE-EAEMPLOYE S10D000O E.L.DISEASE-POLICY LIMI $10001300 CtLiabilHER Professkxial EOC790079310 06/25/03 06/25/04 $1,000,000 per claim ity $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS General Liability policy excludes claims arising out of the performance of professional services. Project:Terminal Reservoir#2 Replacement.Certificate holder Is an additional Insured for General Liability per CG20101001 attached. (See Attached Descriptions) CERTIFICATE HOLDER ADDMONALINSURED'INwRERLETTER: CANCELLATION SHOULDANYOFTFE ABOVE DESCRIBED POLICIES BECANCELLED BEFORETHE 6PRATION Coity of.San Juan.Capistrano2 DATETHEREOF,THE ISSUING INSURERWILLANQ5SOMOMAil SO_—DAYSWRTTEN Attn:P Salgado NOTCETOTHE CERTIFICATE HOLDER NAMEDTOTHE LEFT,a1Me00VISMUNSI)OMM 32400 Paseo Adelanto OR San Juan Capistrano,CA 92675 XROMMMOCUMS. ALT HO 12ED REPRESENT TIVE ACORD 25-S(7/97)1 01`2 #M89461 MNN ® ACORD CORPORATION 1988 DE IPTIONS (Continued from•ge 1) Professional Uablifty deductible: $25,000/claim.Cancellation provisions are solely as shown below. AMS 25.3(07/97)2 of 2 #M69461 POLICY NUMBER: MZX80815501 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Nameof Person or Organization: City of San Juan Capistrano 2 Attn: P Salgado 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II - WHO IS AN INSUREDS amended to (1)All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations services, maintenance or repairs) to be performed for that insured. performed on or on behalf of theadditional insured(s) at the site of the covered B. With respect to the insurance afforded to these operations has been completed; or additional insureds, the following exclusion is added: (2)That portion of "your work" out of which the injury or damage arises has been put 2. Exclusions to its intended use by any person or organization other than another contractor This insurance does not apply to "bodily in- or subcontractor engaged in performing jury"or 'property damage"occuring after: operations for a principal as a part of the same project. CG 20 10 10 01 Client : 1513 BUTIEE GI ACORnN CERTIFIC� OF LIABILITY INSU NCE 07115/2003ry"' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey,Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O:Bou 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland,CA 946042675 5104653090 INSURERS AFFORDING COVERAGE INSURED ' INSURERA:Amerlcan Ins.Co. Butier Engineering,Inc INSURER B:Amerk:an Automobile Ins.Co. Meredith Financial Cerner INSURER C:Zurich American Insurance Co. 17762 E 17th St Suite 107 INSURER D: Tustin,CA 92780 INSURER E: COVERAGES 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 POLICYNUMBER POLICY EFFECTIVE POLICY EXPtRAT10N LIMBS A GENERAL LIABILITY MZX80815501 06/25/03 06/25/04 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anyone fire) $11000,090__ _ CLAIMS MADE OCCUR ME D EXP(Any one person) $10000 PERSONAL B ADV INJURY $1,0--0-0,0-0-0— GENERAL 1000000GENERAL AGGREGATE $2000000 GENT AGGRE GATE LIMIT AP7PER: PRODUCTS-COMP/OP AGO $2000000 X POLICY PRC LOC JECT A AUTOMOBILE LIABILITY MZX80815501 06/25/03 06/25/04 COMBINED SINGLE LIMIT X ANY AUTO (Eaaccident) $110001000 ALL OW NE D AUTOS BODILY INJURY SCHEDULED AUTOS - (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) X Drive Other Car PROPERTY DAMAGE (Per accident) $ OAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGO $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ E DEDUCTIBLE j RETENTION $ 1 Is B WORKERS COMPENSATION AND YYZP80915573 Q]�Q1�03 Q]�Q7�04 X WC STATU- OER TH- EMPLOVERS'LIgB ILITY E.L.EACH ACCIDENT $11000000 E.L.DISEASE-EA EMPLOYEE $1,000000 E.L.DISEASE-POLICY LIMIT $1000000 C OTHER Professional EOC790079310 06/25/03 06/25/04 $1,000,000 per claim Liability $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS General Liability policy excludes claims arising out of the performance of professional Services. Project:SC-04 South Connectors Pipeline I&II.Certificate holler Is an additional insured for General Liability per CG20101001 attached. (See Attached Descriptions) CERTIFICATE HOLDER ADDRIONALINSUFEDONSUfERLETfER, CANCELLATION Ton DaX Notice for Nor�-PaXmant of Premium SFKX)LDANYOFTHEABOVE DESCRIBEDPOUCESSE GW CEDED BEFD ETFE DCPRATK)N City of San Juan Capistrano 1 DATETHEREOF,THEISSUING INSURERWILLIIIN008VOWOMAII.'1Q_DAYSWRnTEN Director of Admin.Services NOTICETOTHE CERTIFICATE HOLDERNAMEDTOTHELEFr,B)Qrl/00 011= 32400 Paseo Adelanto Now OR San Juan Capistrano,CA 92675 s. AUTHORIZED RE PRESENTATIVE zw ACORD 25•S(7197)1 Of 2 #M89461 MNN 0 ACORD CORPORATION 1988 DE*IPTIONS (Continued from ge 1) Professional Uabillty deductible: $25,000/claim.Cancellation provisions are solely as shown below. AMS 252(07197)2 at 2 #M8WI use 32400 PASEO ADELANTO INJIR11111 SAN JUAN CAPISTRANO, CA 92675 • (SlllOflD ' 1961 MEMBERS OF THE CItt COUNCIL (949) 493-1171 1776 DIANE L BATHGATE (949) 493-1053 (FAX) JOHN S.GELFF lvlvlrsanj uancapistran o.org MATT HART • • JOE SOTO DAVID M.SWERDLIN CITY MANAGER GEORGESCARBOROUGH June 13, 2003 _ Butier Engineering 17782 E 17th Street, Suite 107 Tustin, California 92780 RE: ComOiance with insurance Reguirements-Construction Management Services for SC-04 South Connectors Pipeline I & II Project The following insurance documents are due to expire: VGeneral Liability Certificate 6/25/2003 ' V General Liability Endorsement naming the City of San Juan Capistrano as additional insured. V Automobile Liability Certificate 6/25/2003 V Professional Liability Certificate 6/25/2003 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 Paseo Adelanto, San Juan Capistrano, CA 92675 by the above expiration dates. If you have any questions, please contact me at (949) 443-6310. Sincerely, Dawn Schanderl Deputy City Clerk cc: Kathleen Springer Peter Salgado DRUG USE a San Juan Capistrano: Preserving the Past to Enhance the Future Client#: 1513 BUTIEENGI jryACORD, CERTIFICADE OF LIABILITY INSU NCE DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland,CA 94604-2675 510 465-3090 INSURERS AFFORDING COVERAGE INSURED INSURER A:American Ins.CIO. Butler Engineering,Inc1::!L_ j INSURER B:AmerlCan Automobile Ins.Co. Meredith Financial Center INSURER c:Zurich American Insurance Co. 17782 E 17th St Suite 107 INSURER D: Tustin,CA 92780 / ( 1 INSURER E COVERAGES 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 POLICYNUMBER PO LICYEFFECTIVE PO LICYEXPIRATI ON LIMITS T A LGENERAL LIABILITY iMZX80801701 06/25/02 06/25/03 EACHOCCURRENCE $1000000 XCOMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one tire) $1 DDD DDD CLAIMSMADEu OCCUR! MEDEXP(Anyoneperson) ' $10000 PER50NAL&ADI INJURY 1$1,000.000 GENERAL AGGREGATE $2000000 G 'L AGGREGATE L{MIT APPLIESPER'. PRODUCTS-COMPIOP AGG $2000000X7 XENPOLICY PRO LOC A AUTOMOBILE LIABILITY MZX80801701 06/25/02 06/25/03 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 _ ALL OW NED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS IN BODILY JURY Iy X_ NON-OWNED AUTOS (Paraccident) $ _ X Drive Other Car `—� --- ----- PROPERTY DAMAGE $ j (Peraccident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT C ANY AUTO OTHERTHANr,._. ACC AUTOONLY:.- ---APG $ rn EXCESS LIABILITY EACH OCCURRENat - X_ EnOCCUR El CLAIMS MADE AGGREGATE _ C) t I O DEDUCTIBLE RETENTION $ B WORKERS COMPENSATION AND WZP80907416 07/01/02 07/01/03 )( WC STATU- 0TH- lv EMPLOYERS'LIABILITY EL.EACH ACCIDENT $1 000,000 ELDISEASE-EAEMPLOYE $1,000,ODO E.L.DISEASE-POLICY LIMA $1,000,000 C OTHER Professional EOC79DO79309 06/25/02 06/25/03 $1,000,000 per claim Liability $1,000,000 annl aggr. DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Project:SC-04 South Connectors Pipeline I&It.Certificate holder Is an additional Insured for General Liability per CG2010 attached. Professional Liability deductible:$25,000/claim.Cancellation provisions are solely as shown below. CERTIFICATE HOLDER ADDfiIONALINSUPEDINSURERLETTER: CANCELLATION Ton Dily Notice for Non-Pa=ent of Premium SHOULD ANYCFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of San Juan Capistrano DATE THEREOF,THEISSUING INSURER WILyySo08VWOMAIL30 DAYSWRITTEN Director of Admin.Services NOTICETOTHE CERTFIOATE HOLDERNAMEOTOTHE LEFT, 32400 Paseo Adelanto OR San Juan Capistrano,CA 92675 s. AUTHORIZED REPRESENT TIVE ACORD 25-S(7197)1 Qf 1 #M76005 MNN 0 ACORD CORPORATION 1988 POLICY NUMBER: MZX80801701 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES or CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of San Juan Capistrano Director of Admin. Services 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of"your work'for that insured by or for you. CG 20 10 11 85 • daft • 32400 PASEO ADELANTO i/ MEMBERS OF THE CITY COUNCIL DIANATE SAN JUAN CAPISTRANO, CA 92675 ) gUAAOAAIIA COUELBATHGBEL COLLEN GEILFF ELL (949) 493-1171 aunlua 1961 JOHN S.GELFF (949) 493-1053 (FAX) 1776 MATT HART www.sanjuancapistrano.org �� DAVID M.SwERDLIN CITY MANAGER GEORGE SCARBOROUGH June 13, 2002 Butier Engineering, Inc. 17782 E 17th Street S-107 Tustin, California 92780 RE: Compliance with Insurance Requirements-Construction Management Services for SC-04 The following insurance documents are due to expire: General Liability Certificate 6/25/2002 General Liability Endorsement naming the City of San Juan Capistrano as /- additional insured. Y Automobile Liability Certificate 6/25/2002 Y Professional Liability Certificate 6/25/2002 Workers Compensation Certificate 7/1/2002 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 Paseo Adelanto, San Juan Capistrano, CA 92675 by the above expiration dates. If you have any questions, please contact me at (949) 443-6310. Sincerely, Dawn M. Schanderl Deputy City Clerk cc: Lonnie Curtis, Water Services Manager Kathleen Springer, Administrative Assistant onuo usE s San Juan Capistrano: Preserving the Past to Enhance the Future Client#: 1513 BLITIEENGI ACORD CERTIFICAW OF LIABILITY INSU NCE 03/226/22002 PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland,CA 946042675 510 465-3090 INSURERS AFFORDING COVERAGE INSURED INSURER A:American Ins.CO. Butler Engineering, Inc INSURER B:American Automobile Ins.Co. Meredith Financial Center INSURER C,Zurich American Insurance Co. 17782 E 17th St Suite 107 INSURER D: Tustin,CA 92780 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE 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. INSRTypE OFINSURANCE POU YNUMBER POLITYEFFECTIVE POLICY EXPIRATIONLTR LIMITS A 1 GENERAL LIABILITY MZX80764329 .06/25/01 06/25/02 5ACH OCCURRE NCE I$1 00000 X COMMERCIAL GENERAL LIABILITY j FIRE DAMAGE one flre St. Q00 it CLAIMS MADEI X OCCUR MED EXP(Anycne person) 1$10000 PERSONAL&ADV INJURY $1.000.000 GENERAL AGGREGATE s2.000.000 I GEN'LAGGREGATE LIMIT APPLIESPER: PRODUCTS-COMPIOPAGG s2,000,000 X POLICY PRO- I LOC A AUTOMOBILE LIABILITY MZX80764329 06/25/01 06/25/02 COMBINED SINGLE LIMIT X ANYAUTO (Eaace dent) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHE D ULE D AUTOS (Per person) HIRED AUTOS I BODILY INJURY $ X NON-OW NED AUTOS (Par accident) X DfIVB Other Ci8/ _ PqO PERTY DAMAGE $ (Peraccident) GARAGE LIABILITY iAUTO ONLY-EA ACCIDENT $ _ I ANYAUTO I OTHERTHAN EAACC $ AUTO ONLY: AGO $ EXCESS LIABILITYEACH OCCURRENCE $ _] OCCUR n CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WZP80887638 07/01/01 07/01/02 X WCSTATU-Sl OTH- I EMPLOYERS'LIABILITY E.L.EACH ACCI DE NT $1,000000 E.L.DISEA E-EAEMPLOYEE $1,0130000 E.L.DISEASE-POLICY LIMP $1.000.000 C OTHER Professional EOC79DO79308 06/25/01 06/25/02 $1,000,000 per Claim Liability V $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS AD DE D BY ENDORSEMENTISPECIAL PROVISIONS Project:SC-04 South Connectors Pipeline I&II.Certificate holder is an additional insured for General Liability per CG2010 attached. Professional Liability deductible: $25,000/claim.Cancellation provisions are solely as shown below. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION Ton Day Notice for Non-Pament of Premium SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOPETHEEXPIRATION City Of San Juan Capistrano DATETHEREOF,THE ISSUING INSURER WILLM6008IIIWOMAIL30_DAYSWRITTEN Director of Admin.Services NOTICETOTHE CERTIFICATE HOLDERNAMED TO THE LEFT,B 32400 Paseo Adelanto OR San Juan Capistrano,CA 92675 RKROCONDUMS. AUTHORIZE DREPRESENT TIVE ACORD 25-S(7/97)1 of 1 #M62013 MNN © ACORD CORPORATION 1988 POLICY NUMBER: MZX80764329 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES or CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of San Juan Capistrano Director of Admin. Services 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of"your work'for that insured by or for you. CG 20 10 11 86