1997-0314_BLAS AGUILAR FOUNDATION_Insurance CertificateCERTIFICA OF
DATE
LIABILITY INSUONCIELAF1
03/14/97
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The Bowman Company Insurance
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Service, Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 689
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tustin CA 92781-0689
COMPANIES AFFORDING COVERAGE
COMPANY
Phone No. 714-838-0622 Fez No. 714-730-9071
A Western Heritage Insurance Co.
INSURED
COMPANY
e
COMPANY
Blas Aguilar Foundation
C
31806 El Camino Real
San Juan Capistrano CA 92675
COMPANY
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
LTR
TYPE OF IN5URANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
GENERAL AGGREGATE $1,000,000
A
X COMMERCIAL GENERAL LIABILITY
SCP0264325
03/01/97
03/01/98
PRODUCTS-COMP/OP AGG S
CLAIMS MADE [Xj OCCUR
PERSONAL B ADV INJURY S 1,000,000
EACH OCCURRENCE $ 1 , 000 , OOO
OWNER'S S CONTRACTOR`S PROT
FIRE DAMAGE (Any one fire) $50,000
MED EXP (Any one person) $
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
BODILY INJURY $
(Per person)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT S
AGGREGATE $
EXCESS LIABILITY
EACH OCCURRENCE S
AGGREGATE S
UMBRELLA FORM
S
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WCRY AT - OTR
EL EACH ACCIDENT $
THE PROPRIETORI INCL
PARTNERS/EXECUTIVE
EL DISEASE -POLICY LIMIT $
EL DISEASE - FA EMPLOYEE $
OFFICERS ARE: EXCL
OTHER
A
Commercial Applica
SCP0264325
03/01/97
03/01/98
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Per attached Form No. CG2026
CERTIFICATE HOLDER
CANCELLATION
CITYSJC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of San Juan Capistrano
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL
Community Redevelopment Agency
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: Mary Laub
32400 Paseo Adelanto
SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
San Juan Capistrano CA 92675
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRES TATIVES.
AU RIZEDTATIVp
ACORD 25S (1195)
,/{/� CACORD CORPORATION 1988
• 11 8
POLICY NUMBER: SCP02 4325 (11'855
)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 1185
ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CITY OF SCHEDULE
Name of Person or Organization: SAN JUAN CAPISTRANO
COMMUNITY REDEVELOPMENT AGENCY
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 11) is amended to include as an insured the person or organization shown in the Schedule
as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you.
Copyright, Insurance Services Office, Inc., 1984