1991-1013_BOTACO, INC._Insurance Endorsementj LIABILITY ENDORSEMENT
t CITY OF SAN JUAN CAPISTR&
COMMUNITY REDEVELOPMENT AGENCY
32400 Paseo Adelanto
San Juan Capistrano, California 92673
ATTN: CITY CLERICS OFFICE
A. POLICY INFORMATION 1 Endorsement .1 1
J. Insurance Company AMERICAN STATESINS. CO. ;Policy Number OI CC 'i2
2. Policy Term (From) 1 To 10-13-92 ;Endorsement effective Date 13-91
3. Named Insured
4. Address of Named Insured 31921 MIM CAPISPRANO 01 SAN JUAN CAPIMANO CA 92675
5. Limit of Liability Any One Occurrence Aggregate 5 1,000,000. CSL,_
General Liability Aggregate (check one:)
Applies "per location/project" Xc
Is twice the occurrence limit
6. Deductible or Self-insured Retention (Nil unless otherwise specified): $
7. Coverage Is equivalent to:
Comprehensive General Liability form GL0002 (Ed 1/73) xx
Commercial General Liability "claims -made" form CG0002
S. Bodily Injury and Property Damage Coverage is:
"claims -made"
"occurrence"
11 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 and the Community Redevelopment Agency, its elected or appointed
officers, officials, employees and volunteers are included as insureds with regard to damages
and defense of claims arising from: (a) activities performed by or on behalf of the Namec
Insured, (b) products and completed operations of the Named Insured, or (c) premises owned,
leased or used by the Named Insured.
2. CONTRIBUTION NOT REQMED. 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 (c
premises leased 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, officials
employees or volunteers; or stand in an unbroken chain of coverage excess of the Namet
insureds scheduled underlying primary coverage. In either event, any other insurance
maintained by the City, its elected or appointed officers, officials, employees or volunteer
shall be in excess of this insurance and shall not contribute with it.
(OVER)
3. SCOPE OF COVEJWE. This policy, if primary, affor Wverage at least as broad as:
(1) Insurance Services Office form number GL 0002 (Ed. 1/73), Comprehensive General
LIability Insurance and Insurance Services Office form number GL 0404 Broad Fur,m
comprehensive General Liability endorsement; or
(2) Insurance Services Office Commercial General Liability Coverage, "occurrence"
form CG 0001 or "claims -made" form CG 0002; or
(3) if excess, affords coverage which is at least as broad as the primary insurance'
forms referenced in the preceding sections (1) and (2).
4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to ,
each insured who is seeking coverage or against whom a claim is made or a suit is brou3hi,
except with respect to the Company's limit of liability.
S. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any;
failure to comply with reporting provisions of the policy shall not affect coverage provided -
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 suspended,
voided, cancelled, reduced In coverage or In limits except after thirty (30) days' prior written.
notice by certified mail return receipt requested has been given to the City. Such notice
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: ,
Title Department
SEA COAST INSORMM
Company
34197 Pai 11202
Street Address
r,
DANA POINT, CA 92629
City State Zip Code
714 489-1574
Telephone .
D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER
1, JAMES E. PAUL, (print/type name)p warrant that I have authority to bind the below listed'
insurance company and by my signature hereon do so bind thj"mpan+K I '
SATURE OF AUTHOZZED REPRESENTATIVE (ortglnal
ignature required on endorsement furnished to the City)
CFr,PNIZATICN: MA MAa INaROM AMU, IM. TITLE: PREsmwr
pMRM5; 34197 PCH $202, DANA POINT. CA 92629 T7J.Ej7rCM: 6114 ) 489-1574