1991-1013_BOTACO, INC._Insurance Endorsement1 LIABILITY ENDORSEMENT
0 CITY OF SAN JUAN CAPISTRW
COMMUNITY REDEVELOPMENT AGENCY
32400 Paseo Adelanto
San Juan Capistrano, California 92675
ATTN: CITY CLERICS OFFICE
A. POLICY INFORMATION
I.
2.
3.
4.
5.
6.
S.
Endorsement U 1
Insurance Company SCAN MTEs INs. co. • Policy Number Ol�C-79441-2
Policy Term (From) 10-14L (To) 10-13-92 ;Endorsement Effective Date 13-91
Named Insured
Address of Named Insured 31921 CPZffW CAPIMPM MOI, SAN JUAN CAPISnWU CA 92675
Limit of Liability Any One Occurrence Aggregate 1,000,000. CSL
General Liability Aggregate (check one:)
Applies "per location/project" xx
Is twice the occurrence limit
Deductible or Self -Insured Retention (Nil unless otherwise specified?
Coverage is equivalent to:
Comprehensive General Liability form GL0002 (Ed 1/73)
Commercial General Liability "claims -made" form CG0002
Bodily Injury and Property Damage Coverage is:
"claims -made"
XX � "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 attaches
thereto, it is agreed as follows:
1. INSURED. The City and the Community Redevelopment Agency, its elected or appointec
officers, officials, employees and volunteers are included as insureds with regard to damage:
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 REQUIRED. As respects. (a) work performed by the Named Insures
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 polis;
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 spall not contribute with it.
(OVER)
k
3. SCOPE OF COVE#GE. This policy, if primary, affordicoverage at least as broad as:
(1) Insurance Services Office form number GL 0031 (Ed. 1/73), Comprehensive General .
LIabilIty Insurance and Insurance Services Office form number GL 0404 Broad Furor.
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 i
each insured who is seeking coverage or against whom a claim is made or a suit is brought,
except with respect to the Company's limit of liability.
S. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. ,qny.
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,
of ficlals, 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
k
Incidents and claims are to be reported to the insurer at:
ATTN:
Title Department
SEA COAST INSURANCE
Company
34197 PCH 11202
Street Address
r,
DANA POINT, CA 92629
City State Zip Code
714) 489-1574 _ ---_ - --- _
(Telephone)t
D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER ;
1, JAMES E. PAUL (print/type name), warrant that I have authority to bind the below listed
insurance company and by my signature hereon do so bled thjs-gompanM
RE OUTHORfZED REPRESENTATIVE (original
required on endorsement furnished to the City)
CRGaNIZATICN: SEA ca4Sr INSURANCE AGUCY, INC. TITLE: PRESIDENT
ACOWS; 34197 PCH 11202, DANA POINT, CA 92629 -___ TELEPI- : (7 14 ) 489-1574