1990-0613_BOTACO, INC._Insurance Endorsement' LUIBQ.ITY Et4DORSEMENT
u ir.r•tJ is �s+sJ a. s a»von arY OF SAN VAN CAPISTRANO
° COMMUNITY REDEVELOPMENT AGENCY
'I flViinwu'K;nw"3,MU 32400Pa$epAdelaato i
.•ori a•0#0 X) �dng,;f m,ol +!sl :� ]usn � Prp4 r ±�,•.,
r r eq G CITY CL F�KS OFFIC
C
Z2 MX " 1,I'rr7 ,rr,r,• 1 Endorsement / _ I
U.S.F.&G. INS
insursnu Company URANC Et Follq Number ICP 1 1 5 307038
2. -900)
o6-13-91:Endorsement E et vs ate
3. Named insured 0
4t r Address of Named Insured HWY., CAPIST ,
Limlt o(LjabiUty Any Onp ccurrenc Aggregate 1000 00. CSL
General Liability Aggregate (check ones) "
Jam•.: :. a : r. y.:i+✓'.v, .::.1 , • ,
Applies "per locatlon/project"
is twice the occurrence µmit
6. Deductible or Selfdnsured Retention (NU unless otherwise speclfisdk
is equivalent wt
Comprehensive General Liability form GL0002 (Ed 1173)
Commercial General Liability "claims -made" form CG0002
L Bodily Injury and Property Damage Coverage 1st
"dalms-made"
— X "occurrence"
It "ms -made, the retractive date Is
B. j,,'_OLICY AMENDMENTS
This endorsement b Issued le corsslderatlon of the policy premium. Notwithstanding any InconsJster
statement in the, policy to which this endorsement Is attached or any other endorsement attache
thereto, It Is agreed as follows[ ,
1. INSURED. The City and the Community Redevelopment Agency, its elected or appointe
officers, officials, employees and volunteers are Included as Insureds with regard to damage
and defense of claims arlsing from: (a) activities performed by or on behalf of the Name
insured, (b) products and completed operations of the Named Insured, or (c) promises ownec
leased or used by the Named Insured
CONTRIBUTION NOT REQUIRED. As rdspects: (a) work performed by the Named Insure
for or on behalf of the Cityl or (b) products sold by the Named Insured to the Cityl or (c
premises leased by the Named Insured from the City, the Insurance afforded by this polic
shall be primary Insurance as respects the City, 14 elected or appointed of ricers, ofric:lalr
employees or volunteersi or stand In an unbroken chain of coverage excess of the Name
Insureds scheduled underlying primary. coverage. In either event, any other lnsuranc
maintained by the City, Its elected ora pointed at It *ors, officials, employees or voluntesi
$hall be in excess of this insurance and shill not contr2uts with It.
-ore i W. j t..:,,
X $COP& OF FqyRAGZ.'.Th aollcYs .pclmwy, affords coverage at least as broad a:s
(1) Insurance Services Office term number GL 0002 (Ed. 1/73), Comprehensive General
Liability Insurance and Insurance Services Of Lice form number GL 0404 Broad Form
comprehensive General Liability endersementf or
1kY ) Insurance Services Office Commercial General L144114ty Cowags, "occurrence"
term CG 0001 or "claims -made" form CG 00021 or
U excess,"affords coverage which is at least as broad*as the primary Insurance
" forms referenced In the preceding sections (1) and (2).
4. SEVERABII M OF INTEREST. The Insurance afforded by this policy applies separately to
each Insured -who Is socking coverage or against whom a claim is made or a suit is brought,
except with respect to the Company's limit of liability.
3. PROVISIONS REGARDING THE INSURER'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,
of ticlals, employees or volunteers.
6. CANCELLATION NOTICE. The Insurance afforded by "-policy shell not bo suspended,
voldod, cancelled, reduced In coverage or In limits except atter thirty (30) days' prior written
notice by certified mall return receipt requested has been given to the City. Such notice
9*1 be addressed as shown In the heading of this endorsement.
C. INCIDENT AND CLAIM REPORTING PROCEDURE
Incidents and calms are to be reported to the Insurer at;
ATTNt '
(Title) Department
SEA COAST INSURANCE AGENCY, INC.
(Company)
31726 RANCHO VIEJO RD X1213
SAN JUAN CAPISTRANO, CA 92675 • J ,,' ....
(City) tat Z Ip od OT
(714) 831-2963
(Telephone)
i
0. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER
JAMPS' E:' PAUL (print/type name), warrant that I have authority to bind the below listed
Insurance company and.by my gra o hereon do sg49N this company.
At
I N OF ❑�O�RIZED�tEPRESENhAT�T1IE(art ggini4
• "`�.''•:r•� •. , .. .' .sr#a&turs required on endorsement,furnishsd, to the City)'
CW.44NIZATICNt SEA COAST INSURANCETITCEt PRESIDENT
P itFSSt 31726 RANCHO VIEJO RD11213, SAN JUAN CAPIS7RANJ IF1.EFF�Et ( 7'14) '831-2963