1991-1017_BOTACO, INC._Insurance CertificateACI CERTF=.WC
PRODUCER
SEA COAST INSURANCE AGENCY, INC.
34197 PCH #202
DANA POINT, CA 92629
ISSUE DATE iMMIDDrYY)
10-17-91
CONFERS HOLDER. THIS CERTIFICATE
DOES NOTA MEIND,TS UPON THE EXTEND OR AL7ER7FiE�bVERAGE AFFORDED BV THE
COMPANI
COMPANY CITY i LERK
LETTER A AMERICAN ST9iidUHIT CO.
CITY OF jj{{��N
JOAN CAIA-ANO
COMPANY
B
INSURED
LETTER
BOTACO, INC.
LETTTEARNYC
31921 CAMINO CAPISTRANO, CA #401
COMPANY
SAN JUAN CAPISTRANO, CA 92675
LETTER D
COMPANY E
LETTER
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 TYPE OF INSURANCE POLICY NUMBER
LTR
POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MMIDO/VV) DATE (MM/OD/YY)
GENERAL LIABILITY
GENERAL AGGREGATE $ 1,000,7M7.
X COMMERCIAL GENERAL LIABILITY
PRODUCTS-COMPIOP AGO. $ 1,000,000.
CLAIMS MADE X OCCUR, 0I -CC -79441-2
10-13-91 10-13-92 PERSONAL B AOV. INJURY $ 1,000,000.
OWNER'S & CONTRACTOR'S PROT.
EACH OCCURRENCE $ 1,000,000.
A
FIRE DAMAGE (Any one lire) $ 50,000.
MED. EXPENSE (Any one person) $ 5,000.
AUTOMOBILE LIABILITY
COMBINED SINGLE $ 1,000,000.
ANY AUTO
LIMIT
ALL OWNED AUTOS
BODILY INJURY $
A X SCHEDULED AUTOS
(Per person)
01 -CC -519448-2
10-13-91 10-13-92
X HIRED AUTOS
BODILY INJURY
X NON -OWNED AUTOS
(Per accident) $
GARAGE LIABILITY
PROPERTY DAMAGE $
EXCESS LIABILITY
EACH OCCURRENCE $
UMBRELLA FORM
AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
STATUTORY LIMITS
EACH ACCIDENT $
AND
DISEASE—POLICY LIMIT $
EMPLOYERS' LIABILITY
DISEASE—EACH EMPLOYEE S
OTHER
DESCRIPTION OF OPERATIONSILOCATIONE/VENICLES/SPECIAL ITEMS
LANDSCAPE MAINTENANCE, VARIOUS LOCATIONS
CERTIFICATE HOLDER
CANCELLATHM 10 DAY NON -PAY
ADD 'L INSURED: CITY OF SAN JUAN CAPISTRANO &
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CC MINITY REDEVE[ppaolr AGENCY, ITSEXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
ELECTED OR APPOINTED OFFICERS,
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
OFFICIALS, EMPLOYEES & WLUNTEERS
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
32400 PASEO ADLANIO
LIABILITY 9F ANY KW UPOgTHE COMPANY, ITS AGENTS OR REPRESENTATIVES
SAN JUAN CAPISTRAND, CA 92675
ATIN: DAWN SHNUM
pUTNORI2E ESENTATIVE
'
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ACORD 25-5 7/90
ORD CORPORATI,