1993-0520_BOTACO, INC._Insurance CertificateCERTIFICATE OF
PRODUCER 110
Westlaad Insurance Brokers
P: O. Boa 85481
San Diego, CA 92186-5481
(619) 584-6400
INSURED
BOTACO INC
31921 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO,CA., 92675
5/20/1993 118''`':.'
THIS CERTIFICATE ISqm!SSUED AS A MATTER OF
INFORMATION ONLY AND CONFERS NO RIGHTS UPON
THE CERTIFICATE HOLDER. IT DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
COMPANIES AFFORDING COVERAGE<'':;''
COMPANY A: INSURANCE COMPANY OF THE WEST
COMPANY B: 60�), 6j
COMPANY C:
COMPANY D:
COMPANY E: S
:;;:.::::.:::.:::;;•:::<:..;;:.:::�e::,::.<.;:..::.;:.<:.:::.::.......:.. COVERAGES
:;.::::.:::.::..::.::..:.:................ ; .;;:.::..tits...............:.:......:
This is to certify that policies of insurance listed below have been issued to the insured named above for the policy riod
indicated, notwithstanding any requirement, term or condition of any contract or other document with respectto 1k*h Mis
certificate may be issued or may pertain, the insurance afforded the policies described herein is 4 �
by po t6jaaE'.to pij theGterms,
exclusions
CO
and conditions of..such „policies.
:: INSURANCE
IN CE �:,`:<'<">'z?:
Limits shown may have,.,
ICY
POL NUMBER>:;>:
been reduced by paid:.claim„s.._::._.+
..............T.,,.,.,..,...,.;...,...,,.:.,
,::
DATES
-W
GENERAL LIABILITY
Effective
$ 2,000,000 Gene 1 Agg
A
[XI Gen Liability
CSDI14269800
05/01/93
$ 11000,000 Prod/CoOps Agg
[B] Occ [ ] CM
$ 1,000,000 Pers/Adv Inj
[X] OCP
$ 1,000,000 Occurrence
[ ]
Expiration
$ 50,000 Fire Damage
05/01/94
$ 51000 Medical Exp
AUTO LIABILITY
Effective
A
[X] Any Auto
CSD114269800
05/01/93
$ 1,000,000 CSL
[X] All Owned
[E] Scheduled
[X] Hired
[X] Non -owned
Expiration
$ BI (person)
[ ] Garage Liab
05/01/94
$ BI (accident)
[ ]
$ PD
EXCESS LIABILITY
05/01/93
$ 2,000,000 Occurrence
A
[ ] Umbrella
ESD113262900
$ 2,000,000 Aggregate
[X] Other
05/01/94
]
WORKERS COMP
/ /
Each Accitorydent ents
Each Accident
AND
$ Disease -Limit
EMPLOYERS LIAB
/ /
$ Disease-Empl
$
Description of operations/locations/vehicles/other
THE CERTIFICATE HOLDER IB NAMED AS AN ADDITIONAL INSURED PER FORM
UND0360 ATTACHED. POLICY #CSD114269800 INSURES YOUR LIABILITY ARISING
FROM YOUR OPERATIONS PERFORMED BY OR FOR YOU SUBJECT HOWEVER TO ALL
PROVISIONS EXCLUSIONS AND LIMITATIONS OF THE POLICY *10 days for
non-payment
CANCELLATION
CERTIFICATE HOLDER J %Wff ', Should any of the above described policies
be cancelled before the expiration date
thereof, the issuing company will endeavor
CITY OF SAN JUAN CAPISTRANO to mail *30 days written notice to the
COMMUNITY REDEVELOPMENT AGENCY certificate holder named to the left, but
32400 PASEO ADELANTO failure to mail such notice s"ll pose no
SAN JUAN CAPISTRANO, CA.92675 obligation oga ility of any kind upon
t compan s or reps.
� nu..acvi iucay gacyicacu..a ..ivc l
INSURACE COMPANY OF *E WEST
ENDORSEMENT NO.
POLICY NO.
EFFECTIVE DATE
ISSUED TO
CSD114269800
05-20-93
BOTACO INC.,
ADDITIONAL INSURED
OWNERS, LESSEES OR CONTRACTORS (FORM B)
This Endorsement Modifies Insurance Provided Under The Following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
CITY OF SAN JUAN CAPISTRANO
COMMUNITY REDEVELOPMENT CENTER
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 U) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of your sole negligence and resulting from 'your work" for
that insured by or for you.
UND 0360 (10192)