1991-0625_BOTACO, INC._Insurance CertificateAchom . CERTIFICA'..: OF INSURANCE ISSUE DATE M,DDIYY)
6-25
6-25-91 ,
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
SEA COAST INSURANCE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
34 197 PCH 11202
POLICIES BELOW.
DANA POINT, CA 92629
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER AMERICAN STATES INS. CO.
I
COMPANY
B
INSURED
LETTER
BOTACO, INC.
31921 CAMINO CAPISTRANO 11401
LETTER C
SAN JUAN CAPISTRANO, CA 92675
COMPANY D
I
LETTER
i
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.
i
( COPOLICY
LTR TYPE OF INSURANCE POLICY NUMBER
EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS
GENERAL LIABILITY
GENERAL AGGREGATE $ 1,000,000.
X COMMERCIAL GENERAL LIABILITY
PRODUCTS-COMPIOP AGO. $ 1,000,000.
CLAIMS MADE X OCCUR, 01 -CC -79441-1
IA
10-13-90 10-13-91 PERSONAL & ADV. INJURY $ 1,000,000.
OWNER'S & CONTRACTOR'S PROT.
EACH OCCURRENCE S 1,000,000.
i
FIRE DAMAGE (Any one fire) $ 50,000,
MED. EXPENSE (Any one person) $ 5,000.
AUTOMOBILE LIABILITY
COMBINED SINGLE $ 1,000,000.
ANY AUTO
LIMIT
ALL OWNED AUTOS
BODILY INJURY $
X SCHEDULED AUTOS 01 -CC -519448-1
10-13-90 10-13-91 (Per person)
A
X HIRED AUTOS
BODILY INJURY
X NON -OWNED AUTOS
(Per accident) $
j GARAGE LIABILITY
1
PROPERTY DAMAGE $
EXCESS LIABILITY
EACH OCCURRENCE $
iUMBRELLA FORM
AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
STATUTORY LIMITS
'
EACH ACCIDENT $
AND
DISEASE—POLICY LIMIT $
EMPLOYERS' LIABILITY
DISEASE—EACH EMPLOYEE $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VENICLES/SPECIAL ITEMS
LANDSCAPE MAINTENANCE, VARIOUS.LOCATIONS
CERTIFICATE HOLDER
CANCELLATION 10 DAY NON -PAY
ADDITIONAL INSURED:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF SAN JUAN CAPISTRANO & COMMUNITY
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
REDEVELOPMENT AGENCY, ITS ELECTED OR APPOINTED
MAIL30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
OFFICERS, OFFICIALS, EMPLOYEES & VOLL)NTEERS
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
32400 PASEO ADELANIO
LIABI TY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES
' SAN JUAN CAPIS RAND, CA 92675
ATIN. DAWN SHANDERL.
AUTHO ED REPRESENTATIVE
LACORD
�[.�.0�
25-S(7/90)
®ACORD CORPORATION 19901
LIABILITY ENDORSEMENT
• CITY OF SAN JUAN CAPISTRA
COMMUNI'T'Y REDEVELOPMENT AGENCY
32400 Paseo Adelanto
San Juan Capistrano, California 92673
ATTN: CITY Cis OFFICE
A. POLICY INFORMATION Endorsement 9
I. Insurance Company AMERICAN STATES INS. CO.; Policy Number 01 -OC -79441-1
2. Policy Term (From) 10-13-90 To 10- 13-9 1 ;Endorsement Effective Date 10-13-90
3. Named Insured BOTAM INC.
4. Address of Named Insured CAPISTNVU 11401
5. Limit of Liability Any One Occurrence Aggregate 1.000,000.,q�_
General Liability Aggregate (check one:)
Applies "per location/project" XX
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 "clalms-made" form CG0002
S. 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 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 Named
Insureds (b) products and completed operations of the Named Insured, or (c) premises owned,
leased or used by the Named Insured.
2. CONTRIBUTION NOT REQIJI ED. As respects: (a) work performed by the Named Insured
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 policy
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 Named
Insured's scheduled underlying primary coverage. In either event, any other insurance
maintained by the City, its elected or appointed officers, officials, employees or volunteers
shall be in excess of this insurance and shall not contribute with it.
(OVER)
i SCOPE OF COVE 0GE. This policy, if primary, affor Woverage 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 Forma
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).
+'r
4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separatelyo°,
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.
5. 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 writte.':
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 INSURANCE AGENCY
Company
34197 PCH 11202
Street Address
DANA POINL, CA 92629
City State Zip Code
Y.
714) 489-1574
Telephone
D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER
it JAMES E. PAUL (print/type name), warrant that I have authority to bind the below listed
insurance company and by my sigrTa4ure hereon do so bind t is company.
SIGN URE OF UT�D I'� ESENTATIVE (original
si ature required on endorsement furnished to the City)
CRCANIZATICN: SEA COAST INSURANCE AGENCY, INC TITLE: PREsmEmL
PlrMS: 34197 PCT 11202, DANA FOWL CA 92629 TELEPH7Z: (7 14 ) 4Ro—ls7
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