1991-1017_BOTACO, INC._Insurance CertificateEXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION STATUTORY LIMITS
EACH ACCIDENT S
AND
DISEASE—POLICY LIMIT S
EMPLOYERS' LIABILITY
DISEASE—EACH EMPLOYEE 5
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
LANDSCAPE MAINTENANCE, VARIOUS LOCATIONS
CERTIFICATE HOLDER CANCELLATION 10 DAY NON -PAY
ADD'L INSURED: CITY OF SAN JUAN CAPISPRANJ & SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CC["P LAITY REDEVE[.OPEMENT AGENCY, ITSEXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
ELECIED OR APPOINTED OFFICERS, MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
OFFICIALS, EMPLOYEES & VOLUNTEERS LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
32400 PASEO ADLANID LIABILITY 9F ANY KI= UPOgTHE COMPANY, ITS AGENTS OR REPRESENTATIVES,
SAN JUAN CAPISTRANO, CA 92675
AUTHORIZE E9(�ENTATIVE `
ATTN: DAWN SHNDE II
lieA411rhOlt1l.
CERTIFICR_
OF INSURANCE ISSUE DATE
I0-17-917-9,/VVI
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND -
CONFERS NO RIGHTS UPON THE C THIS CERTIFICATE
JINNMHOLDER.
SEA COAST INSURANCE AGENCY, INC. DOES NOT AMEND, EXTEND OR AL VERAGE AFFORDED BY THE
POLICIES BELOW.
PCH 11202C0MPANI
31A
I34197
FO O RAGE
DANA POINT, CA 92629
CITY CLERK
COMPANY
LETTER A AMERICAN ST{6i MU$Ug�T CO .
CF,TY
,INSURED
COMPANY B JUN, CAPIS ANO
LETTER
BOTACO, INC.
COMPANY
LETTER
31921 CAMINO CAPISTRANO,
CA 11401 COMPANY
SAN JUAN CAPISTRANO, CA
D
92675
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 REOUIREMENT, 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
,LTR
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MM/DD/VY) DATE (MM/DD/VV)
GENERAL LIABILITY
GENERAL AGGREGATE S 1,606,
! X COMMERCIAL GENERAL LIABILITY
PRODUCTS-COMPIOP AGG. $ 1,000,000.
CLAIMS MADE X OCCUR.
01 -CC -79441-2 10-13-91 10-13-92 PERSONAL B ADV. 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 10-13-9 1 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 S
AND
DISEASE—POLICY LIMIT S
EMPLOYERS' LIABILITY
DISEASE—EACH EMPLOYEE 5
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
LANDSCAPE MAINTENANCE, VARIOUS LOCATIONS
CERTIFICATE HOLDER CANCELLATION 10 DAY NON -PAY
ADD'L INSURED: CITY OF SAN JUAN CAPISPRANJ & SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CC["P LAITY REDEVE[.OPEMENT AGENCY, ITSEXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
ELECIED OR APPOINTED OFFICERS, MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
OFFICIALS, EMPLOYEES & VOLUNTEERS LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
32400 PASEO ADLANID LIABILITY 9F ANY KI= UPOgTHE COMPANY, ITS AGENTS OR REPRESENTATIVES,
SAN JUAN CAPISTRANO, CA 92675
AUTHORIZE E9(�ENTATIVE `
ATTN: DAWN SHNDE II
0 LIABILITY ENDORSEM@T
CITY OF SAN JUAN CAPISTRh..O
COMMUNITY REDEVELOPMENT AGENCY
32400 Paseo Adelanto
San Juan Capistrano, California 92675
ATTN: CITY CLERICS OFFICE
A. POLICY INFORMATION Endorsement # 1
1. Insurance Company AMERICAN STATES INS. Co. ; Policy Number OI -CC -79441-2
2. Policy Term (From) 4%14L (To) 10-13-92 ;Endorsement Effective Date 3-91
3. Named Insured W D,
4. Address of Named Insured 31921 MM CAPISrRArA 01 SAN JUAN CAPISfRANO CA 92675
5. Limit of Liability Any One Occurrence Aggregate 1,000,000..CSL
General Liability Aggregate (check one:)
Applies "per location/project" XK
Is twice the occurrence limit
6. Deductible or Self -Insured Retention (Nil unless otherwise specifleO
7. Coverage is equivalent to:
Comprehensive General Liability form GL0002 (Ed 1/73) xx
Commercial General Liability "claims -made" form CG0002
8. Bodily Injury'and Property Damage Coverage is:
"claims -made"
X. "occurrence"
If claims -made, the retroactive date is
B. POLICY AMENDMENTS
This endorsement is issued in consideration of the policy premium. Notwithstanding any inconsister
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 arising from: (a) activities performed by or on behalf of the Name
Insured, (b) products and completed operations of the Named Insured, or (c) premises owne<
leased or used by the Named Insured.
2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insure
for or on behalf of the City; or (b) products sold by the Named Insured to the City, or ((
premises leased by the Named Insured from the CIty, the insurance afforded by this poli<
shall be primary insurance as respects the City, its elected or appointed officers, official.
employees or volunteers; or stand in an unbroken chain of coverage excess of the Name
insureds scheduled underlying primary coverage. In either event, any other insuranc
maintained by the City, its elected or appointed officers, officials, employees or voluntee
shall be in excess of this insurance and shall not contribute with it.
(OVER)
3. SCOPE OF CC*r AGE. This policy, if primary, af*- ^overage at least as broad as:
(l) Insurance Services Office form number GL 0002 (Ed. 1/73), Comprehensive General
Liability Insurance and Insurance Services Office form number GL 0404 Broad Form.
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 o
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. 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 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
Incidents and claims are to be reported to the Insurer at.
ATTN:
Title Department
SEA COAST INSURANCE
Company
34197 PCH 11202
Street Address
ri
DANA POINT, CA 92629
City State Zip Code
714 489-1574
Telephone a
D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER
I, 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 bind this-gompanyw-j I '
S,FMATURE OF AUTHOI ZED REPR TATIVE (original
ignature required on endorsement furnished to the City)
CRGPN1ZATICN: SEA COAST INSURANCE AGENCY, INC. TITLE: PRESIDENT
ACCRESS; 34197 PCH 11202, DANA POINT, CA 92629 TELEAIaE-. 5114 ) 489-1574