1989-0605_BOTACO, INC._Insurance Certificatea1:1OW. CERTIFICATOF INSURANCEISSUE DATE MM/DD/YY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
BOSWELL INSURANCE AGENCY
PO BOX 4648 COMPANIES AFFORDING COVERAGE
MISSION VIEJO, CA 92690
COMPANY A
CODE SUB -CODE LETTER AMERICAN STATES INSURANCE COMPANY
CO
INSURED
LETTERNY B CALIFORNIA INDEMNITY INSURANCE COMPANY
WORKER'S COMPENSATION O STATUTORY
B AND P 2243A 1/21/89 1/21/90 $ (EACH ACCIDENT)
$ (DISEASE --POLICY LIMIT)
EMPLOYERS' LIABILITY
$ (DISEASE—EACH EMPLOYE
OTHER
*EXCEPT IN CASE OF CANCELLATION FOR NONPAYMENT OF PREMIUM, 10 DAYS NOTICE MAY BE GIVEN.
DESCRIPTION OF OPERAT(ONS(LOCATIONS/VEHICLES(RESTRICTIONS/SPECIAL ITEMS
JOB: ALL OPERATIONS PERFORMED BY THE INSURED ON BEHALF OF THE ADDITIONAL NAMED INSURED.
CERTIFICATE HOLDER & ADDITIONAL INSURED CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
SAN JUAN CAPISTRANO REDEVELOPMENT EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL )99KK v)mXX0
AGENCY MAIL 3.0—*_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
32400 PASEO ADELANTO LEFT. �i}�X�X6pXMACk SXN?NL�t1C2X9iMXOCX%X]pCN8X9G9NCD[
SAN JUAN CAPISTRANO, CA 92675 XXAiB(N1tdCd�}CTd]6�t34�(OtN9COTX##XIXQN9XX1X9C�Ct#t7�biX747PXIERYADEsX
AUTHORIZED REPRESENTATIVE
JOE A. BOSWELL a r
ACORD 25-S 53/88) ---_` 111 CACORD CORPORATION 1986
C �Q®® ��
BOTACO, INC.
LETTER
32221 CAMINO CAPISTRANO #123
A
SAN
SAN JUAN CAPISTRANO, CA 92675
COMPANY -
LETTER D
�\eCi�o
CIO
E
�_
LETTERNY
11 a i 'I
�—�
COVERAGES
r't�
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
BELOW HAVE BEEN ISSUED TO THE INSURED QED ABOVE FfYT I ppQQII,,ICV PE D
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOC yfENT WgANJ86gP'1'ClWJHI HIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUB.IEJU.1FONtl4ALL THE T MS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
TYPE OF INSURANCE POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION ,BALL LIMITS IN TNOUANDS
-TR
DATE IMM/OO/YY) DATE (MM/DD/YY)
GENERAL LIABILITY
GENERAL AGGREGATE $ 2,000
X COMMERCIAL GENERAL LIABILITY
PRODUCTS COMP/OPS AGGREGATE $ 2,000
A
CLAIMS MADE X OCCUR, 01—CC-103208-3
3/1/89 3/1/90 PERSONAL& ADVERTISING INJURY $ 1,000
OWNER'S A CONTRACTOR'S PROT,
EACH OCCURRENCE $ 1,000
FIRE DAMAGE (Any one lire) $ 50
MEDICAL EXPENSE (Any one person) $ 5
AUTOMOBILE LIABILITY
COMBINED
SINGX
$ 500
ANY AUTO
LIM TLE
ALL OWNED AUTOS
BODILY
A
NJURY $
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
X
BODILY
XNON -OWNED AUTOS 01 -CC -367664-1
INJURY $
3/1/89 3/1/90 (Per accident)
GARAGE LIABILITY
PROPERTY
$
DAMAGE
EXCESS LIABILITY
EACH AGGREGATE
OCCURRENCE
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION O STATUTORY
B AND P 2243A 1/21/89 1/21/90 $ (EACH ACCIDENT)
$ (DISEASE --POLICY LIMIT)
EMPLOYERS' LIABILITY
$ (DISEASE—EACH EMPLOYE
OTHER
*EXCEPT IN CASE OF CANCELLATION FOR NONPAYMENT OF PREMIUM, 10 DAYS NOTICE MAY BE GIVEN.
DESCRIPTION OF OPERAT(ONS(LOCATIONS/VEHICLES(RESTRICTIONS/SPECIAL ITEMS
JOB: ALL OPERATIONS PERFORMED BY THE INSURED ON BEHALF OF THE ADDITIONAL NAMED INSURED.
CERTIFICATE HOLDER & ADDITIONAL INSURED CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
SAN JUAN CAPISTRANO REDEVELOPMENT EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL )99KK v)mXX0
AGENCY MAIL 3.0—*_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
32400 PASEO ADELANTO LEFT. �i}�X�X6pXMACk SXN?NL�t1C2X9iMXOCX%X]pCN8X9G9NCD[
SAN JUAN CAPISTRANO, CA 92675 XXAiB(N1tdCd�}CTd]6�t34�(OtN9COTX##XIXQN9XX1X9C�Ct#t7�biX747PXIERYADEsX
AUTHORIZED REPRESENTATIVE
JOE A. BOSWELL a r
ACORD 25-S 53/88) ---_` 111 CACORD CORPORATION 1986
1111S ENDORSE CIIANGES THE POLICY. PLEASE READ 1WHULLY.
mmdm
g�rawusa�s, AUDITIONAL INSURED - OWNERS, LESSEES Ca 20 to it as
• OR CONTRACTORS (FORM B) COMMERCIAL GENERAL LIABILITY
01—CC-103208-3
Ibis endosemenl modifies Insurance provided under The following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCIIEDULE
Name of Person or Organization!
SAN JUAN CAPISTRANO REDEVELOPMENT AGENCY
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675
(II 110 enlry appears above, information required to complete This endorsement will be shown in the Ueclaralions as applicable
to fids einimsenrenl.)
WIIU M AN INSURED (Section II) Is amended to Include as an Insured the person or organization shown in The Schedule,
bul only with respect to liability arising out of "your work" lot Ibal Insured by or tot you.
Coryr101. Insurance Services Onice. tire. 1984
{ _ JUN 1989
CITY OF n
SAN JUAN CAPISTRANO
CALIFORNIA /