1989-0509_BOTACO, INC._Insurance CertificateCERTIFICAT F INSURANCE ISSUE DATE (MMIDD/YY)
. 5/9/89
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 su0-coDE LETTER AMERICAN STATES INSURANCE COMPANY
INSURED
COMPRNY B CALIFORNIA INDEMNITY INSURANCE COMPANY
BOTACO, INC. LENTERNY C
32221 CAMINO CAPISTRANO #123 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 ANI' REQUIREMENT, TFRM 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 POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
.TR - DATE (MMIDD/YY) DATE (MM/DD/YY)
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONSISPECIAL ITEMS
CERTIFICATE HOLDER
THE CITY OF SAN JUAN CAPISTRANO
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675
ACORD 25-S (3188) ..,,
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 1.0_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ,, • ,, '
JOE A. BOSWELL
®ACORD CORPORATION 1988
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 A 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) $ r 5
AUTOMOBILE LIABILITY
COMBINED
$ 500
x ANY AUTO
LIMIGTLE
ALL OWNED AUTOS
BODILY r
A
INJURY $
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
x
BODILY
INJURY $
x NON GINNED AUTOS
01—CC-367664—i
3/1/89
3/1/90
(Per accidenp
GARAGE LIABILITY
PROPERTY
DAMAGE S
EXCESS LIABILITY
EACH AGGREGATE
OCCURRENCE
$ $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
STATUTORY
B
AND
P 2243A
1/21/89
1/21/90
E
(EACH ACCIDENT)
$ (DISEASE—POLICY LIMtTI
EMPLOYERS' LIABILITY
$ (DISEASE—EACH EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONSISPECIAL ITEMS
CERTIFICATE HOLDER
THE CITY OF SAN JUAN CAPISTRANO
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675
ACORD 25-S (3188) ..,,
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 1.0_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ,, • ,, '
JOE A. BOSWELL
®ACORD CORPORATION 1988