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05-0401_CREST AUTOMATION_Insurance CertificateMar 17 2005 1:07PM COI&MDS 94?SGG-5735 CONTRACTORS OUTPOST AL INSURANCE SERVICES, INC. FACSIMILE TRANSMITTAL SHEET TO FROM: Michelle Perea Shawna Silvas COMPANY: DATE City of San Juan Capistrano 3/17/2005 FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: 949-493-1053 4 PHONE NUMBER: SENDER'S REFERENCE NUMBER: RE: YOUR REFERENCE NUMBER: Additional Insured Certificate NOTES/COMMENTS: Attached is the additional insured certificate as per your request. As always, if you have any questions, please feel free to give me a call Sin , - ozli Shawna Silvas Coau mors Outpost Insurance Services, Inc. 24338 EL TORO RD., STE E130, LAGUNA WOODS, CA 92637 PHONE: (949) 743-9513 FAX: (949) 666-7334 P.1 Mar 17 2005 1:07PM CO0MDS 9466-5735 p.2 AD -08-D. CERTIFICATE OF LIABILITY INSURANCE 03 1CIIA2005 PRODUCER Contractors Outpost Insurance Services, Inc. 24338 El Toro Rd 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 BV THE POLICIES BELOW. POLICY NUMBER Suite E130 INSURERS AFFORDING COVERAGE Laguna Woods CA 92653- a NSISto rusuRENAEvanston Insurance Company INSURERS: Crest Automation and Classic INSURER C: 2913 El Camino Real •119 INS X COMMERCIAL GENERAL LIABILITY E: Tustin CA 92782- VVYCRI,VCO 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR INCS TYPSOPINaMDATE POLICY NUMBER POLICYERECTM f DATE(POLICY LVDQt ffl LMITS a OWM LLANLRY CLO418OL351 01/26/2005 01/26/2006 EACH OCCURRENCE 6 1,000,000 FRE DALIAGE M ole Aro • 50,000 X COMMERCIAL GENERAL LIABILITY NEDEXP(ArVar • 5,000 CLAMS MADE OCCUR I / / I PERSONALE ADVNJURY • 1,000,000 GENERALAGOPEGATE • 2,000,000 / / / / GEN.L AGGRI!MTE LMR APPLIES PER. PRODUCTS-COLPIOPAOG t 1,000,000 POLICY J LOC V LIMWW / / / / COMBINED SINGLE LMR ANYAUTO Me 60OeN) GODLY INJURY ALL OWNED NUNS / / / / SCHEDULED AUTOS IPe pawn) • GODLY INJURY HMDAUTOS / / / / NON -O MEDAUTOS IPQ emkieo t PROPERTYDAIAGE (PIN, Owned) OARAO1 MAM.IIY AUTO ONLY - EA ACCIDENT OTHER THAN EAACC ANY AUTO 7 / I I I AUTO ONLY: AGO EJIOMLLIALM / / / / EACH OCCURRENCE AGGREGATE OCCUR 7CLAIMS MADE • DECIJCTSLE A TENTION 11 TIONAM PABIL�I I I I I iMPLLOYER$,L Y E.L. EACH AGO IDEM E.L. DISEASE -EA BAPLOYE E.L DISEASE -POLICY LIMIT Is oMeN DESORPTION OF OMMTIONVLOCATIDNBNMICLlt=CLUNONS ADDED EY MDORSIDMI MML'kL PROVISIONS • 30 day notice of cancellation, except for son -payment of preaim which is 10 dAye. The Certificate Holdar N City of Ban JUan Cspistrene" in named additional insured per endorsement R1e-009(4-99) Job: irrigation Construction i Repair ACORD 2"(7187) - iI IAVVN{V VVRrVM, iwNi VP *,r, INS036S wo).01 ELECTRONIC LASER FORMS, INC. -IB00),A2r-0 Pop M2 SHOULD ANY OF THE ANOVS WCMWD POLICIES ee CANCLLLED 851011 THIS EXPIRATION CATIE MMWF, THE SSUIND LNSURM WILL ENDEAVOR TO NAL 30 DAYs wmTTaN Nona To TNS ceRTncATs NMJM NAMED TO THE Len, OUT City of Ban Juan Capistrano FAILURE TO DO 00 SHALL INPOeE NO A7NON OR LUUM a ANY RIND UPON THE 32400 Paseo AdelantoINMjW IIS ANOR IQPR AUnIOI1®INVIIMS1TAme Attn: Michelle Peres. San Juan Capistrano CA 92675- ACORD 2"(7187) - iI IAVVN{V VVRrVM, iwNi VP *,r, INS036S wo).01 ELECTRONIC LASER FORMS, INC. -IB00),A2r-0 Pop M2 Mar 17 2005 1:07PM co 0MDS 94066-5735 P.3 Mar 17 2005 1:07PM CID *MDS 949WG-5735 p.4 'EVANSTON INSURANCE COMPANY ADDITIONAL INSURED ENDORSEMENT 'ATTACHED TO ANO FOFUNJD 'EFFE=%& DATE PART OF POLICY N0. OF SICORSBIIEW CL041801351 01/26/2005 'ISSUED TO THIS ENDORSEMENT CHANGES THE POLICY. Crest Automation & Classic SECTION 11- VM IS AN INSURED of the Commercial General Liability Form is amended to include: Person or Entity: Interest of the Above: as an additional insured under this policy, but only as respects negligent acts or omissions of the Named Insured and only for occurrences, claims or coverage not otherwise excluded in the policy. It is further agreed that where no coverage shall apply heroin for the Named Insured, no coverege nor defense shall be afforded to the above -identified additional insured. Moreover, it is agreed that no coverage shall be afforded to the above -Identified additional insured for any "bodily injury," "personal Injury," or "property damage' to any employee of the Named Insured or to any obligation of the additional Insured to indemnify another because of damages arising out of such injury. ME -M (4m) 03/072005 10:20 949-786-2300 1* 0 PAGE 113 CREST AUTOMATION 2913 EI Camino Real 4 119, Tustin, CA 92782 Tel (949) 552-6552 Fax (949) 786-2300 E Mail: cmotorola(a)ao1.com 3/7/2005. City of San Juan Capistrano Attention: Citv Clerk 32400 Paseo Adelanto San Juan Capistrano CA 92675. Dear Madame / Sir, 3 PAGE FAX ( INCLUDES THIS COVER SHEET) MOTOROLA Attached please find my Liability Insurance for my Vehicle. I have asked my liability Insurance broker to please mail to you my Business General Liability, as requested by your letter ( see your letter, attached, dated 2/17/2005.) I thank you for your patience. Sincerely SAUL HIRSCH MANN, dba CREST AUTOMATION, MOTOROLA AUTHORIZED SALES AND SERVICE. LICENSED ELECTRICAL CONTRACTORS, LICENSE # 699349. 1