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