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1996-0910_PARSANS CONSTRUCTION COMPANY_Certificate of Insurance I A1.Iwghtiw C E RTI F I CQ " OF INSURANCE CSR BB DATE(MM/DD/YY) PARSA-1 09/10/96 IPRi4CUCEH THIS CERTIFICATE I UED AS A MATTER OF INFORMATION f oOSWELL INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agents & Brokers, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 4648 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Mission Viejo CA 92690 COMPANIES AFFORDING COVERAGE Joe A. Boswell COMPANY Phon.No. 714-855-0430 Fax No. A Mercury Insurance Company INSURED COMPANY B Ranger Insurance Co. COMPANY Parsans Construction Co. C Golden Eagle Insurance Company 6154 Bellaire Avenue COMPANY North Hollywood CA 91606 D 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ro I I PO:WY EFFECTIVE POLICY EXPIRATION LTR rre yr iiSiiwarii c 1 vLil i KUMO•n DATE(MM/DD/YY) DATE(MM/DD/YY) "ter r' GENERAL UABIUTY GENERAL AGGREGATE $2,000.000 B X ! COMMERCIALGENERALUABIUTY GL0672685 03/12/96 03/12/97 PRODUCTS-COMP/OPAGG $ 1,000,000 CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $1,000,000 _IV OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1,000,000 FIRE DAMAGE(Any one tiro) $ 50,000 I MED EXP(Any one person) $ 5,000 AUTOMOBILE UABIUTY A ANY AUTO AC11017314 03/12/96 03/12/97 COMBINED SINGLE UMIT $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X (SCHEDULED AUTOS (Per person)X I HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ i GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ I ANY AUTO OTHER THAN AUTO ONLY: � - EACH ACCIDENT $ AGGREGATE $ EXCESS UABIUTY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ —CI WORKERS COMPENSATION AND V I EMP r vitaL!" . o,_Tv X STATUTORY UMITS , EACH ACCIDENT $ 1,000,000 THE PROPRIETOR/ INCL NWC37684703 04/16/96 04/16/97 DISEASE-POUCY OMIT $ 1,000,000 PARTNERS/EXECUTIVE — OFFICERS ARE: EXCL I NWC37684703 04/16/96 04/16/97 DISEASE-EACH EMPLOYEE $1,000,000 OTHER CZZ/ c. C C-a-3 z-Q�' rn � �� < CD DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS L" Ill *10 day Notice of Cancellation for nonpayment or nonre rtin of premium. -} 3:r w < Certificate holder, dm pp g p :te ^ ca Transportation Corridor A ency California Cohr�dor --+�+r, no m Constructors Caltrans, Capistrano Unified Sc�ryool Distr ct, Casitas 7.x Capistrano HOA are added as Additional Insureds per CG2010 as respects: !x "4 --_.-- In All Operations of the Named Insured CERTIFICATE HOLDER CANCELLATION. vx SANJU99 SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL MAIL City of San Juan Capistrano *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building & Safety 32400 Paseo Adelanto San Juan Capistrano CA 92675 ` --- AUTHORIZED REPRESENT .!S Joe A. Boswell )‹.:547.e...4...e_e_i—e.,_ ACORD 25-S(3/93) ©ACORD CORPORATION 1993 t. r M Commercial General Liability CG 20 10 10 93 NAMED INSURED: Parsans Construction Co. POLICY NUMBER: GLO672685 EFFECTIVE DATE : 9/9/96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below SCHEDULE: Name of Person or Organization: City of San Juan Capistrano, Transportation Corridor Agency, California Corridor Constructors, Caltrans Capistrano Unified School District, Casitas Capistrano HOA 32400 Paseo Adelanto San Juan Capistrano, CA 92675 ( If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II ) is amended to include as an insured the person or organization shown in the schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. Copyright Insurance Services Office, Inc. 1992 Page 1 of 1 CG2010 (10/93) AC;/1I:I)a CERTIFICA OF INSURANCE CSR BB DATE(MM/DD/YY) PARSA-1 09/18/96 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BOSWELL INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agents & Brokers, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 4648 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Mission Viejo CA 92690 COMPANIES AFFORDING COVERAGE Joe A. Boswell COMPANY Phone No. 714-855-0430 Fax No. A Mercury Insurance Company INSURED COMPANY B Ranger Insurance Co. COMPANY Parsans Construction Co. C Golden Eagle Insurance Company 6154 Bellaire Avenue COMPANY North Hollywood CA 91606 D 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 B X COMMERCIAL GENERAL LIABIUTY GL0672685 03/12/96 03/12/97 PRODUCTS-COMP/OPAGG $ 1,000,000 CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $ 1,000,000 X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one fire) $ 50,000 MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILITY A ANY AUTO AC11017314 03/12/96 03/12/97 COMBINED SINGLE UMIT $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE _ $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATION AND X STATUTORY OMITS C EMPLOYERS'LIABILITY EACH ACCIDENT , $1,000,000 THE PROPRIETOR/ INCL NWC37684703 04/16/96 04/16/97 DISEASE-POLICY OMIT $ 1,000,000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL NWC37684703 04/16/96 04/16/97 DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS *10 da Notice of Cancellation for nonpayment or nonreporting of premium. Certificate holder, its elected or appointed officers, officials, employees, and volunteers are added as Additional Insuredser Compan Form Attached as respects General Liability. Primary Wording is Included iiiii endorsement. CERTIFICATE HOLDER CANCELLATION SANJ U99 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL MAIL City of San Juan Capistrano *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Community Redevelopment Agency 32400 Paseo Adelanto San Juan Capistrano CA 92675 AUTHORIZED REPRESENT Joe A. Boswell ACORD 25-$(3/93}'' ©ACORDcORPO:..,TION 1993 ENDORSEMENT END. NO. #7 (PAGE 1 OF 2) ADDITIONAL Ev_wzRED PROVISIQNS IT IS AGREED THAT THE FOLLOWING PROVISION(S) AMEND THE COVERAGE PROVIDED TO THE ADDITIONAL INSUREDS) NAMED IN IHIs ENDORSEMENT AS FOLLOWS: ((NLY THOSE CHEMED APPLY) r1 PRIMARY INSURANCE CLAUSE IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THIS POLICY FOR THE BENEFIT OF THE ADDITIONAL INSURED SHOWN SHALL BE PRIMARY INSURANCE, AND ANY OTHER INSURANCE MAINTAINED BY THE, ADDITIONAL INSURED(S) SHALL BE EXCESS AND NON-CONTRIBUTORY, BUT ONLY AS RESPECTS ANY CLAIM, LOSS OR LIABILITY AR/SING OUT OF THE OPERATIONS OF THE NAMED INSURED(S) OR ITS SUE-CONTRACTORS, AND ONLY IF SUCH CLAIM, LOSS OR LIABILITY IS D TO BE SOLELY THE NEGLIGENCE OR RESPONSIBILITY OF THE NAMED INSURED. HOLD HARMLESS CLAUSE IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THIS POLICY FOR THE BENEFIT OF THE ADDITIONAL INSURED] SHOWN BELOW SHALL INDEMNIFY AND HOLD HARMLESS THE ADDITIONAL INSURED,BUT ONLY AS RESPECTS ANY CLAIM, LOSS OR LIABILITY ARISING OUT OF THE OPERATIONS OP NAMED INSURED(S) OR ITS SUB-CONTRACTORS. SEVERABILITY OF INTEREST IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THIS POLICY FOR THE BENEFIT OF THE ADDITIONAL INSURED SHOWN BELOW SHALL APPLY SEPARATELY TO EACH ADDITIONAL INSURED AGAINST WHOM A CLAIM IS MADE OR SUIT IS BROUGHT, EXCEPT WITH RESPECTS TO jilt. LIMITS OF INSURANCE UNDER THIS POLICY. AU.OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Policy Number Insures Effective GL0672685 PARSANS CONSTRUCTION COMPANY g1 - /k-- 5c, Issuing Carrier Duly Authorized Representative RANGER INSURANCE COMPANY _ Joe A. Boswell -- ■ ENDORSEMENT ` END, NO. I 17 • (PAGE 2 OF 2) I x I NOTICE OF CANCELLATION OR NON-RENEWAL IT IS AGREED THAT THE COMPANY WILL PROVIDE THE ADDITIONAL INSURED SHOWN BELOW WITH 30 DAYS NOTICE OF CANCELLATION OF THIS POLICY IN THE EVENT OF CANCELLATION DUE TO COMPANY ELECTION ONLY_ El WAIVER OF SUBROGATION IT IS AGREED THAT WE WAIVE ANY RIGHT OF RECOVERY WE MAY HAVE AGAINST THE PERSON OR.ORGANIZATION SHOWN IN THE SCHEDULE BECAUSE OF PAYMENT WE MAKE FOR INJURY OR DAMAGE ARISING OUT OF "YOUR WORK"DONE UNDER A CONTRACT WITH THAT PERSON OR ORGANIZATION. THE WAIVER APPLIES ONLY TO THE PERSON OR ORGANIZATION SHOWN Its THE SCHEDULE. SCHEDULE NAME OF PERSON OR ORGANIZATION ALL.OTidFRTERMS AND CONDITIONS OF TMis POLICY REMAIN C}-BANGED_ Policy Number !muted Effective GL0672685 PARSANS CONSTRUCTION COMPANY q -/F-96, Issuing Carrier- _. Duly Authorized Rcpresentstive RANGER INSURANCE COMPANY ,C.L-c-i f Joe A. Boswell 1111