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EL 112 , . ••• LE• P• 11 .... el LI a ACORDCERTIFICA OF LIABILITY INSU NCEF : 09/02/1998 r PRODUCER (714)979-6543 FAX (775)549-2943 THIS CERTIFICATE IS I SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE pligmore Insurance Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 2970 Harbor Blvd. #215 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Costa Mesa, CA 92626 - COMPANIES AFFORDING COVERAGE," Lic #0811959 ............................................. ........... ...........Comp an...............................rn ................................................... COMPANY Mercury Casualty y Attn: Ext: A i INSURED { . r _ �_-_.._.__.__...____ Md Construction Group COMPANY r-, • .---t• rn P.O. Box 1 B `"''_,- - m Corona Del Mar, CA 92625 COMPANY _{(1 -7-1 co rn C'^ COMPANY { D c. '~COVERAGES - .gy _ . ___ .' _ ,._.. 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 POLICY EFFECTIVE POLICY EXPIRATION • LTR -TYPE OF-INSURANCE» P_OLICY_NUMBER — DATE"(h1M/DDIYY) DATE(t IM1DD/YY)' - __LIMITS _ GENERAL LIABILITY j ] GENERAL AGGREGATE I $ COMMERCIAL GENERAL LIABILITY ( PRODUCTS-COMP/OP AGG , $ € 1 CLAIMS MADE { OCCUR 1 PERSONAL&ADV INJURY I $ OWNER'S&CONTRACTOR'S PROT i I EACH OCCURRENCE I $ .................................................... ........... W FIRE DAMAGE(Any one fire) i $ � i MED EXP(Any one person) I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000 ANY AUTO , , ALL OWNED AUTOS { BODILY INJURY { $ X I SCHEDULED AUTOS ' (Per person) A . .....� AC11021559 01/07/1998 01/07/1999 .......................................... ........ ...... _..,......,...$.............._........... .._................. X I HIRED AUTOS } BODILY INJURY NON-OWNED AUTOS (Per accident) { 1... ..... ............................................... .. ... ................. PROPERTY DAMAGE I $ I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT I $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ ........ _....._..___..,.._m.____.________ AGGREGATE $ .__.. .__. _... EXCESS LIABILITY I I EACH OCCURRENCE 1.$ ty_LUMBBELLAEORM ___^:— AGGREGATE $ {OTHER THAN UMBRELLA FORM { I ( $ { WC STATU- I OTH-, ,, : . WORKERS COMPENSATION AND ,TORY LIMITSIJER__ EMPLOYERS'LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ EL DIS *� INCL ! EASE-POLICY LIMIT $ PARTNERS/EXECUTIVE (------+ }.--_.___.....................__.___.__.___.____._._... . .. .. . OFFICERS ARE: I I EXCL { EL DISEASE-EA EMPLOYEE I$ OTHER I ! DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS :ERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED * CANCELLATION NOTICE IS 10 DAYS IN THE EVENT OF NON-PAYMENT OF PREMIUM , CERTIFICATE•HOLDER^,' _ E .`.: . :..' CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CITY OF SAN JUAN CAPISTRANO BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 32400 PASEO ADELANTO OF ANY KIND UPON THE COMPA - ^GENT ,ENTATIVES. SAN JUAN CAPISTRANO, CA 92675 AUTHORIZED REPRESENTATIVE Timothy Wigmore - 1__ ... : . -, � ©A D'CORPORATION1908 • • :;1- - :::::i,;..: >. .::.,;;f ::.:::i :::: :.::::: .: ,:; :. ::o.; ..::.::::>:>:: j:;';ii:;;%;::it:;k;tgi:S';:i;:>::::>::;s;::S:ri'i;r':::<;: DATE(MM/DD/YY) ... J.�: .��i.11�.tl© Ua�Q►N.CEA8 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Averbeck Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3270 Inland Empire re B 1vd #10 0 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ontario, CA 91764 COMPANIES AFFORDING COVERAGE COMPANY AMassachusetts Bay/SSI INSURED - COMPANY MD Construction B P.O. Box 1 Corona Del Mar, CA 92625 COMPANY c • COMPANY D 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/DDNY) DATE(MM/DD/YY) A GENERAL LIABILITY ZD Z 5 310 919 0 0 12/20/97 12/20/98 GENERAL AGGREGATE $2 , 000, 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $1, 000 , 000 CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $1, 000, 000 X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1, 000 , 000 X PD Ded: 1, 000 FIRE DAMAGE(Any one tire) $50 , 000 MED EXP(Any one person) $5, 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO _ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY 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 $ WORKERS COMPENSATION AND I STATUTORY LIMITS .................................. EMPLOYERS'LIABILITY EACH ACCIDENT $ THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE - OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS RE.: City Bridge Repairs - CIP No . : 117 The City of San Juan Capistrano, Its Elected or Appointed Officers, (See Attached Schedule . ) ... ................................................... ..... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City o f San Juan Capistrano EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL MAIL 32400 Paseo Ade 1 ant o 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, San Juan Capistrano, CA 92675 _ - - . Attn. : Brian Perry Senior Civil Engineer AUTHORIZED REPRESENTATIVE . �. .�P.: .�. N nt�nu ::fir::orn:::•.�' �'::::1::�:::::::>:»:>:;»>»:;:>::::>::>::>:::::>:::::::::: ::::::::::::.::::>:;:>:>:;;;:::. Officials, Employees and Volunteers are Additional Insureds as per the Attached Form. The Cancellation Clause is Amended to Delete the "Endeavor To" and "But Failure To. . . " Wording. ..... ...... • LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO 32400 Paseo Adelanto San Juan Capistrano, California 92675 ATTN: Brian Perry A. POLICY INFORMATION Endorsement Massachusetts Bay s ZDZ531091900 1. Insurance Company ; Policy Number - 2. Policy Term (From) 12/20/97(To) 12/20/98;Endorsement Effective Date u i/z4/98 3. Named Insured David Beador DBA:'MD.Construction Group 4. Address of Named Insured 514 Margerite Avenue- S. Limit of Liability Any One Occurrence/Aggregate Si ,nnn,nnn /S2,000.000 General Liability Aggregate (check one:). . Applies "per location/project" Is twice theoccurrence limit X 6. Deductible or Self-Insured Retention (Nil unless otherwise specified): . $ 1,000 Property Damage per Occurrence 7. Coverage is equivalent to: *see below Comprehensive General Liability form GL0002 (Ed 1/73) Commercial General Liability "claims-made" form CG0002 Commercial General Liability Form 000001 (11/85) 8. Bodily Injury and Property Damage Coverage is: "claims-made" X "occurrence" If claims-made, the retroactive date is B. POLICY AMENDMENTS This endorsement is issued in consideration of the policy premium. Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows: , 1. INSURED. The City, its elected or appointed officers, officials, employees and volunteers are included as insureds with regard to damages and defense of claims arising from: (a) activities performed by or on behalf of the Named Insured, (b) products and,completed operations of the Named Insured, or (c) premises owned, leased or used by the Named • Insured. 2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insured for or on behalf of the City; or (b) products sold by the Named Insured to the City; or (c) premises leased by the Named Insured from the City, the insurance afforded by this policy shall be primary insurance as respects the City, its elected or appointed officers, officials, employees or volunteers; or stand in an unbroken chain of coverage excess of. the Named Insured's scheduled underlying primary coverage. . In either event, any other insurance maintained by the City, its elected or appointed officers, officials, employees or volunteers shall be in excess of this insurance and shall not contribute with it. (OVFR) 3. SCOPE OF COVERAGE. This policy, if primary, affords coverage at least as broad as: (I) Insurance Services Office form number GL 0002 (Ed. 1/73), Comprehensive Genera Liability Insurance and Insurance Services Office form number GL 0404 Broad Forr comprehensive General Liability endorsement; or (2) Insurance Services Office Commercial General Liability Coverage, "occurrence form CG 0001 or "claims-made" form CG 0002; or (3) If excess, affords coverage which is at least as broad as the primary insurance forms referenced in the preceding sections (1) and (2). 4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately tc each insured who is seeking coverage or against whom a claim is made or a suit is brought; except with respect to the Company's limit of liability. 5. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. An) failure to comply with reporting provisions of the policy shall not affect coverage providec to the City and the Community Redevelopment Agency, its elected or appointed officers, of ficials, employees or volunteers. 6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspended, voided, cancelled, reduced in coverage or in limits except after thirty (30) days' prior.writter notice by certified mail return receipt requested has been given to the City. Such notice shall be addressed as shown in the heading of this endorsement. C. INCIDENT AND CLAIM REPORTING PROCEDURE Incidents and claims are to be reported to the insurer at: ATTN: Joan F. Carey (Title) (Department) Averbeck Company (Company) 3270 Inland Empire Blvd. #100 (Street Address) Ontario, CA 91764 (City) (State) (Zip Code) (909) 941-6699 (Telephone) D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER I, Joan F. Carey (print/type name), warrant that I have authority to bind the below listed insurance company and by my signature hereon do so/ bind this company. A F. l ' . SI'' ATURE OF AUTHORIZE REPRESENTATIVE (original signature required on endorsement furnished to the City) CRCANIZATIQ4: Averbeck Company TIRE: Account Manager MQgESS: 3270 Inland Empire Blvd. #100 TELEpE. : (909) 941-6699