1994-0921_ ALL CITY MANAGEMENT SERVICES, INC._Insurance ALL CITY MANAGEMENT SERVICES, INC. September 21, 1994 City Clerk City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 Dear City Clerk: Please find the enclosed original special insurance endorsement for the City of San Juan Capistrano. If you have any further questions regarding insurance provisions you may contact our representative Shaida Monshi with Prism Insurance Service at (213) 655-9999. She is familiar with your city's insurance requirements and she is available to assist in these matters. If I may be of any assistance, please contact me. Sincerely, aron Farwell, Operations Manager N m t0 L. 5839 Green Valley Circle, Suite 102 Culver City, CA 90230 310/348-9990 Fax 310/348-1167 LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO RECEIVED COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Juan Capistrano, California 92675 SEP ZZ ATTN: p'�Vk69MEN1 A. POLICY INFORMATION Endors&n5ent If 1. Insurance Company FIE D INS. CO: Policy Number cPP154901 2. Policy Term (From)?-14-94 To)7-14-95 ;Endorsement Effective Date 3. Named Insured ALL CITY MANAGEMENT, INC. 4. Address of Named Insured BEEN VALLEY CIRCLE #102 Culver Cit Ca. 5. Limit of Liability Any One Occurrence Aggregate 1,000,000 $2,000,000 General Liability Aggregate (check one:) Applies "per location/project" Is twice the occurrence limit X 6. Deductible or Self-Insured Retention (Nil unless otherwise specified): $ 2,500.00 7. Coverage is equivalent to: Comprehensive General Liability form GL0002 (Ed 1/73) "New Occurrence" Commercial General Liabilit JkJVAUMKft X 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. Tire City and the Community Redevelopment Agency, ' R174R16�X�(145.4flI�X44Xsi�4li g �g�gg (a) activities performed by or on behalf of the Named Insured, b qrRAy&Mb [R�[ltb)[�lgX�lI+94��@1i'A4i�f 2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insured for or on behalf of the City; or (b) 1� PX3F34��A'�7r$fIDE4Igl9Z7E�Qgllilllf, or (c) Argliggagggj;g tai � ) � igg� j{fp, the insurance afforded by this policy shall be primary insurance as respects the City,]!! [4Ih#llf�Ek911;SBP�tRc71E![ C7P1� [4IiIF�[aC gKqgg*RXsjebp1L"Mk or stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. In either event, any other insurance maintained by the City, its elected or appointed officers, officials, employees or volunteers shall be in excess of this insurance and shall not contribute with it. (OVER) 3. SCOPE OF COVERAGE. This policy, if primary, affords coverage at least as broad as: (1) 41r}F14R4I4C*R'iN!Wx9kk *NM AMCkXXFA rX41NMWXl k3&-d1IXMKQ#MllbIXXk XMIM Ixi loam xxx9rAiln> (2) Insurance Services Office Commercial General Liability Coverage, "occurrence" �4X1�1[3Cl(`]Ii1dRYlPR4Ch�l [lF��l�C4[� "NEW OCCURRENCE FORM" (3) 11�1f4X1[l[ 841XNlEXCR+�k4lCl[ [lF$l±iR> Xli�C7�1C #[lIBk�PlIl�I7PI4Ilc1PI�lPIlH4 �PiIIC9�X7��l4CA>>��{SlF�C4C414F�t�X4Fl�@II47E�C�Pl�fL(l�r 4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to 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. S. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any fail;r� tc cc_pl, .:.t� .cpo. . b p: ons cf ; policy ahvl: iiot offtYi wverage provided vrsi to the City and the Community Redevelopment Agency, its elected or appointed officers, officials, 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 written 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: IDA MONSHI Title) (Department) PRISM Company NO. SAN VICENTE BLVD. #301 (Street Address Beverly_Hills Ca. 90211-2326 TC_'ty) (State Zip Code (21J 655-9999 Telephone D. SIGNATURE OF INSURER AUTHORIZED EPRESENTATIVE OF THE INSURER I,vry AN B. ENRIQUEZ (p • t/type name), arrant that I have authority to bind the below listed insurance company and by my signat r eon so bind this company. IGNAT RIZED REPRESENTATIVE (orig'nal s re on endorsement furnished to the City) aZC NI2ATICN: CANON INSURANCE SERVICE TITLE:VICE—PRESIDENT UNDERWRITING ADCRESS: 9171 WILSHIRE BLVD. #509 TELEPHJ. E: ( 10 )859-8600 BEVERLY HILLS, CA. 90210 X-o:',,.� ......................... ........ ........... ................. ............... IME (MI"DIM CIERTI. P...IIN.S.URANC:E:.,.:z":.:'.:: :1::,:: Ok� 15/ 0 . . . . .. 7 1994 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE (213) 655-9999 Pax(213) 655-0578 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Prism POLICIES BELOW. .................. ...... 113 N.San Vicente Blvd. 301 COMPANIES AFFORDING COVERAGE Suite301 .......... .................. .......................... ......... Beverly Hills,CA 90211 COMPANY A Northfield Insurance Co. UETRER .............-1-....... .........---............. ................................. ...... COMPANY B INSURED LETTER ............................. ...... ..................... ................. ...... All City Management, Inc. COMPANY c 1-ErrER 5839 Green Valley Circle, #201 ........... ...................................... .........----................................ Culver City, CA 90230 COW'my D LETTER ....................... ............. ....................... ........... .............................. ....... COMPANY E LETTER .......... ............. .....R,.c- ............. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE Uii6 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. ................ ......I................................. ......................--.......................................-... ............. .......I--................... ........ Co LTIR. TOE OF INWRANCE POLICY NUMBERPOLICY EFFECTIVE POLICY EXPIRATION Lam DATE (MM/DD/YY) OATE(MMADD" .....................I...........I.. ........... .......-1-1.1-1........................ ........ ........................................ ......-... .......... GENERAL LL4kBL1IV GE I NERAL AGGREGATE S 10,000I,000 COMMERCIAL GENERAL LIABILITY CPPIS4901 PRODUCTS COMP/OP AGG. s 0 .......... ...... ................... ................ ........................... 14AL&AN.RJURY 1 11000,000 OCCUR. 07/14/94 07/ 14/ 95PEF80 1.1. cows MADE OWNERM&CONTRACTORS PROT EACH OCCURRENCE 1,P00,000 .......... ...........----......... ...................... FERE DAMAGE(Ay ane Are) i 2 5,0 0 0 MED.EXPENSE(AM pe,wrr):11I 1,000 .................................. ........................................... ........ .................... .................. .......I...... AUTONOSILE LIABLITY COMBINED SINGLE ANY AUTO LIMIT .......... ...... ALL OWNED AUTOS BODILY*UURy SCHEDULED AUTOS (per person) .......... .............. ......................................... .HIRED AUTOS BODILY 94JLRY NON-OWNED AUTOS (Per emiclard) ................................... GARAGE LIABILITY PROPERTY DAMAGE .................. ........ .............................................................._..........................................>.................._ ............................. ........................ EXCENI LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE .......... ...........................-.......... OTHER THAN UMBRELLA FORM STATUTORY LIMITS WORKIOVS co�BAYM ..................... ..................... AND EACH ACCIDENT EMPLDYE1W ILLABILM DISEASE-POLICY LIMIT $ ....... DISEASE EACH EMPLOYEE OTHER MICRwnDN OF OPERATIONSIJWA71ONWVECLENSMIAL ITIONS Certificate holder dean"additional insured" as their intereiV C; may appear. 28 Additional Insureds share the same occurrenc*Z-a, aggregate limits - Limits of insurance shown may have been reduced by outstanding claims ....... i,*......... VA .. ........ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 32400 Paseo Adelando *-` MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE San Juan Capistrano, CA 92675 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Attn: Cheryl Johnson LIABILITY OF ANY KIND UFON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 'AUTKOFIMO REPRESENTATIVE ................. ........... ........... 0 �1. 6A* .......... _vApq -i oww~wd ........ gy. ................. �ODW 4 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE (213) 655-9999 Fax(213) 655-0578 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ...................................... ....... .......... ................ Prism E301 COMPANIES AFFORDING COVERAGE 113 N.San Vicente Blvd. ............. ............. ............. ..........- ................... Suite 301 com"ANY A Northfield Insurance Co. BeverlyHills,CA 90211 ..............--........ ....................... ..........................--............................ COMPANY E; LETTER NSURW .............. ........... .......... .................—.1—........-.....I--....... ....... All City Management, Inc. COMPANY LETTER C 5839 Green Valley Circle, #201 ........-............. ................... .......--......1-1.1--.1......-...... Culver City, CA 90230 COMPANY D LEITER .................... ................................... .................... .................................-........ COMPANY E LEITER . ......... 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. .........................................................................--............................................................--.......................................... .............I.......I--................. ............................. 00 LTR TYPE OF WOURANCE POLICY NUM 131 DATE POLICY(MWDDNY)EFFECTIVE KPOLICY(MMADDEXPIRA)YYTIO)N LAM 0AT ............I................................................................................................................................ ............. ........—....................... ........................................................ A 009mL LIABILITY GENERAL AGGREGATE is 2F00.0.,,000 COMMERCIAL GENERAL LIABILITY CPPIS4901 PRODUCTS-COMP)OP AGO. S 0 OCCUR. 3 MAIM MADE . 07/14/95 """AL"ADv,.NAw 1'.0.0 0'r 000 :07/14/94 - OWNERS"CONTRACTORS PROT. EACH OCCURRENCE $ 1,000,000 ............... . ....... .............. FIRE DAMAGE(Arry eee fire) s 25,000 MED.EXPENSE(Any pe m, rwr,).IS 1,000 ........................................................ ........ ................. ............... ......... ............. ................................ ........ :AUTOMOBILJ:LIABILITY COMBINED SINGLE LIMIT ANY AUTO .............—...-................ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per pwwrr) ....................... HIRED AUTOS BODILY INJURY NONLOVAIED AUTOS (Per amildont) ..........-..................—........................ ......... GARAGE LIABILITY PROPERTY DAMAGE is .................. ...... .......... ...... ........... ........... ........... .................... ...... _:................."I....._..... .................... ............................ nCE88 LIABILITY EACH OCCURRENCE i UMBRELLA FORM AGGREGATE ...........--................... ................—.... OTHER THAN UMBRELLA FORM STATUTORY LIMITS WORKIMS C0111PIDIIIIATION EACH ACCIDENT AND DISEASE-POLICY LIMIT EMPLOYER/LIABILITY .............................. ............ DISEASE-EACH EMPLOYEE OTHIN TZI Ir" DIDICRIPTION OF OPIDIATIONVLOCATIONVIVNIUMIlPlICIAL"M Certificate holder is an "additional insured" as their interq>� may appear. 20 Additional Insureds share the same occurrences,&x O1 rno aggregate limits - Limits of insurance shown may have been 266ibedLby outstan din claims . ......... N7777 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO 32400 Paseo Adelando MAIL " DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE San Juan Capistrano, CA 92675 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Attns Cheryl Johnson LIABILITY OF ANY YJND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ! ::AUTHORIZED REPRESENTATIVE ,o....... ....... ..... .... ... • • SV STATE P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE POLICY NUMBER: 0711283 - 94 ISSUE DATE: 08-01-94 CERTIFICATE EXPIRES: 08-01-95 CITY OF SAN JUAN CAPRISTRANO JOB: VERIFICATION OF COVERAGE DEPT OF BUILDING AND SAFETY ATTN: ED GREEN 8-1-93 THRU B-1-94 32400 PASEO ADELANTO SAN JUAN CAPRISTRANO CA 92675 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10days' advance written notice to the employer. We will also give you 10 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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. PREN EMPLOYER'S LIABILITY LIMIT: $3,000,000.00 PER OCCURRENCE. c— N M o n 2 m CD L EMPLOYER LEGAL NAME ALL CITY MANAGEMENT CO. ALL CITY MANAGEMENT, INC #102 5839 GREEN VALLEY CIR CULVER CITY CA 90230 PRINTED: 07-21-94 P0408 I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE BOLTON/RGV INSURANCE BROKERS DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 1100 EL CENTRO STREET POLICIES BELOW. PO BOX 820 COMPANIES AFFORDING COVERAGE SOUTH PASADENA,CA 91030 COMPANY A CAL COMP INSURANCE LETTER LTH COMPANY B INSURED LETTER All City Management,Inc. LCOMETTERPANY c 5839 Green Valley Circle#102 Culver City,CA 90230 COMPANY D LETTER COMPANY r LETTER e- 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 POUCY EFFECTIVE POLICY EXPIRATION UNITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGG. $ CLAIMS MADE= OCCUR. PERSONAL A ADV.INJURY $ OWNERS & CONTRACTORS PROT EACH OCCURRENCE $ FIREDAMAGF (Anyonetire) $ MED.EXPENSE(Any one Parson) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per socclent) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION I STATUTORY LIMITS EACH ACCIDENT $ 1,000,000 A AND W948109850 08/01/94 08/01/95 DISEASE—POLICY LIMIT $ 1,000,000 EMPLOYERS' LIABILITY I DISEASE—EACH EMPLOYEE I S7 1,000,000 OTHER al rn Li r1n DESCRIPTION OF OPE"TIONSILOCATtObIgNEHMLEWSPECIAL ITEMS All Operations of the Named Insured o COMM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 32400 Paseo Adelanto MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE San Juan Capistrano,CA 92675 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 -: MEMBERS OF THE NE CW NCI BELL COI I GARYL CAMPBELL GARY SOORFER GILDRUG USE (�� voxvxxxno CA JONES ./ JEFF LYNVAS NASH mglnsxm 1961 JEFF VASOUEZ 1776 • • CITY MANAGER GEORGE SCARBOROUGH August 24, 1994 Ronald Farwell, President All City management 5839 Green Valley Circle, #102 Culver City, Califomia 90230 Re: Crossing�azd Services Dear Mr. Farwell: At their meeting of August 16, 1994, the City Council of the City of San Juan Capistrano approved the 3rd Amendment to the Agreement for Providing Elementary School Crossing Guard Services. The Amendment provides for a rate of$11.49 per hour of guard service provided, in an amount not to exceed 2,532 hours or$29,092. The Amendment is effective for the period of September 8, 1994 through June 22, 1995. A fully-executed copy of the Amendment is enclosed for your files. The general liability insurance certificate received by the City did not meet the original Agreement requirement of$5,000,000 combined single limit per occurrence for property and bodily injury. A copy of the City's Liability Endorsement Form is enclosed for your use in meeting the requirement to provide an endorsement that the City has been legally added as an additional named insured to the insurance policies required by the Agreement. Please forward the insurance certificates to the City Clerk's Office as soon as possible. If you have any questions, please contact Dawn Schanderl, Deputy City Clerk, at 443-6310. Very truly yours, Cheryl Johnson City Clerk Enclosure cc: Lt. Paul Sullivan 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 0 (714) 493.1171 Issui DATE (nirino/vr) . t . . IURNC . . . 9/ 3/1993 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE (213) 655-9999 FaX(213) 655-0578 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE LFC Insurance POLICIES BELOW. ............................................................................................................................................................ 13 N. San Vicente Blvd. , #301 COMPANIES AFFORDING COVERAGE everly Hills, CA 90211 .... -1-............................ ...... . ........_..... _..._..... ..... . ............. coMEANY A Northfield Insurance Co. LETTFA .......................................................................................................... .......... LETTER COMPANY B Royal Indemnity Company INSURED :.........................................................................---..................................................................................... All City Management, Inc. COMPANY C LETTER 5839 Green valley Circle, #201 -R Culver City, CA 90230 COMPANY D w LETTER z -+ COMPANY E LETTER s My, eKss a „ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVETOR THE POLPERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHfCFi THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THk.SRMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lab .......:......................................................................................---....................................................................................................................----........................................................................ . CO : TYPE OF VISURANCE POLICY NUMBER POLICY EFFECTIVE :POLICY EXPIRATION LIMITS LTR: : DATE (MM/DD/YY) DATE(MMrDD/i Y) .. .'......... ..................... .. ........ ........:....... ......... .......... .. '. _..._..... ....... ............,. ....__._ .............. ............_ ............... A.GENERAL LIABILITY GENERAL AGGREGATE s 1.,.000,000 _X COMMERCIAL GENERAL LIABLRV CPP1S4901 PRODUCTS-COMP/OP AGO..... ,f Q OCCUR. A ADV XRY , 000,000CVSMAD ... / / 3.4/ / RL OWNERS S CONTRACTORS PROT. EACH OCCURRENCE f 1,000,000 ......._._._. ..................... . FRE DAMAGE(Any ane fire) s 25r,000 L.. _........ __, ....' ............ _. ... MED.EXPENSE(My one pereon)S 1,000 . ........ . . . .................... . . ....... .. .: .... ............................... ....................... .......... .............. ......... ............................. ............... ',AUTOMOBILE WBGITY ' COMBINED SINGLE .......:ANY AUTO p LIMIT !f ALL OWNED AUTOS BODILY INJURY .... SCHEDULED AUTOS (Per person) :f '........: ........... _._._. ..._._....... ............ HIRED ADIOS SOON INJURY NON-0VMED ADIOS - :(Per accident) 'f .........!GARAGE LIABILITY . ii PROPERLY DAMAGE :f ............................I..............................._._.............................................._._._._......................................._.........................................-_............................................_._....._..................... EXCESS UABRRY EACH OCCURRENCE x 4,0 0 0, 0 0 0 b UMBREUAFORM HN200276 07/14/93 07/ 14/ 94 AGGREGATE s 4, 000, 000 ...... ,, .. ........ ...X OTHER THAN UMBRELLA FORM - WORKER'S COMPENSATION .._...... STATUTORY LIMITS ............_..............._._._...........:........................................ AND EACH ACCIDENT f I '. ......... DISEASE-POLICY LIMIT :f EMPLOYERS'LWBI ITY ............ ... ........... ............. DISEASE-EACH EMPLOYEE 'f OTHER ....... ................_... DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS Certificate holder is an "additional insured" as their interest may appear. >: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 32400 Paseo Adelando MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE n Juan Capistrano, CA 92675 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE �COMPANY, ITS AGENTS OR REPRESENTATIVES. y :AUTHOR�D REM I y f 13fA/'a`I use=:o;>;•:`;��s::'='�<;<;;Y�::a:"s�?�;;>:,n;::;o::.::-�aai::� xwowimix IPIJIIm MIDWNq 1993 PRoaMIeeMM =7NLICERIE OK 16411=10s As A YATM OP-NONYIITION Olar AND (213) 655-9999 Fats(213)655-0578 Do jgrrAmxw6- oRA HOLDER. BY THE LFC Insurance ` POLICES 11111M it --- -- -- 113 N. Ban Vicente Blvd., #301 COMPANIES AFFORDING COVERAGE Beverly Hills, CA 90211 ---..._......._.._._. .—_....................... A Northfield Insurance Co. —....-................-_-----............................------ -----.._........ ----- � 8 Royal Indemnity Company All City management, Inc. C � � � 5839 Green valley Circle, #201 __—•__..........._................._....._...............................,............_..........r J........._......................... Culver City, CA 90230 = SANp LEM rn CdIAm E eV :T )117161 - W THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOYff•fOA THE POLI'PERIOD µ INDICATED. NOTWIIHSTANDINO ANY PEOUIREM®R.IIWN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VM-W THIS CERTIFICATE MAY BE ISSUES OR MAY PERTAIN,7HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THi EXCLUSIONS AND CONDNIONS OF SUCH.POUCB. LIMITS SHOWN MAY HAVE BEEN REDUCE) BY PAID CLAIMS. .................................................._..._.......___.;. _._................._....-.._....,.......-__......................._..........__...... ..........................................._...._............................. CO :POLCY @RICIN[ PC=DMATI= TA: TLP[OF MIIR•NC[ POKY INR�MI DAN[ OrPAOOh'Y) DAT[(WpD,MY) Lam ..:...................................................................I.................._..............................................:.................................i........ -A oenmALUAsurr € ODOM AGGREGATE............. s.._l.t_�_��.i_OC .. CPPIS49M PRDDUCMSCOGIATP AG0. if $ coLrelcuL G6N61AL LHABun .. ......... .... ...... . .... CLAM MrOE i $ :ocani 07/14/93 07/14/94wADv.wuR + 1t..0.00.t.O. C?�sot : OWNERS a ccHlRAcrar+s tA10". EACH OCCLPFENCE es 1,000,0C ..........................................DAMAQE"Aro An.r.) : 2 5 0 C ................................:........................N....... MEG.E7IEM Ww air pwR )::S 1,D .....a..................................................................i........................_......................................................................... ................................:................................................:................................... AUTOUDIlt LMNUTY COLIaED SINCU ;........ 1R0 LMR Am A .._.... Au oMrED Autos € BODILY KAM scNEDum tyros (ft,Pm ) if [ ............................................ ............................... NON-OWED AurOS ;........<GN1At3E uAILm :...............................................a.................................. treOPE711r DAMAGE :S ..............i............................................................................................................................................................d................................i.........................................._....................................... IIC=LIMLRY 4 EACHOCCLPIPE M :L 000.,.0( .................---..................._....:...... b uIAELLAFawA HN200276 :07/14/93 07/14/94 AGWGAIE is 4 00 0f.-O(__. % i OTTIn 711AN..LB.F11A FORM ; € ': .........a... WOPAM"C01I111MTCN STA7NORY LAYI9 : ................................................. :............................... ANDi :.�................T,.......................s... OlLOY01T LIAILRY '..� ............................ POLICY LMIf....-.--...qf DIEASE-EACH 61LOYEE i ........................................................................<..................................................................;.................................j.................................;.................................................................................. 0"11171 ............................................................ _......_..._. ............................... 9aso m OF OP/MTCNNM1.00•TDIWYONI'1Jd7lBIAL R_ Certificate holder is an Pladditional insured" as their 'interest may appear. SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE City of Ban Juan Capistrano EXPIRATION DATE THEIDF,THE ISSUING COMPANY WILL ENDEAVOR TO 32400 Paseo Adelando MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Ban Juan Capistrano, CA 92675 LEFT. BUT FAILURE TO MNL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Attn: Cheryl Johnson UAaUIY OF ANY IOND UPON THE COMPANY, TTS AGENTS OR REPRE3E37TATNES. NIIIIOR®H1LPtIPeli•THYNInsuranum 00 E OCT-M-1993 14:14 FRCN TO VnOUK167 PAG LIAMLITY ZKOMWAU M' " CITY OF SAN JUAN CAPLSTRANO COAIMU ITY REDEYRLOPhWXr AQIINGY 32400 Paw"Addesese San Jt"Q Wransl,CalUmb !u7! A. POLICY IIdP UATION Eadorsemerd 0 1"C 1. insurance Company Northfield Ins. CA,. Percy Number CPP154901 2. Policy Term¢from) 4 o Endorsement Effective Dain 3, Named Insmi nc e. Addre»s of N nsu valley rc a ver cat -Wz�lu 3. Limit of Liability Any One Oceurre ggregate 000 General Liability Aggregate(check oiled tP ieocromi twICS otnlimit "- 6. Deductible or Sed-Inoaeed Retention(NU unleta other wLse spocULedk 32,500 7. Coverage Is ex;ulvalant to Compreh"ve General Liability form CL0002 (Ed 1173) )0t Commercial General Liability"clalmt-made" farm C00002 S, Bodily Injury and Property Damage Coverage Is *aMmrmede" �'-"occurrence" It dalme-madep the rctroectivs date Is L EOM AAfENO .t [5 This endorsement Ls Issued In consideration of the polier premium, Notwithstanding any Inconsiste statement In the policy to which this endorseuneM b attaChed or any other endorsement attache theretq It b',greed as follow* L USURR0. The City and the Community Redevelopment Agemryr Its elected or appoints ofncer%officiaiep employees aMMMMURWare Included W insureds with regard to damag, and defense of claims arkkq front (a) oetLAttes performed by or on Whail of the Na" r by Named Insured, and Completed o�attons of td,he Named Ifianor(C)premises own* ka aver Z OONTitD UTION NM RBQt UWJL As respecter (a) work performed by the Named Insure for or on behalf of the City; or(h) products sold by the Named Insured to the Cityl or ( premises leased by the ]Named Insured from the City, the Insurance afforded by this poli( shall be primary insurance as -aspects the City, Its elected or appointed officers, official employees or volunteers; or stand In An unbrakon chain of coverage excess of the game Inured', sCtmduled underlying primary eovoroge. to either event- any other lrwuram maleetalntd by the CJt�yy, its elected or apeatnad otHe*n, otfleiais, employees a voluntee shall be In excess of hila Insurance and fha)1 not contribute with it. (OVER) lOd S00 1N3W30VNVW Allo 111 0666 GVC 01E 95:E1 10-01-E66 • OCT-7-19913 14--15 FIRM TO 13107481164 P.87 3. JCOP6 OF COVERAGB. This policy, it primary, afford;coverage at lout as broad sa (1) Insurance Services Office form number GL 0002 (Ed. 1/73),Cemprohenalve Geeen Liability Insarance And Insurance Services Office farm number GL 0404 Brad For comprehensive General Liability andodemeMf or (2) insurance Services Office Commercial General Liability Coverag(y "occurrence form CG 0001 or"claims-mads" form CG 00021 or (3) 11 excess, affords coverage which Is at but as brad as the primary insuranc forms referenced In the preceding sections(t)end(2). e. SEYEBABMIW OF 94TEP.W. The insurance afforded by this policy applies separately t each insured who is seeking coverage or agailut whom a claim to merle or a suit Is brought except with respect to the Company's limit of liability. 3. PROVISIONS REGARDING THE INSIiRED'S DUTIES AFTER ACCIDENT OR LOSS. An: failure to comply with reporting provisions of the peliey shall not affect aoverage provide to the City and the Community Redevelopment Agency, Its elected or appointed officers officials,employees or volunteers. 6. CANCELLATION NOTICE`. The Insurance afforded by this policy shall not be suspended voided, canreelled, reduced in coverage or in limits except after thirty(30)days'prior wrltts: 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. Except 10 days for Non—navment., C YVCl46NT AND CLAN RBPORIVQ PROCEDURE Incidents and claims are to be reported to the Insurer air ATTNs Pat Rodri ez t partmo LFC Insurance Brokers & Agents (company) 113. N. San Vicente Blvd. , #301 t" Beverly Hills, CA 90211 ty tat p car el) 655-9999 �'aCtpTfene T— D. RRPR=NTATM OF TM MWVJM 4 Shaida T. Monshi (ptln,tte "Mn e), warrant that f have authority to hind the below Ilstec Insurance company a y my gnatuo so bt(id 06 eornpatry. UDIUZED R USUN1ATig! (ort signature required on endorsement furnished to the City IMTKNt L Insurance B kpLz R. A=ts TMAv A en.mt FSrarnitiyP- AMRIS.Ss 113 N. San Vicente Blvd. #301 Tf2F MMs (213)655-9999 verly Hills, CA 90911 TOWL P.WI 1993-10-0T 13:18 PAGE " 07 ZOd 500 iN3W35VNHW ALIO 11V 0666 06e OIC LS:CI l0-01—CSSI 1 (2 3OVd MUM) 2 331)d EIZ60E6£IZ 1e £66r ZS:SI L9181 a3n13333 1 - - ------ ---- - - --------- T .. .... ................. ........... _'Z"L4 U-UMPAMAES Ai�uGMUIIKJU COVERAGE CA9021t ............... .................................. • A Noxthfiald in*iAramee co. ---------------­­­........................... ............ S Royal ludsamity companImo — y ....... . ............... .. .... . .......... All CiLyWanaLjonunL, C 53312 Green Valley Circle# 1201 ............... ---------............... .............. ............. ..................... ................................................... .......... -------------------------------- ........ A ...... ........... .............. ........... . ;yrs e XO4194. q 07/i4/93 07/14/94: .......... F-CE'JAAL-Ov 25,0001 ........... ... ...... ........ .......................................---------------- .............. .. ......... .................... -------------- ..................... ODWR4rD 'MY ........................................................................ .............. .......... .......... ........... _4,000,0.00 A2. NNt 6 07/14/93 07/14/94 4,000,066 X MY DW LUMIAFCW . .............. ................................ .............. MOM=$60rel3 w= ........... .......... ........ aswM-PCLCV uar EMPLOYMW U� ......................... 'a .............................. OW".EP&K MFLOVW . . ........................ ............. ....... .................................... o­ ............. fK'�­_vn=M_. — nM'x!r_!z 74P CA 9267S LUT.BUT FAUW, io wmL %ucsY JALtn: vnory-- LtASIU, OF ANN'MNO Gpj5N r"P C%IM .. ?00'391jd 30NUdnSNI DAI WOdd 4E:91 Cc . L IDO ** E00'39tld �1i1Q1 ** OLT-R+'1993 14314 F7id'I 70 S7i�Biil7 P:OG LL40LUT RNDORSMMW CM eF MK JUAN CAPIRrAANO AqUr.T an am cllbkLjL cdmdmk l7iT! A. LX�tleOlrtwTfeer 1. X L1rYly1CR Northfield 7n6. (b, P ( 1549D1 i �ad l A Limit at Lhh tity Away ve C M%t LkbZly AWgate(Chrdt wm) AWWX Isads tmgwrer or r vlaa eraettt y« Cor..�a Ia+qutitllmt tar S?.5oo cwm"hrtt G ew L Llaty w lana CilAA03 t o CG ' 1 GeNeal L(ahittty wC�tttfYaad/a�CGODOf ttedtly Y attd►ke7arty t mww map dt tt atu" eM nftoMtdm daft 4 � ICY Ar�eara D�t4r rt ntith thts iia liO�Y ptrmhahr MOMthNtryd4i 4y ItrateilaNtnt th.ater 1t If aOaat as aattrefs rtsior+rtnaM b ateagted any athtr a K atfteled L ' mw city set the Camalatd i aw' .� a� as Vmxy' m°�vdnted tttl�t�a4 abl 'trteaneti aea"�.tdam`W"`n'tt�,a«t.�.a br a oa ba to durA„d band or ON by qts PIN.WW Wmd"a at thr Ntamad bIfWO4 ae tra e�aMes olrt . L Cp pty fpr RVAMMM Aa re%ft _ �� boWby�qtr= �.apet�omb SW i'j� ehf�bm a d" t orr U aala `yAW be pkwy bowafte as MIPOCU ft ameuteau orabmwonce s,o1r� k wm �aetyh% a rma.y Omw,apr m d hw,on ot „ aca by IaPtk tt$Olo�OCee ;a pmt aflrlt ea N exacta tI1t11 nae otat°! r�wM�t''amPlOYOa or vduntem rovEat tOd 500 LNMdMVf .ILIO TV 0686 etc OTC 95rE1 dO—OI—E66t C (1 xaea ==led) l x F.I7mwwl7 rr stir reser isms ..o E88'39tld 33NUdnSNI Jdl W06d 92'L1 E6 , 8 1J0 oar-W-19913 14=15 Pf1lk1 To 331B2eBiSSr P.� 3. SOWS OF 1OVEiAOM TMI palW. 2 prbrearr.attends aowrega at bast a brood as il) Sarvkats Oilhea ftrrn medw GL On=testi Alm Caenpnaee:rrrba cww �Lr9ean0a and tnt omen Sa wom oix"tares a AMM GL Ma Brad Par GanrN L!•hiRtlr andufarraere I or ti! leealrlrros SsrAm Ottlee C,omalertal Camel UaW ty Cowwsg% "noaar nm torn CG 0001 or Adahm-ma"tone CG am or d> 11 adtif& UWW4 d4 rhkh is d Malt Y brand as ft primer/ iatAMIC tWM n M=d In the pnoe ft sw*m(1)need(11„ a. SUVERAll NY OF llITliIW- Thu hwwamn atixdud by Wo poday Np W suparstal/t 4"Hllted rho It HBe cersn or Isaw whm pB whom4 d Is meft or s Kit Is Sr"Ol wow v th ratpm se 19 Awt at aadWgr- I PMIS 2WAanM TIM RaMM eriMW AFM /{CCMffiT 4W LR$. Air, fafiw' ate why "I e' W°`.et Grp Ift " as or, f�1 «tldaler aet0s/oae or sebmiso s. a CANCOJ ATIM lI11 ICL The Afavaou dswdad b/ thte port ahsel not be wrpe:eew. a� a r~m d in °'e��rA d W bm st fin%ya j .ie eOw ebNi be ad�/pad t»titawwu b the of ehtt�. Q rAmom bwddats aW eldms tar io 5v rapvrbtd m the laatrer.tr Arnot t umpartfilow LFIC Insuranoe Brokers & Agents mdiww- 113:-F. San Viomte Blvd, , #1301 teat Belrerlp Hills, CA 90211 p D. 7ew to Shaida T.s ekxldli nsae.h .artwo that i haw eithmIr to hired the bNew hl"wd UwA seoa m/+rs� son do a hind 06 eanyarq:. PfR3 (W4004A ds acme mwAmd oa endorserrert tureeitlea.to tba Cls/] cm7m 7vxl* t inseams B`okQrs . r s Tm3l �t im-- -.. It1�2it 113 N. San Vicente Blvd. #Sol- 7t713a17Lr (21316y55-J is, CA 90¢11 1QRL P.1" a 282-1v-or 12:19 FACE . 07 OflJ LAA I�YluvatiulNY Iltn 1T. Z08 ' 39tld 100 30NuanSNI '031 WO SZ :LI E6+, 8 STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION AUG g ? tyy3 I N S U R A N C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AUGUST 24, 1993 POLICYNUMBER: 0711283 — 93 CERTIFICATE EXPIRES: 8-1-94 CITY OF SAN JUAN CAPRISTRANO DEPT OF BUILDING AND SAFETY/ATTN: ED GREEN 32400 PASEO ADELANTO SAN JUAN CAPRISTRANO CA 92675 JOB: VERIFICATION OF COVERAGE B-1-93 THRU B-1-94 L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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. X. PRESIDENT �V �1 l_ l EMPLOYER - ALL CITY MANAGEMENT COMPANY 5839 GREEN VALLEY CIR CUL-VER CITY CA 90230 L SCIV 1026:' (HF V. 10-80) V; r,> LFC8AGENTS?113 NO.SAN VICENTE BOULEVARD,SUITE90718EVERLY HILLS,CA 90211 MM 6669999/FAX 421%6660678 FACS MILL COVER SHEET FA: NO: 714-493-1059 DATE: October 7, 1993 NO. 07 7AGE8 TO FOLLOW: 1 TO: Ms.Cheryl Johnson City of Ban Juan Capistrano FROK: Shaida Monshi RE: All City Management, Inc. MOTES: Please find attached our revised certificate of insurance, evidencing $5,000,0000 if coverage, and 30 days notice of cancellation as requested on your letter of 10/7/93. Original will follow in the mail. We have forward your General Liability endorsement to our underwriters for their review and execution. we will forward this endorsement to you as soon as it's received. In the meantime, if you have any questions, or need additional information, please feel free to contact me. Co. Ron Farwell/ACK 310-348-1167 T00 ' 3Stld 30NUNPSNI Odl W063 EE :91 E6 , L 130 RECENED 53 hu 193 C11Y CLERK LFC YAOKFiS i ASWMi 113 Na sm VFCENIE SOMMAFiF:IPIh{IE RLY HILLS,GA 90211 t} !FAX(219!0!!&WM � «. - E&QVIMILE COVER SHEET FAX No: 714-493-1053 DATE: October 8, 1993 NO. OF PAMIR TO FOLLOW: 2 TO: Ms. Cheri Johnson City of Sam .Tuan Capistrano nOK: shaida Nonshi RE: all City Mam9ement >STOT88: Following my fax of 10/7/93, the underwriters have authorized us to execute your General Liability endorsement. Original will follow in the mail. co: Ron Farwell 310-348-1167 100 ' 39tid 30NuanSN1 OJI WCdJ sa :2 1 E6 , 8 100 r i MEMBERS OF THE CITY COUNCIL COLLENE CAMPBELL GARY L.HAUSOORFER p 11K GIL JONES ^(� ` mmun°a CAROLYN NASH a f5111l SNU 1961 JEFF VASOUEZ 1776 • • CRY MANAGER GEORGE SCARBOROUGH October 7, 1993 Mr. Ron Farwell ALL CITY MANAGEMENT 5839 Green Valley Circle, Suite 102 Culver City, CA. 90230 Dear Mr. Farwell, On August 19, 1993 the City Clerk for the City of San Juan Capistrano sent your office a letter explaining that there were several discrepancies with the insurance information that was submitted to the City by your office. I was informed today that the City of San Juan Capistrano is withholding payment of your latest invoice because your company has not met the insurance requirements as required in the agreement signed with the City for Crossing Guard Services. Because of the necessity to speed this process I am sending this via FAX and not mail. In the agreement between ALL CITY MANAGEMENT and the City of San Juan Capistrano there is a requirement for general liability with a combined single limit of not less than $5,000,000.00 per occurrence for property damage and for bodily injury or death. This requirement is item 13 on the signed agreement. The same item of the agreement further states that there is a requirement for thirty (30) days written notice prior to cancellation of the insurance. The insurance Certificate that was supplied to the City shows 10 days. The City also requires a general liability form naming the City as an additional insured. Attached is a form that can be returned to fulfill this requirement. I am sure that this was all an oversight by your staff. In order to speed up the payment to your office, please feel free to FAX the required information to the City Clerks Office at (714) 493-1053. The insurance company can send the appropriate original documents. 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 0 (714) 493.1171 If you have any further questions feel free to contact either myself or the City Clerk's Office at (114) 493-1171. Thank you for your cooperation. Very truly yours, Hal Brotheim Administrative Sergeant Sent via FAX (310) 348-1167 cc: Lt. Martini City Clerk a�:��isi�. CE IFIe E P INSURANCE GM T1 3/i993 N1000CLII THIS CERTIFICATE IS ISSUE A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFlCATE ` (213) 655-9999 FaY(213) 655-0578 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE LFC Insur7lnce POLICIESBELOW. 113 N. n Vicente Blvd. , /301 COMPANIES AFFORDING COVERAGE Bevertp Hills, CA 90211 LEnER A Northfield Insurance Co. IIcRIm ' LErIEI B -; All City Management, Inc. C 5839 Green valley Circle, ,#201 1E7T 11 Culver City, CA 90230 COMPANY D LETTER COMPANY E iYse.� LErIFR COXHRAQl r,a A d..:.., 2 F k )q THIS IS TO CERTIFY THAT THE POIJCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POIJCY 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 TVPE OP N+IIRAIMM POLCY NUMIHII POLICY Owwm POLICY CVPUITION 16711 DATE (MAADIM DATC(M JV1YY) .....:..... . .. ..... .. .. .. . .. ...................................._....... ....... .................. .......... .. ........... .... ............ _.... A oo1aAL MAEa+FY GENERAL AOO/EOA + 1,000,00 $ CaM,erAAL GENERAL LIABLIIY CPP164901 PROglcl9c40lp ADB + 0 CLAW MACE $ OCCUN• - .. .. .. .. .. 07/14/93 8 1 : 07/14/ 94 �0NAL + ,000,000 OWNERS a cCHrnACTCRs Plan + 100000000 FIE DAIAKE(bry 25,000 CLAW _.. MED EXPENSE IAMYIk.P~)+ 1,000 .... .. ...... .. ............................... ._ ........ . .. ...._ ......... ..... .. .................. .......... _.... AUlO1gEEi WYIIY COMBINED SINGLE LIMIT ....... :ANY AUTO ......... ......._.. + ...... ALL OMED ALROB - BODLY NAM .....:SC/EDUAD AUTOS (PN Pww) + .... :HIED AUTOS BOOLY VAow NdLOVRED AUT011 (PW.ePMMO '3 GARAGE LIABILITY CCL PROPERTY UNAKE ....... + ...... ..... . ............... ;�,,.��1 ...crew LMEIRY ....... ........, �, .......... EACH Ocaiwe«s + UMEeLLA FORM (Jf GALYEX%f Q . a ................... .... 07 ER THAN UMBRELLA FORM WORKM Cow"IYYION STAYUTOHY UNIS EACH ACCIDENT + AND f DKEASE.POLICY LAVT :+ UWLDTWWUANUM ............_..................................5_.._....,......................... DBEA9E-EAtlI IDA9.OYIE + OTHWI DalCRIFFIp1 OP OPMATIpe\,OCATION11906CLIblPlICMLL DBA Certificate holder is an "additional insured" as their interest may appear. : :..,<:< w u. ... mw " iCdlat �vatxi`' W. SHOULD•., �m.THE ABOVE DESCRIBED POLICIES BE CANCELI M BEFORE THE City of San Juan Capistrano <} EXPI 0 THEREOF, THE ISSUING COMPANY WALL ENDEAVOR TO 32400 Paseo Adelando MAIL YS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE San Juan Capistrano, CA 92675 LEFT, LURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Attn: Cheryl Johnson LIABILITY OF ANY IOND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AYM00®ROPREfCITATIK 8 � �+•/� IIGCRQ�;� 'gyrryxy;n a �..... ��.a-z„ . �' ' � ;xbxr$,�u � ...• :�,�i-��, .: ��'�;'tbR�8A1lT[ON�t _. Ik. MEMBERS OC LENEC MPSE I CARYL CAMPBELL GARY N HAUSOORFER ® GL.GNES mllnmil CAAGLYN NASH a 011unm 1961 .EFF VASGUEZ 1776 • • CITY MANAGER GEORGE SCARBOROUGH August 19, 1993 Ronald G. Farwell, President All City Management Services, Inc. 5839 Green Valley Circle, Suite 102 Culver City, California 90230 Re: Crossine Guard Services - City of San Tuan Capistrano Dear Mr. Farwell: At their meeting of August 17, 1993, the City Council of the City of San Juan Capistrano approved the agreement with your company to provide crossing guards for the City of San Juan Capistrano. The initial term of the agreement is for the period ending June 30, 1994, at a cost not to exceed $19,794 for 1,448 hours of service. A fully-executed copy of the agreement is enclosed for your files. The insurance requirements set forth in Section 13 of the Agreement have not yet been met. Please forward the required worker's compensation, general liability, and endorsement certificates to the City Clerk's Office as soon as possible. Thank you for your cooperation. Very truly yours, C� Cheryl Johnson City Clerk Enclosure cc: Lieutenant Dan Martini (with copy of agreement) Sergeant Hal Brotheim (with copy of agreement) 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO. CALIFORNIA 92675 0 (714) 493.1171 . LIABILITY ENDORSEMIO CITY OF SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Juan Capistrano, Califontia 92671 ATTN: A. POLICY INFORMATION Endorsement / 1. Insurance Company Policy Number 2. Policy Term (From) To ;Endorsement Effective Date 3. Named Insured 4. Address of Named Insured 1. Limit of Liability Any One Occurrence Aggregate General Liability Aggregate (check one:) Applies "per location/project" Is twice the occurrence limit 6. Deductible or Self-Insured Retention (Nil unless otherwise specified} $ 7. Coverage is equivalent to: Comprehensive General Liability form GL0002 (Ed 1/73) Commercial General Liability "claims-made" form CG0002 8. Bodily Injury and Property Damage Coverage is: "claims-made" "occurrence" If claims-made, the retroactive date is B. POLICY AMENDMENTS This endorsement is issued in consideration of the policy premium. Notwithstanding any inconsistet statement in the policy to which this endorsement is attached or any other endorsement attache thereto, it is agreed as follows: 1. INSURED. The City and the Community Redevelopment Agency, its elected or appointe officers, officials, employees and volunteers are included as insureds with regard to damage and defense of claims arising from: (a) activities performed by or on behalf of the Name Insured, (b) products and completed operations of the Named Insured, or (c) premises owne, leased or used by the Named Insured. 2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insure for or on behalf of the City; or (b) products sold by the Named Insured to the City; or (4 premises leased by the Named Insured from the City, the insurance afforded by this polic shall be primary insurance as respects the City, its elected or appointed officers, official employees or volunteers; or stand in an unbroken chain of coverage excess of the Name Insured's scheduled underlying primary coverage. In either event, any other insuranc maintained by the City, its elected or appointed officers, officials, employees or voluntee shall be in excess of this insurance and shall not contribute with it. (OVER) 3. SCOPE OF COVERAGE. This policy, if primary, affords coverage at least as broad as: (1) Insurance Services Office form number GL 0002 (Ed. 1/73), Comprehensive Genei Liability Insurance and Insurance Services Office form number GL 0404 Broad Foi comprehensive General Liability endorsement; or (2) Insurance Services Office Commercial General Liability Coverage, "occurrent form CG 0001 or "claims-made" form CG 0002; or (3) If excess, affords coverage which is at least as broad as the primary insurarn forms referenced in the preceding sections (1) and (2). 4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately each insured who is seeking coverage or against whom a claim is made or a suit is brough except with respect to the Company's limit of liability. S. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Ar failure to comply with reporting provisions of the policy shall not affect coverage provide to the City and the Community Redevelopment Agency, its elected or appointed officer, officials, employees or volunteers. 6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspender voided, cancelled, reduced in coverage or in limits except after thirty (30) days' prior writte notice by certified mail return receipt requested has been given to the City. Such notic 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: Title Department Company Street Address City (State) Zip Code) ) Telephone D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER I, (print/type name), warrant that I have authority to bind the below liste insurance company and by my signature hereon do so bind this company. SIGNATURE OF AUTHORIZED REPRESENTATIVE (original signature required on endorsement furnished to the City) CRC'ANIZATIC N: TITLE: ADRESS: TELEPH2\E: ( ) MSUE 9/ 3/1993 PDQ TiIS CERTIFICATE IS ISSUED AS A MATTER OF "im ONLY in CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE (213) 655-9999 PaX(213) 655-0578 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE LFC Insurance POLICIES BELOW. .............................I....................................................................................................................... 113 N. San Vicente Blvd. , #301 COMPANIES AFFORDING COVERAGE Beverly Hills, CA 90211 ..............-........................................ ....... ...................I.......-1.............. cDMPAN� A Northfield insurance Co. LEnER ............................ ..........---....... ................................................................. COMPANY B INSURED LETTER .......................................................... .......... ..............--............... .............. All City Management, Inc. COMPANY C LETTER 5839 Green Valley Circle, #201 ...........---....................... .................................................................-.................. ........ Culver City, CA 90230 COMPAW D LETTER ........................................I............._ ...............................-........................... ................... COMPE , LETTERTHIS 18 TO CERTIFY THAT THE P—"JC:ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 08 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. ................................--....................................... ..................I....I--....... .................... ....--.................................-................... .......--..................................... 00 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMA)DrM DATE(MMA)DNY) ........... ................................... ............................. ........................... .........—....................... ................... GENERAL AGGREGATE :6 1"000F000 COMMERCLAL GENERAL LABILITY CPPiS4901 PRODUCr-COMPIOP AGO. :$ 0 ............... .......... ...........I........ ................ ............. ................... CLAIMS MADE X �OCCUR. V.wum ....... ': 07/ l4/94;.P"`CNA-&AD -- 1,F 000, 000 OWNERS&CONTRACTORS PROT ........ EACH OCCURRENCE ....... :5 11000f..000 ..............---................ .................... FIRE DAMAGE Wry ar Be) $ 25,000 WED.EXPENSE(AM one peimrr):11 1,000 ............... ............... ................. ....... ...... ......... ................... ....... ....................................................................................... AUTOMOSL[LIABILITY COMBINED SINGLE if ANY AUTO LIMIT .............. .................. ............. ALL OWNED AUTOS BODILY"RY SCHEDULED AUTOS (Per perm) :................................................:i....................... HIRED AUTOS BODILY NA)Ry NON-OWNED AUTOS (Per accklent) ..........---........... ............................... GARAGE LIABLrrY :3 PROPERTY DAMAGE .......... ... . . ...... ..............................I................... ....... .................................. 1=61i LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE .................................... OTHER THAN UMBRELLA FORM STAnAu"'r LIARSWORSE"COMPEMTON L EACH ACCIDEN AND DISEASE-POLICY LIMIT EMPLOYERS LIABILITY ......-........................................................................... . ... DISEASE-EACH EMPLOYEE .. ... OTHER DESCRIPTION OF CPMkT40N$nJDCATPDKWVMMCLELIWfZihL ITIOn Certificate holder is an "additional insured" as their interest may appear. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 32400 Paseo Adelando MAIL 10 DAYS wFtirrFN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE San Juan Capistrano, CA 92675 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Attn: Cheryl Johnson LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. .1.�AUTHORIMED REPRESENTATIVE RVRIWWW�mm� -,P.5 IPA Z C c_ M Memorandum C-� ' November 1, 2002 vn r To: Dawn Schanderl p o � Go Fr: Baron Farwell Re: Crossing Guards Status I do apologize for not being clear in my last communication regarding the status of our Crossing Guards. Crossing Guards are indeed "our" employees and yet they are "leased" for administrative purposes. This "administrative relationship" in no way, form or fashion compromises our contracted duties and responsibilities or the management of our Crossing Guard Programs. The intent of the wording on Page 1, item number 2 is to affirm the disassociation of Crossing Guards from the employment of the City. In most cases when we assume control of a Crossing Guard program the Guards are typically City employees. This wording was included to clarify the fact that the City has no employer/employee relationship with Crossing Guards beyond the contract date. As we continue to dutifully provide Crossing Guard Services as per our agreement, I would ask that the City release payment for services rendered this school year. Sincerely, ar 11, Cc: Lt. J.B. Davis City Attorney Main Office: 1749 S. La Cienega Blvd. •Los Angeles, CA 90035 • 310-202-8284 FAX 310-202-8325 Northern California Office: 6500 Dublin Blvd., Ste. 216 •Dublin, CA 94568 . 800-540-9290 FAX 925-803-6992 Dawn Schanderl To: Dottie Shaw Subject: All City Management Finally got the mess cleared up with All City. Would you please release their check (s)? Will do formal list on Friday • �, ate., • 32400 PASEO ADELANTO i�� L.l MEMBERS OF THE CITY COUNCIL SAN .JUAN CAPISTRANO, CA 92675 �/ In(nwuF(p DIANCOLLENE CAMPBELL E L.BATHGATE (949) 493-1171 Buu¢up 1961 JOHN S.GEIPF (949) 493-1053 (FAX) 1776 WvATT HART www.sanjuancapistrano.org •� • DAVID M.SWERDLIN CITY MANAGER GEORGE SCARBOROUGH June 19, 2002 All City Management Services 1749 S. LaCienega Blvd Los Angeles, CA 90035 Attention: Baron Farwell, General Manager Dear Mr. Farwell: An amendment to an agreement between All City Management Services, Inc. and the City of San Juan Capistrano for providing School Crossing Guard Services was approved by the City Council on June 18, 2002. It is in the process of being executed. All original agreement terms related to Section 13. of the original agreement must be met prior to issuance of a Notice to Proceed or commencement of work. I have provided a copy of this section for your reference. Please provide the required evidence of insurance to the City Clerk's office. This evidence may be faxed to (949) 493-1053, followed by original signed documents. If you have questions specific to the agreement, please contact the project manager, Lt. Rick Stahr, Chief of Police Services (949) 443-6371. If you have questions regarding the forms of insurance needed, please contact Dawn Schanded, Deputy City Clerk (949) 443-6310. Thank you, Meo han, CMC City Cler enclosure: Section 13 of original agreement cc: Lt. Rick Stahr, Chief of Police Services Dawn Schanded, Deputy City Clerk DRUG USE IS San Juan Capistrano: Preserving the Past to Enhance the Future Meg Monahan From: Dawn Schanderl Sent: Thursday, June 20, 2002 3:24 PM To: Meg Monahan Subject: All City Management I have General liability, endorsement and workers comp. Agreement may be distributed Dawn Schanderl To: Meg Monahan Subject: All City Management I have General liability, endorsement and workers comp. Agreement may be distributed 32400 PASEO ADELANTO MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO, CA 92675 ' �/ I IIbInRRI DIANE L.BATHGA DIME CAMPBELL (949) 493-1171 snMISID 1961 JOHN S.GELFF (949) 493-1053 (FAX) 1776 MATT HART www.sanjuancapistrano.org DAVID M.SWERDLIN w . CITY MANAGER f4 rY�ri"'► GEORGE SCARBOROUGH June 19, 2002 All City Management Services 1749 S. LaCienega Blvd Los Angeles, CA 90035 Attention: Baron Farwell, General Manager Dear Mr. Farwell: An amendment to an agreement between All City Management Services, Inc. and the City of San Juan Capistrano for providing School Crossing Guard Services was approved by the City Council on June 18, 2002. It is in the process of being executed. All original agreement terms related to Section 13. of the original agreement must be met prior to issuance of a Notice to Proceed or commencement of work. I have provided a copy of this section for your reference. Please provide the required evidence of insurance to the City Clerk's office. This evidence may be faxed to (949) 493-1053, followed by original signed documents. If you have questions specific to the agreement, please contact the project manager, Lt. Rick Stahr, Chief of Police Services (949) 443-6371. If you have questions regarding the forms of insurance needed, please contact Dawn Schanderl, Deputy City Clerk (949) 443-6310. Thank you, ci Me o han, CMC City Cler enclosure: Section 13 of original agreement cc: Lt. ick Stahr, Chief of Police Services awn Schanderl, Deputy City Clerk DRUG USE IS San Juan Capistrano: Preserving the Past to Enhance the Future pertaining to general pedestrian safety and school crossing areas. 11 . Crossing Guard Services shall be provided by the Contractor at the designated locations and at the designated hours on all days on which the designated schools in the City of San Juan Capistrano, are in session. 12 . The Contractor shall provide all Crossing Guards with apparel by which they are readily visible and easily recognized as Crossing Guards. Such apparel shall be uniform for all persons performing the duties of Crossing Guards and shall be worn at all times while performing said duties. This apparel must be appropriate for weather conditions. The Contractor shall also provide all Crossing Guards with hand held Stop signs and any other safety equipment which may be necessary . Apparel and equipment shall be pre-approved by the City Manager. 13 . The Contractor shall at all times provide Worker's Compensation insurance covering its employees, and shall provide and maintain public liability insurance for Crossing Guard activities with the City named as an additional insured. Such insurance shall include, but not be limited to, comprehensive general liability with a combined single limit of not less than $5, 000 ,000.00 per occurrence for property damage and for bodily injury or death of r persons. Such insurance shall be primary with respect to any insurance maintained by City and shall not call on City' s insurance contributions . Such insurance shall be endorsed for contractual liability and personal injury and shall include the City, its officers, agents and interest of City. Such insurance shall not be cancelled, reduced in coverage or limits or non-renewed except after thirty ( 30) days written notice by Certified Mail, Return Receipt Requested has been given to the City Attorney or City Manager. 14 . Contractor agrees to indemnify the City, its Officers, employees and agents against, and will hold and save them and each of them harmless from, any and all actions , claims damages to persons or property, penalties , obligations or liabilities that may be asserted or claimed by any person , firm , entity , corporation , political subdivision or other organization arising out of the negligent acts or intentional tortious acts , errors or omissions of Contractor, its agents, employees, subcontractors, or invitee, provided for herein. a) Contractor will defend any action or actions filed in connection with any of said claims, damages, penalties, obligations or liabilities and will pay all costs and expenses including attorney's fees incurred in connection herewith. Jgww 32400 PASEO ADELCOLLENECCAMAM ANTO � © MEMBERS E UNCIL LKJ1 COLPBELL SAN JUAN CAPISTRANO,CA 92675 JOHN GREINER (714)493-1 171 - ynrono��Ile WYATT HART GILJO(714)493-1053 (FAX) n1776 X861 DAVID ES 176 DAVIDM SWERDLIN • • CITY MANAGER GEORGE SCARBOROUGH March 25, 1998 12 Mr. Baron Farw All American M 5839 Green Vall Culver City, Cal Re: Renewal Dear Mr. Farwel The Workers' CG...y.,...... >ogmwng aie auuve-rererencea project, is due to expire on April 1, 1998. In accordance with your agreement,the insurance certificate needs to be renewed for an additional period of one year. Please forward an updated certificate to the City of San Juan Capistrano, attention City Clerk's office, by April 14, 1998. If you have any questions, please contact me at(714) 443-6310. Thank you for your cooperation. Very truly yours, /� ( 1'—� ' Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Lt. Paul Sullivan oeua use 1s ae San Juan Capistrano: Preserving the Past to Enhance the Future • Jwa„ ! ��V F MEMBERS OF THE CITY COUNCIL 1s COLLENE CAMPBELL JOHN GRAINER kr� imloxvaxxllp GIL JO HART �uuxm 1961 GIL JONES 1776 DAVID M.SWERDLIN •� • CITY MANAGER GEORGE SCARBOROUGH September 3, 1997 ' I i All City Management, Inc. 5839 Green Valley Circle, #201 Culver City, California 90230 Re: Renewal of General Liability Certificate of Insurance (Crossing Guard Services) Gentlemen: The General Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on September 14, 1997. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. The agreement requires a general liability endorsement form naming the City of San Juan Capistrano as an additional insured. I have included a City approved endorsement form to submit to your insurance company; however, your insurance company may provide their own endorsement form. Please forward the updated certificates and the endorsement form to the City, attention City Clerk's office, by September 19, 1997. If you have any questions, please contact me at(714) 443-6310. Thank you for your cooperation. Very truly yours, AVQi0jW Dawn M. Schanderl Deputy City Clerk Enclosure cc: e; C 1 Jdhnson,City Clerk Lt. Paul Sullivan .'J 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171