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1992-0528_BATHGATE, WILLIAM_Agreement AGREEMENT FOR OVERSEER SERVICES CITY OF SAN JUAN CAPISTRANO SWANNER PROPERTY This Agreement is made as of the first day of July, 1993, between the City of San Juan Capistrano ("City") and William A. Bathgate ("Bathgate") . RECITATIONS OF FACT A. On or about May 28, 1992, the City acquired certain property described in Exhibit A ("Swanner Property") for open space and agricultural purposes. B. Bathgate has farmed adjacent land and has first-hand knowledge of the land, the crops and facilities comprising the Swanner Property. C. Bathgate has, as a matter of fact, managed and overseen the Swanner Property since its acquisition by the City. D. City desires to have Bathgate continue as manager and overseer of the Swanner Property. NOW, THEREFORE, IN CONSIDERATION OF THE PREMISES, City hereby hires Contractor, as an Independent Contractor, to manage the Swanner Property on the following terms and conditions: 1. Term. The term of this agreement shall commence on July 1, 1993, and shall continue until terminated by either party by written notice delivered to the other no later than ninety (90) days prior to the intended termination date. 2. Scope of Work. Contractor shall, subject to criteria promulgated by the Director of Public Land and Facilities: a. Oversee and direct the work of Ignacio Lujano. b. Oversee the care and maintenance of the Swanner Property, including the irrigation, spraying, cultivation and harvesting of the orange grove located therein. C. Oversee the maintenance and operation of Egan Wells No. 1 and No. 2. ; coordinate access to the wells and collection of charges from others entitled to their use. d. Oversee the weed abatement program. e. Provide periodic reports on the state of Swanner Property, including problems or other matters of concern. 1 GO J 3 . Contractor's Responsibilities Beyond Scone of Work. a. Any other work or labor required in the performance of the tasks enumerated in g 2 shall be provided by the City by separate agreement with that employee or contractor. b. Any work or responsibility required of Contractor by the City, beyond that set forth in 1 2, shall also be set forth in a separate written agreement signed by both parties. C. The cost of materials, repairs and replacement of tools, equipment, machinery and vehicles shall be borne by the City and paid upon presentment of invoice(s) . 4 . Responsibility of City. The City shall, through its Director of Public Land and Facilities, provide: a. A written statement of the duties and responsi- bilities of Ignacio Lujano. b. Written directions, criteria or specifications, if any, relating to Contractor's Scope of Work. 5. Relation of Parties. The relationship between City and Contractor shall be that of an Independent Contractor; Contractor shall, accordingly, have the right and authority, independent of the City, to: a. Establish his own work schedule. b. Establish, at his sole cost and expense, such office and office equipment and supplies as he may deem necessary for the fulfillment of his contract with the City. 2 6. Compensation. a. Contractor has been paid the sum of $9,800 for services performed from May, 1992, through June, 1993. b. Contractor shall be paid the sum of $700.00 each month commencing on July 1, 1993, and continuing for the duration of this Agreement. C. Compensation for any work in addition to that set forth in q 2 shall be by separate agreement. 7. Liability Insurance. Contractor shall, at his sole cost and expense, maintain a policy of general liability insurance insuring his acts and activities (including motor vehicles) under this Agreement in an amount of not less than $1, 000, 000. 00 Combined Single Limit. A certificate of such insurance, showing the City as an additional insured, shall be delivered to the Director of Public 2 Land and Facilities within fifteen (15) days after execution of this Agreement by the City. 8. Certification of Non-Existence of Conflict of Interest. Contractor certifies, to the best of his knowledge, that: a. No City/Agency employee or office of any public agency connected or involved with this Agreement has any pecuniary interest in his business. b. No person associated with him has any interest that would conflict in any manner or degree with the per- formance of this Agreement. C. He has no interest and shall not acquire any interest, directly or indirectly, which would conflict in any manner or degree with his faithful performance of this Agreement. d. He is familiar with the provisions of §$ 87100 et seq of the California Government Code, and that he does not know of any facts related to his performance of this Agree- ment which would constitute a violation thereof. 9. Binding Effect. The entire agreement between the City and Bathgate for the management and overseeing of the Swanner Property is contained in this document. Any changes or amendments must be in writing signed by both parties. The terms contained shall, moreover, inure to the benefit of and be binding upon the successors and assigns of City and Bathgate. IN WITNESS WHEREOF, the City and Bathgate have signed this Agreement as of the date first above written. Cit of San an Capistrano William A. Bathga 3 Mar-19-04 09: 35A Hofstad Insurance 9496612066 P.02 ,.K wauuu,I unrt wrzu rla¢1al arrup It lXlnWWEM ewO. • EVIDENCE OF INSURANCE •STATE FORNUI PATRICIA BATHGATH Polity(Amber: 97 16272-31-17 PO BOX 217 EOntiw;pain: 03/19/2004 SN JN CAP CA 92693-0217 ExpraOul pole: 09/17/2004 WtIitk l.p.lo'. IT'4RN70D6H0031740 Year: 1987 Alike: TOYOTA Madel: PU 2WD FARMERS INSURANCE:EXCHANGE,LOS ANGELES,CALIFORNIA ,an authorized California Insurer, in compliance with the California Financial Responsibility Act, certifies that it has issued a policy in an amount not less than that required by the California Financial Responsibility Law for the described motor vehicle. radar Aged lame: Ben I fofstad K10 W H PMelrr 949-661-6692 VEHICLE 9-01 IM OEV=SIDE tA9@IRLY. aloemt READ CAREMY THE CALIFORNIA FINANCIAL RESPONSIBILITY ACT, (SECTION 16020) OF THE VEHICLE CODE, REQUIRES EVERY OWNER OR OPERATOR OF A VEHICLE SUBJECT TO THE REQUIREMENTS OF THE FINANCIAL RESPONSIBILITY ACT SHALL CARRY EVIDENCE OF FINANCIAL RESPONSIBILITY IN THE VEHICLE AT ALL TIMES.UNDER VEHICLE CODE (SECTION 16025) EVERY DRIVER INVOLVED IN AN ACCIDENT MUST PROVIDE EVIDENCE OF FINANCIAL. RESPONSIBILITY AT THE SCENE.FAILURE TO COMPLY IS AN INFRACTION AND SHALL BE PUNISHABLE BY A FINE OF NOT MORE THAN TWO HUNDRED FIFTY DOLLARS(5250). In your time of need, caD us at I-800-HelpPoint' (1-800-435-7764) for assistance. What to do In case of accident 1. Stop and do*for iljrim Cal an ofto a,if amylose is k*ffW. 2. Wam adw drivm to Mrmd AWw damgL Set flue.Sgnal Yllh flashigld at IaghL 3. Notify ole pose.Ahny times a pesilg*W Of 4ftdd will do tlrt far you 4. Gaiew tie fads k Sme to gel She name of tonnes, as well as Wet pubnem ildot vion. (.e. *W's km d, blmam0 blfumeioe and daaipim of D1e oft ww&) S. Be tuvN oder you say.Dont adink ragwfiibiily.inm1 6011 mEy show you were not responsible. 6. Repots to proper atalnri ieL W state has As own requremen6 for su dl repats.Know de law for yu stare and ton". 7. Ya may Am npon•leas on she Fwerlet at www.Famas=L PARMERS INSURANCE GROUP OF COMPANIES . 4690 WILSHIRE BLVD,LOS ANGELES,CA 50010 Mar-19-04 09:34A Hofsta6nsuvance 94966066 P .01 1p '?a "'li. Date: 03118/04 FROM: HOFSTAD INSURANCE AGENCY Phone(949)661-6692 Fox(949)661-2066 No.Of Pp including this cover page 2 TO: Marie(.CITY OF SAN JUAN CAPISTRANO RE : INSURANCE FOR PATRICIA BATHGATE HERE IS THE EVIDENCE OF INSURANCE FOR THE POLICY THAT WAS CANCELLED. LET ME KNOW IF YOU NEED ANYTHING ELSE CALL WITH ANY QUESTIONS THANKS BEN HOFSTAD Fax 3553 Camino Min Costa,Ste G San Clemente,CA 92672 FARMERS • • FARMERS FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST MORTGAGEE OR OTHER INTEREST: DATE MAILED: 03 -02-2004 CITY OF SAN JUAN c/OMEG MONAHAN X, CANCELLATION DATE: 324 PASEO ADELANTO SN JN CAP CA 92675 i 03-17-2004 EFFECTIVE AT: 12:01 A.M. POLICY NUMBER : 97 13997 -86 -37 HOUSEHOLD NUMBER: 139978637 VEHICLE YEAR: 1987 TOYOTA & DESCRIPTION: PU 2wD VEHICLE ID NO: JT4RN70D6H0031740 NAMED INSUREE9r-wILLIAM BATHGATE You are hereby notified that all coverage extended to you under the above described policy is cancelled effective at the date and time above. Your loan with this policyholder may have expired; however, this notice complies with the provision of our policy. FARMERS INSURANCE GROUP OF COMPANIES SERVICE CENTER OFFICE , a P. O. BOX 4820 ` c POCATELLO, ID 83205 AGENT NAME: „� ^. y AGENT NO: AGENT PHONE: Ben S Hofstad 97 15 356 (949) 661 -6692 25-o 73-Di 03 -02 -2004 Awonm THIS PAGE LEFT INTENTIONALLY BLANK • FARMERS T1017101 LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 'RECEIVED 32400 Paseo Adelanto San Juan Capistrano,California 92675 tUO3 NOV -1 P 04 ATTN- m`n rl7�n/ANA/tl A. POLICY INFORMATION Endorsement# G1 17 G-i_,tt _ USANJlldtEB of riy��riny� lf):5 . ;Policy Number 2. Policy Term(From) (To) aEndorsementEffectiveDate SQrhe_ 3. Named Insured -f49123 n.f 4. AddressofNamedlnsured 99? Cam"n i rG y 5. Limit of Liability Any One Occurrence/Aggregate $ /i OootpoU General Liability Aggregate(Check one:) / Applies "per location/project" ✓ Is twice the occurrence limit 6. Deductible or Self-Insured Retention(Nil unless otherwise specified): $___ IS-0 7. Coverage is equivalent to: Comprehensive General Liability form GL0002(Ed 1/73) Commercial General Liability "claims-made"forth 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 inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows: I. INSURED. The City and the Community Redevelopment Agency,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)projects 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)projects 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. 3. SCOPE OF COVERAGE. This policy, if primary,affords coverage at least as broad as: (1) Insurance Services Office form number GL0002(Ed. 1/73), Comprehensive General Liability Insurance and Insurance Services Office form number GL0404 Broad Form Comprehensive General Liability endorsement; or, (2) Insurance Services Office Commercial General Liability Coverage, "occurrence" form CG0001 or "claims- made"form CG0002: or, V (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 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. 5. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply with reporting provisions of the policy shall not affect coverage provided 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 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: Ilel✓J (Title) (Department) r✓M a V- (Company) (Company) (Street Address) (City) (State) (Zip code) aa (Telephone) D. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER I � y D S'�kyY _ _(print/type name), warrant that I have authority to bind the below listed insurance company and by my signature hereon do so bind this compan SIGNA O REPRESENTATIVE (Original signatu e r fired on endorsement furnished to the City) ORGANIZATION: AO&W—Trl TITLE AgQh'f / l�Wne✓' ADDRESS: TELEPHONEtef 1- Io 6cY� • � - FARMERS 75 YEARS SERVING AMERICA COMPANY NAME: FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA AN INTER-INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY PART I CERTIFICATE OF INSURANCE INSI(RED'S NAME&ADDRESS: POLFCY NO: 97 13997-86-37 WILLIAM BATHGATE POLICY EDITION: 03 PATRICIA BATHGATE EFFECHVEDATE: 11-22-2003 PO BOX 217 EXPIRATION DNIE: CONTIN110I SUNTILCANCELLED SN JN CAP CA 92693-0217 EXPIRATION TIME: 12:01 A.M. Standard Time ISSUING OFIgCE: P. O. BOX 4820 AGENT: Ben S Hofstad POCATELLO, ID 83205 AGEN'I'No: 97 15 356 AGEN'IPHONE: (949) 661-6692 DESCRIPTION OF VEHICLE rear Melee Mdrl - Wide Wengmtun WAM 1987 TOYOTA PU 2WD JT4RN70D6H0031740 COVERAGES • EN,rKIF:S INT1101TSANDSOFDOLLARS. (SEE REVHSESIDE FOI COVRAGE D61GXA110RS) /odly/taY Y.D. unilewed Mowia Me&eV ($Wekffik CelkMn teeing NonAuM P.O. __ ____ -_ Ib feuh Oed,," Dok" _ __ _ ._.__- �•___ ,I• _ _ ...__ _._..—._� --COV 250 ; 5ON 00 ; 100 250 500 : COV xxx xxx 5,000 240 500 NC i NC EaA i Fads EaA Eedt xxx xxx 500 _.. _� D�. j Mated Paw 0ewnena Peron Omrrane COV I'his certificate 1s subject to all of the temis, conditions and limitations set fords in the policy(ies) and endorsements attached to it. It is furnished as a matter of information only and does not change,modify or extend the policy in any way. It supersedes all previously issued certificates. � PART 11 ADDITIONAL INSURED ENDORSEMENT El 136 ltd Edition W'c provide the coverages indicated by "COV," or the limit of die Company's liability, on the above Certificate of Insurance. We provide this coverage in respect to the vehicle described above, to the person or organization named below as an additional insured. 'Phis coverage applies only: (1) while the named insured is the owner, or has care, custody, or control of the above described vehicle,and (2) when liability arises out of die acts and omissions of the named insured. "I'his Coverage does not apply: (1) where liability arises out of negligence of die additional insured, its agents, or employees, unless the agent or employee is the named insured,or (2) to any defect of material, design or workmanship in any equipment of which the additional insured is the owner,lessor,manufacturer,mortgagee,or beneficiary. If any court shall interpret this endorsement to provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibility law of the state, province, or territory where the named insured resides,as applicable to the vehicle described above. If there is no such law, our limit of liability shall be $5,000 on account of bodily injury sustained by one person in any one occurrence and subject to this provision respecting each person, $10,000 on account of bodily injury sustained by two or more persons in any one occurrence. Our total liability for all damages because of all property damage sustained by one or more persons or organizations as the result of any one occurrence shall not exceed $5,000. '111C insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attached to it."Chis endorsement does not increase the limits of the policy. Upon cancellation or termination of this policy or policies from any cause we will mail 15 days notice in writing to the other interest shown below. CITY OF SAN JUAN 324 PASEO ADELANTO ' SN JN CTAP CA 92675 cvn. - AUTHORIZED SIGN 1RE 91-1176 2119 FDRIOM 497 G07 11136731 CITY OF SAN JUAN 324 PASEO ADELANTO SN JN CAP CA 92675 COVERAGE DESIGNATIONS COVERAGES -- Indicated by "COV" or the lint of Company's liability against each coverage. "NC" or "NOT COV" means "NOT COVERED." "MAX"menus"Maximum Deductible." BODILY INJURY — Boddy Injury Liability COMPREHENSIVE — Comprehensive Car Damage P.D. — Property Damage Liability COLLISION — Collision-Upset UNINSURED -' Benefits for Bodily Injury(includingproperty NONAUTO — Comprehensive Personal Liability-Each MOTORIST damage coverage if policy issued in New occurrence. Mexico)caused by Uninsured Motorists Medical Payments to Others- Each Person. MEDICAL — Medical Expense Insurance,Family Medical Guest Medical Expense-See Damage to Property of Others- Expense,and GSee Policy Poor Lvntts per occurrence.Policy Provision. If policy contains the E-550 No-Fault "COWING — Towing&Road Fnnce Coverage. Endorsement or No-Fault Coverage D,Auto OTHER — One or more miscellaneous coverages added Medical Expense Coverage does not apply. by endorsement to the policy. NOFAULT _- See Endorsement E-550(Illinois F2250)or Coverage D if applicable. LOSS PAYABLE PROVISIONS (Applicable only if lienholder is named,and no other Automobile loss payable endorsement is attached to the policy) It is agreed that any payment for loss or damage to the vehicle described in this policy shall be made on the following basis: (1) At our option, loss or damage shall be paid as interest may appear to the policyholder and the lienholder shown in the Declarations,or by repair of the damaged vehicle. (2) Any act or neglect of the policyholder or a person acting on his behalf shall not void the coverage afforded to the lienholder. (3) Change in title or ownership of the vehicle, or error in its description shall not void coverage afforded to rhe lienholder. The policy does not cover conversion,embezzlement or secretion of die vehicle by die policyholder or anyone acting in his behalf while in possession under a contract with the lienholder. A payment may be made to the lienholder which we would not have been obligated to make except for these terms. In such event,we are entitled to all the rights of the lienholder to the extent of such payment. The lienholder shall do whatever is necessary to secure such rights. No subrogation shall impair die right of the lienholder to recover the full amount of its claim. We reserve the right to cancel this policy at any time as provided by its terms. In case of cancellation or lapse we will notify die lienholder at the address shown in die Declarations. We will give the lienholder advance notice of not less than 10 days from the effective date of such cancellation or lapse as respects his interest. Mailing notice to the loss ppayee is sufficient to effect cancellation. Tlie following applies as respects any loss adjusted with the mortgagee interest only: f1) Any deductible applicable to Comprehensive Coverage shall not exceed $250. 2) Any deductible applicable to Colliston Coverage shall not exceed $250. 91-1136 2ND 1DNIDN 6-97 G-07 11136232 . . Javan � p4 MEMBERS OF THE CITY COUNCIL DIANE TE }`Y JOHNS..GELFF GELFF MAU HART JOE O 32400 PASEO ADELANTO l�/,(� + DAVID M.SWERDLIN SAN JUAN CAPISTRANO, CA 92675 jY I IABARRID DAVID M (949) 493-1171 BuluSAn X961 (949) 493-1033 (FAX) (776 • • INTERIM CITY MANAGER wwsv.sanjuancapistrano.org PAMELAGIBSON November 5, 2003 Pat Bathgate P.O. Sox 217 San Juan Capistrano, CA 92693 RE: Compliance with Insurance Requirements - Overseer Services, Swanner Property The following insurance document is due to expire: Jy V ✓ Automobile Liability Certificate 11/22/2003 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 324(A Paseo Adelanto, San Juan Capistrano, CA 92675 by the above exp' tionV1fve any questions, please contact me at (949) 443-6309. in )aGu Secretary cc: Jack Galaviz, Public Works Manager San Juan Capistrano: Preserving the Past to Enhance the Future MEMORANDUM TO: Jack Galaviz, Public Works Manager FROM: Meg Monahan, CMC, City Clerk Vl—� RE: Swanner Ranch — Pat Bathgate as Overse r DATE: October 17, 2003 Jack — I bring this issue to your attention because you have oversight for this agreement. Pat Bathgate has not met the insurance requirements the contractor/overseer of the Swanner Ranch. She has had her various subcontractors, such as the picker, sprayer, and other, forward insurance documents (which don't meet our specifications anyway), instead. John Shaw confirmed that the insurance needs to be in the contractor's name, not the subcontractor's names. Pat's General Liability insurance expired January 8, 2003, the automobile liability expired February 22, 2003 and we also need an endorsement form naming the city as additionally insured. At this point, we need you, as project manager, to get involved and assist her in getting her insurance into compliance. As you probably know, we are very short staffed and have also taken on more responsibilities, inherited from Mechelle and Cristi. I have attached copies of sample documents she need to provide and the agreement terms that apply to insurance requirements. Cc: Amy Amirani, Public Works Director 3. Contractor's Responsibilities Beyond Scope of Work. a. Any other work or labor required in the performance of the tasks enumerated in S 2 shall be provided by the City by separate agreement with that employee or contractor. b. Any work or responsibility required of Contractor by the City, beyond that set forth in q 2, shall also be set forth in a separate written agreement signed by both parties. C. The cost of materials, repairs and replacement of tools, equipment, machinery and vehicles shall be borne by the City and paid upon presentment of invoice(s) . 4. Responsibility of City. The City shall, through its Director of Public Land and Facilities, provide: a. A written statement of the duties and responsi- bilities of Ignacio Lujano. b. Written directions, criteria or specifications, if any, relating to Contractor's Scope of Work. 5. Relation of Parties. The relationship between City and Contractor shall be that of an Independent Contractor; Contractor shall, accordingly, have the right and authority, independent of the City, to: a. Establish his own work schedule. b. Establish, at his sole cost and expense, such office and office equipment and supplies as he may deem necessary for the fulfillment of his contract with the City. 2 6. Compensation. a. Contractor has been paid the sum of $9,800 for services performed from May, 1992, through June, 1993 . b. Contractor shall be paid the sum of $700.00 each month commencing on July 1, 1993, and continuing for the duration of this Agreement. C. Compensation for any work in addition to that set forth in q 2 shall be by separate agreement. 7. Liability Insurance. Contractor shall, at his sole cost and expense, maintain a policy of general liability insurance insuring his acts and activities (including motor vehicles) under this Agreement in an amount of not less than $1,000, 000.00 Combined Single Limit. A certificate of such insurance, showing the City as an additional insured, shall be delivered to the Director of Public Land and Facilities within fifteen (15) days after execution of this Agreement by the City. 8. Certification of Non-Existence of Conflict of Interest. Contractor certifies, to the best of his knowledge, that: a. No City/Agency employee or office of any public agency connected or involved with this Agreement has any pecuniary interest in his business. b. No person associated with him has any interest that would conflict in any manner or degree with the per- formance of this Agreement. C. He has no interest and shall not acquire any interest, directly or indirectly, which would conflict in any manner or degree with his faithful performance of this Agreement. d. He is familiar with the provisions of S§ 87100 et seq of the California Government Code, and that he does not know of any facts related to his performance of this Agree- ment which would constitute a violation thereof. 9. Binding Effect. The entire agreement between the City and Bathgate for the management and overseeing of the Swanner Property is contained in this document. Any changes or amendments must be in writing signed by both parties. The terms contained shall, moreover, inure to the benefit of and be binding upon the successors and assigns of City and Bathgate. IN WITNESS WHEREOF, the City and Bathgate have signed this Agreement as of the date first above written. 4 Cit of San an Capistrano a.�a� William A. Bathga 3 • • .......... AClWDDP awil ORD DATE(M 111 ru, PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC, HOLDER. THIS BERTIFIGATE DGES 11104: AMEND, E)REN8 At::FEFt iii eeVERAOE AFFEIREIES BY T IE Pel:memES BE-1:4 COMPANIES AFFORDING COVERAGE COMPANY A INSURED COMPANY COMPANY C COMPANY D 25Q'll R"ll"R S THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI( INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERN 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(MMMUIYY) DATE(MMI Ih GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ CLAIMS MADE F]OCCUR PERSONAL&ADV INJURY $ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ I: FIRE DAMAGE(Any one fire) $ $ AUTOMOBILE LIABILITY COMBINEE,SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (P person) $ SCHEDULED AUTOS �P__e_rp�_'son) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO [OTHER THAN AUTO ONLY. EACH ACCIDENT $ AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ I WC STATU- TH- WORKERS COMPENSATION AND _LTQ6YAjMITs EMPLOYERS'LIABILITY I EL EACH ACCIDENT $ THE PROPRIETOR/ INCL I EL DISEASE-POLICY LIMIT $ PARTNERSEXECUTIVE OFFICERS ARE. FlEXCL FEL DISEASE EA EMPLOYEE S OTHER it DESCRIPTION OF OPERATIONS/LOCATIONS EHICLEWSPECIAL ITEMS ........ .... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL FI IIEWOR Xg DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE !POSE 118 806660i OR IIW ��NE GOMPANY, FIB AUTHORIZED REPRESENTATIVE 0011";OR 7" U%ggg"$' -g�,oggg""gg" % I? g 112—doll. IWO POLICY NUMBER: COMMERCIAL GENERAL LIABILITY 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. SCHEDULE Name of Person or Organization: (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 11) 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 work"for that insured by or for you. j i CG 20 10 1185 Copyright, Insurance Services Office, Inc. 1984 I i California JPIA Contract Guide 131 i G MEMORANDUM TO: John Shaw, City Attorney FROM: Meg Monahan, CMC, City Clerk RE: Swanner Ranch — Pat Bathgate as Overseer DATE: October 14, 2003 Pat Bathgate's general liability insurance and the associated endorsement naming the city as additionally insured, expired in January 2003. Her Auto liability insurance is due to expire in October 2003. Pat has begun to have each of the "subcontractors" such as the Orchard Picker, Orchard Sprayer, etc... supply us with insurance certificates and we still have not received up to date insurance from her. Please let me know if we need to pursue proof of insurance directly from her or if the proof of insurance from her subcontractors will suffice. I would appreciate your response as soon as possible as these subcontractors are scheduling work within the next week. I've attached a copy of the agreement. Cc: Cindy Russell, Interim Assistant City Manager; Pamela Gibson, Interim City Manager AL MEMBERS OF THE CITY COUNCIL DIANE L BATHGATE }y JOHN S.GELFF WYATTHART JOESOTO 32400 PASEO ADELANTO /.� IA[IHOHi[I DAVID M.SWERDLIN SAN JUAN CAPISTRANO, CA 92675 . I"S1 561 (949) x93-1171 1776 (949) x93-1053 (FAX) INTERIM CITY MANAGER ivmiv.sanj uancapistrano.org PAMELAGIBSON MEMORANDUM TO: Cindy Russell, Interim Assistant City Manager/Administrative Services Manager FROM: Meg Monahan, City Clerk RE: Pat Bathgate/Overseer services for the Swanner Ranch DATE: October 16, 2003 Cindy, I bring this issue to your attention, as I know that Administrative Services has oversight for this agreement, but I do not know who the project manager is, at this point. Pat Bathgate has not met the insurance requirements as the contractor/overseer of the Swanner Ranch. She has had her various subcontractors, such as the picker, sprayer, and others, forward insurance documents (which don't meet our specifications), instead. John Shaw has confirmed that the insurance needs to be in the contractor's name, not the subcontractors' names. The City Clerk's staff has tried to explain the difference, but we need the project manager's involvement is getting this situation resolved and to continue her education and compliance with insurance requirements. Cc: John Shaw, City Attorney ORUO USE IS San Juan Capistrano: Preserving the Past to Enhance the Future ME ORANDUM TO: /hnaw, City Attorney FROM: Meg Monahan, CMC, City Cler RE: Swanner Ranch — Pat Bathgate s Overseer DATE: October 14, 2003 S Pat Bathgate's general liability insurance and the associated endorsement naming the city as additionally insured, expired in January 2003. Her Auto liability insurance is due to expire in October 2003. Pat has begun to have each of the "subcontractors" such as the Orchard Picker, Orchard Sprayer, etc... supply us with insurance certificates and we still have not received up to date insurance from her. Please let me know if we need to pursue proof of insurance directly from her or if the proof of insurance from her subcontractors will suffice. I would appreciate your response as soon as possible as these subcontractors are scheduling work within the next week. I've attached a copy of the agreement. Cc: Cindy Russell, Interim Assistant City Manager; Pamela Gibson, Interim City Manager OCT 14 200 I AGREEMENT FOR OVERSEER SERVICES CITY OF SAN JUAN CAPISTRANO SWANNER PROPERTY This Agreement is made as of the first day of July, 1993, between the City of San Juan Capistrano ("City") and William A. Bathgate ("Bathgate") . RECITATIONS OF FACT A. On or about May 28, 1992, the City acquired certain property described in Exhibit A ("Swanner Property") for open space and agricultural purposes. B. Bathgate has farmed adjacent land and has first-hand knowledge of the land, the crops and facilities comprising the Swanner Property. C. Bathgate has, as a matter of fact, managed and overseen the Swanner Property since its acquisition by the City. D. City desires to have Bathgate continue as manager and overseer of the Swanner Property. NOW, THEREFORE, IN CONSIDERATION OF THE PREMISES, City hereby hires Contractor, as an Independent Contractor, to manage the Swanner Property on the following terms and conditions: 1. Term. The term of this agreement shall commence on July 1, 1993, and shall continue until terminated by either party by written notice delivered to the other no later than ninety (90) days prior to the intended termination date. 2 . Scope of Work. Contractor shall, subject to criteria promulgated by the Director of Public Land and Facilities: a. Oversee and direct the work of Ignacio Lujano. b. Oversee the care and maintenance of the Swanner Property, including the irrigation, spraying, cultivation and harvesting of the orange grove located therein. C. Oversee the maintenance and operation of Egan Wells No. 1 and No. 2 . ; coordinate access to the wells and collection of charges from others entitled to their use. d. Oversee the weed abatement program. e. Provide periodic reports on the state of Swanner Property, including problems or other matters of concern. 1 3 . Contractor's Responsibilities Beyond Scope of Work. a. Any other work or labor required in the performance of the tasks enumerated in q 2 shall be provided by the City by separate agreement with that employee or contractor. b. Any work or responsibility required of Contractor by the City, beyond that set forth in q 2, shall also be set forth in a separate written agreement signed by both parties. C. The cost of materials, repairs and replacement of tools, equipment, machinery and vehicles shall be borne by the City and paid upon presentment of invoice(s) . 4 . Responsibility of City. The City shall, through its Director of Public Land and Facilities, provide: a. A written statement of the duties and responsi- bilities of Ignacio Lujano. b. Written directions, criteria or specifications, if any, relating to Contractor's Scope of Work. 5. Relation of Parties. The relationship between City and Contractor shall be that of an Independent Contractor; Contractor shall, accordingly, have the right and authority, independent of the City, to: a. Establish his own work schedule. b. Establish, at his sole cost and expense, such office and office equipment and supplies as he may deem necessary for the fulfillment of his contract with the City. 2 6. Compensation. a. Contractor has been paid the sum of $9,800 for services performed from May, 1992, through June, 1993. b. Contractor shall be paid the sum of $700.00 each month commencing on July 1, 1993, and continuing for the duration of this Agreement. C. Compensation for any work in addition to that set forth in q 2 shall be by separate agreement. 7. Liability Insurance. Contractor shall, at his sole cost and expense, maintain a policy of general liability insurance insuring his acts and activities (including motor vehicles) under this Agreement in an amount of not less than $1, 000,000.00 Combined Single Limit. A certificate of such insurance, showing the City as an additional insured, shall be delivered to the Director of Public 2 Land and Facilities within fifteen (15) days after execution of this Agreement by the City. 8. Certification of Non-Existence of Conflict of Interest. Contractor certifies, to the best of his knowledge, that: a. No City/Agency employee or office of any public agency connected or involved with this Agreement has any pecuniary interest in his business. b. No person associated with him has any interest that would conflict in any manner or degree with the per- formance of this Agreement. C. He has no interest and shall not acquire any interest, directly or indirectly, which would conflict in any manner or degree with his faithful performance of this Agreement. d. He is familiar with the provisions of §§ 87100 et seq of the California Government Code, and that he does not know of any facts related to his performance of this Agree- ment which would constitute a violation thereof. 9. Binding Effect. The entire agreement between the City and Bathgate for the management and overseeing of the Swanner Property is contained in this document. Any changes or amendments must be in writing signed by both parties. The terms contained shall, moreover, inure to the benefit of and be binding upon the successors and assigns of City and Bathgate. IN WITNESS WHEREOF, the City and Bathgate have signed this Agreement as of the date first above written. Cit of San an Capistrano William A. BathgatW 3 Aug-24-04 01 : 50P Hofstad Insurance 9496612066 P.02 - Policy Number 053846 ACORDRI CERTIFICAT F LIABILITY INSURANC B/23%Zoo4 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3553 CA14INO NIRA COSTA STE G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LICN0830647 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SAN CLEEOLNTE, CA. 92672 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (949)661-6692 123 4,56 INSURERS AFFORDING COVERAGE INSURED PATRICIA BATBGATE INSURERA FARMERS INSURANC6LXCHANGE INSURER B. PO BOX 217 INSURER C. SAN JUAN CAPISTRANO, CA 9,675 INSURER D- INSURER E' -- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAV BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY ONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 SEEN REDUCED BY PAID CLAIMS. INSR. — __. _. _— —__.._. . .POLICYEFFECTME POUCYEXPIMTIOH TYPE OF INSURANCE LIDY NUMBER LINTS GENERAL LIABILITY EACH OCCURRENCE S1,000,000 A COMMERCIAL GENERAL ix 6033389 4 8/24/2004 8/24/2005 FIRE DAMAGE HAAT Doan..) 41.000,000 ICLAIMS MADE I„I OCCUR' MED EXG(Any we Fem.—4 PERS UMBRELLA PERSONAL 8 ADV INJURY 81,000'000 _ GENERALAGGREGAT_E 41,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO S 1,000,000 POLICY PRY-lFrT LOC — AUTOXII ILE LABXITY COMBINED SINGLE LIMIT 4 AMY AUTO I I[a arclHmtl —_—— – _ ALL OWNED AUTOS BODILY INJURY 250,000 A X SCHEOULEDAUTOS 162723117 3/17/2004 1 9/17/2004 (Pm Pmso^I HIRED AUTOS BODILY INJURY 4 500,000 NONOWNEDAUTOS - PROPERTY DAMAGE 4 100,000 (PK iGCICMIt) GARILGE LAM” AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA AGC S AUTO ONLY AGO $ EXCESS LIABILITY EACH OCCURRENCE f OCCUR CLAIMS MADE AGGREGATE S _ I DEDUCTIBLE RETENTION S 4 WCSTAIU- 0TH. ! WORKERS COr NSATON AND I IOBY LIMITS_ R - EMPLOYERS'LIABILITY _ELL EACH ACCIDENT_ _ f E L DISEASE FA EMPLOYEE S EL DISEASE-POLICY-III 4 OiH1ER DESCRIPTION OF OPERATIONWLOCATIONSIVERCLe$MXCLUSO 45 ADDED BY ENDO.SEF ISPECIAL PROVISIONS 10 DAYS NOTICE OF CANCELATION CITY OF SAN JUAN CAPISTRANO IS D AS ADDITIONAL INSURED CERTIFICATE HOLDER ADDITIONAL INSURE ;INSURER LETTER: CANCELLATION SHOULD ANY OF TIE ABOVE DESCRIBED MLK"BE CANCELLED BEFORE THE EXPIRRTIOM CITY OF SAN JOAN CAPISTRAIFO DATE THEREOF, THE ISSUING INSURER WILL EIOEAVOR TO NAM.15 DAYS WRITTEN 32400 PASEO ADELAETLO NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL SAN JUAN CAPISTRANO, CA 92675 MICI NO OBLIGATION OR LMMLIW OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTWO DREPRESENTAWE ACORD 268(7197) C ACORD CORPORATION 188 Aug-24-04 03: 19P Hofstad Insurance 9496612066 P-02 LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Juan Capistrano,California 92675, ATTN: k POLICY INFORMATION EndorsemcniN _ ____ _ I InsuranceCompany_ F /)t ✓ -1- /7 ,PohcyNumber / vygrJ��(e 7� 2 Policy Term(Froni �(To)_S/-?_ ;Endorsement Effective Date 3 Namedlnsurecl �. '— 4 Aduress ofNamedInsured _/�. ,.�� y{ A 4-s2 < Limit of Liability Any Ont Occurrence/Aggregatt $ /r oonr ooU General Liability Aggregate(Check one:) Applies per location/project" _ ._V_ Is twice he occurrence limit r, Deductible of Self-Insured Retention(Nil unless otherwise specified) $� Coverage is equvalent to Compre ensive General Liability form GL0002 (Ed 1/73) Comme ia1 General Liability "claims-made" form CG0002 b Bodih Inlan and Prope Damage Coverage is: "claims-made' 1/ "occurrence" If claim made,the retroactive date is POLICY- AMENDMENTS hhs endorsement , issued m consideration o the policy premium. Notwithstanding any inconsistent statement m the pohcy to which thi, ennorse:nent is anached or any other endorsement attached thereto, it is agreed as follows- INSURED. the Ci-.y and tic Community RedevelopmentAgency, its elected-or appointee officers,officials,employees and volunteers are included as insureds with regard to damages and defense of claims arising from. (aj actrviur, periornrc hs or on behalf of the Named Insured, (b)projects and completed operations of the Named Insuredort-i prenuse u„Tied, leased or used by the Named Insured ('ONTRIBUTION NOT REQUIRED. As respects. (a)work performed by the Named Insured for or on bchalt 01 the L n. or 1b�projects sold b the Named Insured to the Ciry;or(c)premises leased by the ?lamed Ins.iree from [he Cir. ;he ins.uance afforded by this policy shall be primary insurance as respects the City, its clecfed or appointed otfl vr, , fc.ah_employees or vol nteers,or stand in an unbroken chain of coverage excess ofthe Named Insured's scheduled um,ler.,i�, pr-mar, cove age In either event, any other insurance maintained by rhe ;'ny. ns elected or appumied ..I llren otllcia h, employ es or volunteers shall be in excess of this insurance and shad not confrrbake with. Il s(OPF OF (-OV ERAG .. I-his policy, if primary, affords coverage at least as broad .n - tc,_iiance 5ervic s' Office form number G1.0002 (Ed 1'73), Comprehensive ur ner.a Lid",:ilj I )surun,e and u,,,rmce Scrvick s Office farm number CL0404 Broad Fortin Comprehensive (leneral I u,,.Iu, endorscricrii in,urmce lcra¢ s Office Commercial General Liability Coverage, "occurren..c' lone i Y�000 ai 'Yfaiin�- „-•r" form CG 003, or. Aug-24-04 11 : 39A Hofstad Insurance 9496612066 P .01 • Date: 08/24/04 FROM: HOFSTAD INSURANCE AGENCY Phone(949)661-6692 Fax(949)661-2066 Email is bhofstadfaYarmersaeentcom No.Of Fits including this cover page 2 TO: CITY OF SAN.IUAN CAPISTRANO ATTN: MARIA RE: LIABILITY POLICY FOR PATRICIA BATHGATE HERE IS THE CERTIFICATE OF INSURANCE FOR PATRICIA BATHGATES LIABILITY POLICIES. IF YOU NEED ANYTHI qG ELSE OR HAVE ANY QUESTIONS PLEASE CALL ME. THANKS JERI Fax(949) 493-1053 3553 Camino Mira Costa,Ste G San Clemente,CA 92672 I FARMERS NEW DISCOUNT AVIALABLE IF WE WRITE A LIFE POLICY ON ANYONE IN YOUR HOUSEHOLD YOU'LL GET A DISCOUNT O ALL OF YOUR CARS AND HOME. CALL FOR A QUOTE. �"v Aug-24704 11 :39A Ho-Fsta Insurance 9496612066 P_02 rmmy ITumwl. u .o ACORD� CERTIFICATE F LIABILITY INSURANC 1w 8/23i2TE O04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3553 CANINO MIRA COSTA STE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LIC90830647 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SAN CLEMENTE, CA. 92672 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (949)661-6692 123 4 6 INSURERS AFFORDING COVERAGE INSURED pATRICIA BATHGATE INSURER FARMERS B78URANCi EXCHANGE INSURER B'. _H PO BOX 217 INSURER SAN JUAN CAPISTRANO, CA 92675 INGURERD _ - -- -- INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEENISSUEDTOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT.TERM OR CONDITION OFANYWNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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� TYP-0 INSURANCE PO UMSPA YNPOLICY EFFECTIVE POLICYEXPRATION UNITS GENERAL UABLITY EACH OCCURRENCE 51,000,000 A COMMERCIAL GENERALLIABILITY70112678 6/24/2004 6/24/2005 FYiE DwMAGE IAr�y OM oral 51,000,000 CLAIMS MADE / i OCCURMED HT-1 Any e Perron) _ S _ PERS UMBRELLA _ I on PERSONAL B AOV INJURY $.1,000,000 GENERAL AGGREGATE S 1— '060,000 000,000 GENTAGGREGATE LIMITAPP_LIESPER PRpDUCTS-COMP/OP AGG S OrOOO POLICY PRD LGO AUTOLIDRLE L.IARILRY Co SNGLE LIMIT $ ANY AUTO [EA acclMml ALL GINNED AUTOS I 1,wBCDILY pereomINJURY 5250,000 A3CHEDV LEO Auros � 16272311 3/17/2004 , 9/17/2004 (PerHIRED AUTOS BOOILY INJURYNONOWNEDAUTOS (pyi5O0,000 PROPERTY DAMNGE S 100,000 (Per acaoenD "RAGE LPBAITY AUTO ONLY-EA ACCIDENT i ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG f EXCESS UABIITY EACHOCCURRENCE S OCCUR f _ CLAIMS MADE AGGREGATE_ ._ $ DEDUCTIBLE S RETENTION S 5 WC STA U OO.. WORKERSCOMPENSATIONAND ___To YyLMIiS. ER _ EMPLOYERS'UAMITT E LEACH ACCIDENT 7 E.L DISEASE EA EMPLOYEES EL DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPEFUITIONNVUDQATIONSWENICLESIEXCLUVC IS ADDED W ENDORSEMENTISPECIAL PROVISIONS 10 DAYS NOTICE OF CANCELATION CITY OF SAN .JUAN CAPISTRANO AS ADDITIONAL INSURED CERTIFICATE HOLDER ADDITIONAL INSu ;INSURER LETTER: CANCELLATION CITY OF 37115 JUAN CAPIS SHOULD ANY DF TIE ABOVE DESCIUBED POI RE CANCELLED 1 FORE THE EXNRATRIN DATE THEREOF. THE NIRIIND INSURER WILL NL L ENDEAVOR TO M _GAYS WRITTEN CONINUNITY DEVELOPMENT AGE BUY NOTICE TO THE CERTIFIGITE HOLDER NAMED TO THE LEFT.BUT FNLURE TO DO SO SHALL 32400 PASO ADELANTO NIPOSE NO O"ATIDN OR LNRUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR SAN JUAN CAPISTRANO, CA 2675 REPRESER AUTHORSTFD REPRESENTATIVE ACORD 25.S 17197) ®ACORD CORPORATION 19N Aug-24-04 01 :49P Hofstad Insurance 9496612066 P.01 r • Date: 08/24/04 FROM: HOFSTAD INSURANCE AGENCY Phone(949)661-6692 Fax(949)661-2066 Email is bhofstad(alfarmersa¢ent.com No.Of Pgs including this cover page 2 TO: MARIA RE: PATRICIA BA HGATE HI MARIA,RE: THE A IDITIONAL INSURED ENDORSEMENT WHAT WE HAVE DONE PRIOR TO THIS IS FI OUT A LIABILITY ENDORSEMENT,CITY OF SAN JUAN CAPISTRANO FOR YO U. IF YOU COULD FAX ONE OF THOSE OVER TO ME I'LL GO AHEAD AND FILL IT UT AND FAX IT BACK TO YOU. IF YOU NEED ANYTH NG ELSE OR HAVE ANY QUESTIONS PLEASE CALL ME. THANKS JERI Fax(949) 493-1053 3553 Camino Mira Costa,Ste G San Clemente,CA 92672 �& FARMERS NEW DISCOUNT AVIALABLE IF WE WRITE A I IFE POLICY ON ANYONE IN YOUR HOUSEHOLD YOU'LL GET A DISCOUNT 011 ALL OF YOUR CARS AND HOME. CALL FOR A QUOTE. N Au,g-24004 03 : 19P Hofstad Insurance 9496612066 P.01 • I' Date: 09/24/04 FROM: HOFSTAD INSURANCE AGENCY Phone(949)661-6692 Fnx(949)661-2066 Email is bhofsta4darmersaeent.com No.Of Pgs including this cover page 2 TO: MARIA RE: PATRICIA BA HGATE HI MARIA, RF.: THEA DITIONAL INSURED ENDORSEMENT WHAT WE HAVE DONE PRIOR TO THIS IS FIL OUT A LIABILITY ENDORSEMENT,CITY OF SAN JUAN CAPISTRANO FOR YO . IF YOU COULD FAX ONE OF THOSE OVER TO ME I'LL GO AHEAD AND FILL IT T AND FAX IT BACK TO YOU. IF YOU NEED ANYTHI IqG ELSE OR HAVE ANY QUESTIONS PLEASE CALL ME. THANKS JERI Fax(949) 443-1053 3553 Camino Mira Costa,Ste G San Clemente,CA 92672 �& FARMERS NEW DISCOUNT AVIALABLE 1F WE WRITE AIFE POLICY ON ANYONE IN YOUR HOUSEHOLD YOU'LL GET A DISCOUNT O ALL OF YOUR CARS AND HOME. CALL FOR A QUOTE. FARMERS COMPANY NAME: FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA AN INTER-INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY PART I CERTIFICATE OF INSURANCE INSURED'S NAME&ADDRESS: POLICY NO: 97 1(5272-31-17 PATRICIA BATHGATE POLICY EDITION: 03 PO BOX 217 EFFECTIVE DATE: 03-17-2004 SN JN CAP CA 92693-0217 EXPIRATION DATE: CONTINUOUS UNTIL CANCELLED EXPIRATIONTIME: 12:01 A.M. Standard Time ISSUING OFFICE: P. O. BOX 4820 AGENT: Ben S Hofstad POCATELLO, ID 83205 AGENTNO: 97 15 356 AGENTPHONE: (949) 661-6692 DESCRIPTION Of VEHICLE - Yeo1 Meta - YatJ �: -. YMiY Yee6lmYai Rueter 1987 TOYOTA PU 2WD JT4RN70D6H0031740 COVERAGES +ENTRIES IN THOUSANDS OF DOLLARS. ISR REVERSE SIN FOR CDYRAGE D01GUTIM1 h�Mv r.D NWwdW1aM C tem Nee Awe *.. ; * * x I . - - NOT COV 250 500100 250 1500 COV xxx xxx 50,000 300 500 NC NC Payson Dummy Pe 0WIM xxx xxx 500 NOT COV Method This certificate is subject to all of the terms, conditions and limitations set forth in the policy(ies) and endorsements attached to it. It is furnished as a matter of information only and does not change,modify or extend the policy in any way. It supersedes all previously issued certificates. PART II ADDITIONAL INSURED ENDORSEMENT E 1136 2nd Mika We provide the coverages indicated by "COV," or the limit of the Company's liability, on the above Certificate of Insurance. We provide this coverage in respect to the vehicle described above,to the person or organization named below as an additional insured. This coverage applies only: (1)while the named insured is the owner, or has care, custody, or control of the above described vehicle,and (2)when liability arises out of the acts and omissions of the named insured. This coverage does not apply: (1) where liability arises out of negligence of the additional insured, its agents, or employees, unless the agent or employee is the named insured, or -- (2) to any defect of material, design or workmanship in any equipment of which the additional insured is the owner,lessor,manufacturer,mortgagee,or beneficiary. If any court shall interpret this endorsement to provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibility law of the state, province, or territory where the named insured resides,as applicable to the vehicle described above. If there is no such law, our limit of liability shall be $5,000 on account of bodily injury sustained by one person in any one occurrence and subject to this provision respecting each person, $10,000 on account of bodily injury sustained by two or more persons in any one occurrence. Our total liability for all damages because of all property damage sustained by one or more persons or organizations as the result of any one occurrence shall not exceed $5,000. The insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attached to it. This endorsement does not increase the limits of the policy. Upon cancellation or termination of this policy or policies from any cause we will mail 15 days notice in writing to the other interest shown below. CITY OF SAN JUAN CA 324 PASEO ADELANTO CA CA 92675 ` 3N JN CAP 92675 AUTHORIZED S[GN NRE 911136 tNDEDNIDN 497 GC! flntnl P.O. 13C 9200 SHAWNEE _s, KS 66201 CITY OF SAN JUAN CA 324 PASEO ADELANTO SN JN CAP CA 92675 COVERAGE DESIGNATIONS COVERAGES -- Indicated by "COV" or the limit of Company's liability against each coverage. "NC" or 'NOT COV" means "NOT COVERED." "MAX"means"Maximum Deductible." BODILY INJURY — Bodily In ury Liability COMPREHENSIVE — Comprehensive Car Darnage P.D. _ Property Damage Liability COLLISION — Collision-Upset UNINSURED — Benefits for Bodily Injury(includrngpeopeay NONAUTO — Comprehensive Personal Liability-Each MOTORIST damage coverage dpolmy issued in New occurrence. Mexico)caused by Uninsured Motorists Medical Payments to Others- MEDICAL — Medical Expense Insurance,Family Medical Each person. Expense,and Guest Medical Expense-See Damage to Property of Others- prbey Provision. See Policy for Limits per occurrence. If policy contains the E.550 No Fault TOWING -- Towmg&Road Servrce Coverage. Endorsement or No-Fault Coverage D,Auto OTHER --- One or more macellaneous coverages added Medical Expense Coverage does not apply. by endorsemeut to the policy. NO FAULT '- See Endorsement E-550(Illinois E 2.150)or Coverage D dappltcable. 10$S PAYABLE PROVISIONS (Applicable only if lienholder is named,and no other Automobile loss payable endorsement is attached to the policy) It is agreed that any payment for loss or damage to the vehicle described in this policy shall be made on the following basis: (1) At our option, loss or damage shall be paid as interest may appear to the policyholder and the lienholder shown :n die Dcclarations,or by repair of the da aged a elide. (2) Any act or neglect of the policyholder or a person acting on his behalf shall not void the coverage. afforded to the lienholder. (3) Change in tide or ownership of the vehicle, or error ui its description shall not void coverage afforded to die lienholder. The policy does not cover conversion,embezzlement or secretion of die vehicle by the policyholder or anyone acting in his behalf while in possession under a contract with the lienholder. A payment may be made to die lienholder which we would not have been obligated to make except for these terms. In such event,we are entitled to all die rights of the lienholder to die extent of such payment. The lienholder shall do whatever is necessary to secure Such rights. No subrogation shall impair die right of die lienholder to recover the full amount of its claim. We reserve die right to cancel this policy at any time as provided by its terms. In case of cancellation or lapse we will notify the lienholder at the address shown in the Declarations. We will give the lienholder advance notice of not less Than 10 days from tie effective date of such cancellation or lapse as respects his interest. Mailing notice to The loss payee is sufficient to effect cancellation. The following applies as respects any loss adjusted with the mortgagee interest only: 1) Any deductible applicable to Comprehensive Coverage shall not exceed $250. 2) Any deductible applicable to Collision Coverage shall not exceed $250. 91-1136 2ND EDITION 497 G02 11136231 Aug-28-03 09: 55A Hofs - d Insurance 94 12066 P - 02 T Policy Nu o1sos 3846 ACORQT CERTIFICATE OF LIABILITY INSURANCE 8128/12003 PRODUCER HOFSTAD INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3553 CANINO NIRA COSTA SZE G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SAN CLENaNTE, CA. 92672 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (949)661-6692 123 656 INSURERS AFFORDING COVERAGE INSURED PATRICIA SATHGATE INSURER FAIQER9 INSVRANC& EXCHANGE INSURER S PO SOX 217 INSURER C _ SAN JUAN CAPISTRANO, CA 9 675 INSURER INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAV E 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 ilEEN REDUCED BY PAID CLAIMS. II TSIRH TYPE OF INSURANCE LILY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ILIMITS GENERAL LIABILITY EACH OCCURRENCE SI,DDD,DDD A COMMERCIAL GENERAL LIABILITY 602196852 8/27/2003 0/27/2004 FIRE DAMAGE(Any PnA nre) a1,000,000 CLAIMS MADE OCCUR MED EXP IAnY_one PAnanJ $ PERS UMBRELLA PERSONALSAOVINJURY $ 1,000,000 GENERAL AGGREGATE 5.1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER ; PRODUCTS-COMPA)PAGG 51,DDD,000 POLICY 7 PRO- LOCJECT - - - - - AUTOYO&LE LIABILITY COMBINED SINGLE LIMIT 5 ANY AUTO IEa a..Ml ALL OWNED AUTOS BODILY INJURY A SCHEOULEDAUTOS 1399786 7 5/22/2003 11/22/2003 fpa'mraml- - s250,000 _ HIRED AUTOS BODILY INJURY 5500,000 'NONAWNED AUTOS IPAl accleenp PROPERTY DAMAGE $ 100,000 (Perawidanl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO 13 EXCESS LIABILITY EACH OCCURRENCE S F—J OCCUR CLAIMS MADE 'AGGREGATE s DEDUCTIBLE RETENTION $ S WORKERS COMPENSATION AND WC STAII} I OTH- 11 T RY ME(S:, EMPLOYERS'WBRITY EL EACH ACCIDENT E L DISEASE_EA EMPLOYEES _ EL DISEASE POLICY LIMIT E OTHER Cf) n DESCRIPTION OF OPENATIONWI.00ATIONSNEMCLESIE%CL ADDED BY ENDORSENENTISPECIAL PROVISIONS 10 DAYS NOTICE OF CANCELATION /V D--- m 0 D CD m CITY OF SAN JUAN CAPISTRANO AS ADDITIONAL INSURED —C_ VJ--- CERTIFICATE HOLDER lxll ADDITIONAL INSURE D;INSURER LETTER: CANCELLATION {� SHOULD ANY OF THE ABOVE DESCRNIED POLICId BE CANCELLED BEININA THE EXPIRATION CITY OF SAN JUAN CAPISTRANO J„y,15 GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR �W AIL DAYS WRITTEN CONNUNITY DEVELOPMENT AGENCY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 32400 PASEO ADELANTO IMPOSE NO OBLIGATION OR rBIUTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR SAN JUAN CAPISTRANO, CA 92675 REPRESENTATVES. AUTHORMED REPRESENTATN ACORD 25-S(7197) 0 ACORD CORPORATION 1988 Novy-05703 Q4: 27P Hofst Insurance 949C�066 P.02 LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO OMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Juan Capistrano,California 92675 ATTN: •A POLICY INFORMATION Endorsement# Insurance Company //h ✓ 1 n ;Policy Number 2 PolicyTerm(From) (To) ;EndorsementEffectiveDatefe 3. Named Insured 4. AddressofNamed Insured >. Limit of Liability Any 0 ie Occurrence/Aggregate $_ /�Ooor Doti / General Liabilir i Aggregate(Check one:) / Applie "per location/project" ✓ Is twit the occurrence limit 6. Deductible or Self-Insured Retention(Nit unless otherwise specified): $_ �O 7. Coverage is equivalent to: Comprehensive General Liability form GL0002(Ed 1/73) Commercial General Liability "claims-made" forth CG0002 8, Bodily Injury and Propery Damage Coverage is: "claims-made" "occurrence" If clai s-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: I. INSURED. The City and the Community Redevelopment Agency, 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 perforated by or on behal of the Named Insured, (b)projects 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.lnsured fur or on behalf of the City,or(b) projects sold y the Named Insured to the City;or(c)premises leased by the Named Insured from the Cit., the insurance afforded by this policy shall be primary insurance as respects the City, its elected or appointed officers, officials,employees or vo unteers; 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,emplo ces or volunteers shall be in excess of this insurance and shall not contribute with it SCOPE OF COVERAC E. This policy, if primary,affords coverage at least as broad as: III Insurance Servic s Office form number GL0002 (Ed. L73), Comprehensive General Liability Insurance and Insurance Servic s Office form number GL0404 Broad Form Comprehensive General Liability endorsement. or. 121 InWrance Servi es Office Commercial General Liability Coverage, "occurrence" form 060001 m "claim,- made" form CG 002: or, Novi-05703 04: 27P Hofs Insurance 9492066 P.03 (3) If excess,affor s coverage which is at least as broad as the primary insurance fomes referenced in the preceding sections(I)an (2). 1 SEVERABILITY OF NTEREST. The insurance afforded by this policy applies separately to each insured who is seeking coverage or aga nst whom a claim is made or a suit is brought, except with respect to the Company's limit of liability. 5. PROVISIONS RECAP DING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the City and the Community Redevelopment Agency, its elected ora pointed officers,officials,employees or volunteers. 6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspended,voided,cancelled,reduced in coverage or limits exci pt 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. INC112ENT AND Incidents and claims are to be reported to the insurer at ATTN: (Title) (Department) (Company) (Street Address (City) (State)` (Zip code) OU — elephone) D. SIGNATURE OF INSURER AUTHORIZED REPRESENTATIINSURER —(print/type name), warrant that I have authority to bind the below listed insurance company and by my signature lu reon do so bind t+signatur SIGNA REPRESENTATIVE (Originon endorsement furnished to the City) OROANIZAIION: D _ .may$ TITLE ►—Y44v, 't" �nQv— _.._---- ADDRESS: 355.3__cL���1IIs _[�.5,l�c` �TELE`P`HO�NF.:(el c(�k(Qf_(�.�� �JQ� (tifert�en < , CW 92Co1fp 09/17/2003 15: 45 805-52411 VILLA PK.OFFICE PAGF 02 COMM L IMS POLICY.COMMON POLICYTIONS F. NAILUS INSURANCE CANY " SCORadale, Arizona rIw Tnn19p1! N R°' Poll ' ND NC252859 N1wnW and Malting Address Tl tx CHV,rtamry,slat. -,Ip Cadtl)':' "s *ROVE SHRVtr:F - ;'- R ZAPATA Lip STAGE CUURT K CA 9,771 0000 ' 1p 1k� �tndMdjngAddressanCyNa. ^� 5_-0� :Torn of Chy,County.eh.19 LWt:ad4,I' . . YII BecuY1Cy Aurplur r >s,t Brokers - T3Xean STreer _ 0. CA 91101.• 211,x1 I. if Mi LI II. 11110;,FLAT CANCELLATION From 04rLW2001 to 04/1s/2atk' at IZ01 A.M.StUdal at your mallshown&Wvo. r ld6wriptlon. FARM [.ABdtd • TRACTOR 55' TeX»tete IN RETURN FOR THE OF THE PREMIUM,AND SUBJECT TO ALL TERMS OF THIS POLICY. WE AGRFO WOV TO PROVIDE THE INSURANCE STATE IS POLICY 61.+i THIS POLICY CONSISTS�E ROLLOWING COVERAGE PARTS FOR WI XPREMIUM IS INDICATED PROMIUM MAY BE SUBJECT TO ADJUSTM PREMIUM ILIpNrCld!General Liabilityll#f#so'Part 1 lt� t TOTAL ADVANCE PRI i Tax R Fee SaheduMr ..zz.p�.6pp.Sg tMinlmum &papo.l� .. IETAR6CE $ 3.,0 1 TAX 3% 4 TOTAL TAXIES$ f__.,,.,,.,,w145_31 r Iggbfp TAX 12$1-, itr� IS , I' f � 1,495.32 ( I,( (4 M1d EnUoreement(Q 1711110 0Irt W thlS POKY at time of Issue: -,� Poefet I:o t (12/99) Schedule of Forms and' raemrpt.c. eS•s ' I Paanden.a, CA RY_.�. 04/ apol 114M DECLMATI'N ECOMMON POLICY CONIxnONS,':OVFFIl PA/1T a COVEM015 PMT t4VERAt$ N F0eM(SI AND`MNIF A.NO 6 ENS$,IF ANY.•SVIJED TO;-- MT OFAI A I' TI IEgEOP• E 9 A90VL NUMb"D r+a. InNudaa Mlylyhlnd ""j"N inM bvN sC)R,—.I nr ll.h imWm04 v,., f;aPytl'h1,1 9aNltna C1PHx..Inc.tBn3.1964 OR I'CINAL " • 09/17/2003 15: 45 805-52411 VILLA PK.OFFICJ, PACT 03 l 71 pl I I _ }'fiLUS INSURANCE COMPANY r�TC'LpR's GROvS SEi � VXCTOR 7APATA SG,H S OAF_ FryORMS AND E_NOONOIN -- f L g� °q/g�+ Ca CulAt et PX' i m p 1 S __�. t u LLy0011, 04///DB) E7llFc1VE�.a9a1Cc.a"n Nu1[jeaF QI erL Lidb i /Oli Flc R neDaCiem.Ter^Or 11,0 cvg 12/0. y�(7 Part Dec ±. ° °3 4tiL cogeraga Form -Rf 1g0F(}f xc),�Y2K C resat er-Other. . . 2069 tp�%� Mer or TeX'rotism e�c01 - 170 U to T rrOr°m xCl Carr. ActC. : 3 „t rem cod 06 64/99 : 8%C R1asv]]fiCcation 1AMILAtian , 07 0i./ CoaprRc:yLual 1 yimi at ion �. 072 04/97 005, iA In``� On S. �XP 038 a2/ f1t o'F L1Quor LLX%% Fxcl 9955577 Ia,�64xc1 Conde 8SS O4�99 %C-.' LOad Co 0tamination p92417 0 /99 Sm Oil pp{4I{.. COv raqa JJ ° C -M1 CYO.BS OIQCr�-bnt a, �o� 6z� z cr>nu Sz j4CA 8ero,ce of, Suit •dii; 0'tl 'r'; CA. Notice S l l i i i p � 1 'r . iild ' iyt I a 7 I ` I 11 rISOELLANEOUS FORMS APPLIC nlw; r . y m ei All other Foes end Erdereel of 111:1`Al1 Cy Reeeie OncM'q!d• f 09/17/2003 15: 45 805-524- 411 VILLA PK.OFFICE PAGE 01 960 aro Street Fillmore, CA 93015 Villa Park Orchards Fax# 805-524-5912 Office 805-524-0411 Fax SSW et nr7 er— /t 4,111� qq 7b: S h �,✓W- &- Fac l 7 ��'f c/3 Pages: -3 Phone: y / —Zy (p3�1� Data: M7110 i Re: CC: ❑ Urgent or Review ❑ Please Comment ❑Please Reply ❑Please Recycle Lia Z�X Nov-05-03 04: 21P HofstInsurance 9496066 P-01 Date: 11/05/03 FROM: HOFSTAD INSURANCE AGENCY Phone(949)661-6692 Fax(949)661-2066 Email is hhofstad(i),formersa¢ent.com No.Of Pgs including this cover page 3 TO: CITY OF SAN UAN ATTN: MEG MONAHAN RE: LIABILITY ENDORSEMENT FOR PATRICIA BATHGATE I WILL SENT THE ORIGINAL OUT IN TODAYS MAIL. IF YOU NEED ANYTHING ELSE OR HAVE ANY QUESTIONS PLEASE LET US KNOW. THANKS JERI Fax(949) 493-1053 3553 Camino Mira Costa,Ste G San Clemente,CA 92672 FARMERS ex/-) "g-a0l, rv� G l /11 G7Z Jsee � • 11� 32400 PASEO ADELANTO A7 I MBpppD SAN JUAN CAPISTRANO, CA 92675 • ieMEMBERS1961 MEMBERS OF THE CITY COUNCIL (949) 493-1171 1776 DIANE L BATHGATE (949)493-1053 (PAX) JOHN S.GELFF wirer.sanjuancapistran o.org WYATT HART • • JOE SOTO DAVID M.SWEROUN .3`CITY MANAGER GEORGE SCARBOROUGH t July 28, 2003 Pat Bathgate P.O. Box 217 San Juan Capistrano, CA 92693 RE: Compliance with Insurance Requirements - Overseer Services, Swanner Property The following insurance document has expired: I General Liability Certificate 1/8/2003 Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office,32400 Paseo Adelanto,San Juan Capistrano,CA 92675 as soon as possible. If you have any questions, please contact me at (949)443-6310. Sincerely, Mc3 G � ONt -"-L� � DD, Dawn Schanderl )P n Deputy City Clerk dot �� 11 U 'kn cc: Diane Regier rI �� ,yu U" lc. Ct tL-to C�dI DRUG USE n San Juan Capistrano: Preserving the Past to Enhance the Future s Maria Guevara To: Jack Galaviz Subject: RE: Insurance-Pat Bathgate -----Original Message----- From: Jack Galaviz Sent: Wednesday, November 05, 2003 11:22 AM To: Maria Guevara Subject: RE: Insurance-Pat Bathgate Thanks chula.....I will contact her. Jack Galaviz Ext, (6364 ) -----Original Message----- From: Maria Guevara Sent: Wednesday, November 05,2003 11:19 AM To: Jack Galaviz Cc: Diane Regier Subject:Insurance-Pat Bathgate Hi Jack, FYI - her auto insurance will expire on 11/22. 1 didn't send her a reminder letter since she is on the non-pay list. Thanks Maria 1 MEMBERS OF THE CITY COUNCIL DIANE .BATHGATE S. JOHN MATT HART L JOE SOTO 32400 PASEO ADELANTO /L' le(IIIe111U DAVID M.SWEROLIN SAN JUAN CAPISTRANO, CA 92675 FSlll0S10 1 10 (949) 493-1171 1776 (949) 493-1053 (FAX) 0 INTERIM CITY MANAGER lvlvw sanjuancaprstrano.org PAMELAGIBSON October 20, 2003 Pat Bathgate PO Box 217 San Juan Capistrano, CA 92693 RE: Insurance requirements: SJ Community Task Force and Pat Bathgate/Swanner Ranch Dear Pat: Thank you for calling today. As promised these are the current needs for the agreements listed above. San Juan Community Task Force: Enclosed is a copy of the Certificate of Insurance and of the Endorsement, naming the City of San Juan Capistrano as additional insured. Please provide updated forms when the insurance is renewed. Pat Bathgate — Overseer of Swanner Ranch Please provide a liability Endorsement, naming the City of San Juan Capistrano as additional insured. Also note — On November 22, 2003 —when you Auto liability insurance expires, please provide a new Certificate of Insurance for that renewed policy. Thank you, Meg Mon an, MC City Cl oxuo� n San Juan Capistrano: Preserving the Past to Enhance the Future =DT n ACORDERTIFICATE 0 LIABILITY INSURANCE THIScERTIF1enrE,s,sBUEDASA MATTER OF INFORMATIO Walcher Tns- a •039403 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFKATE Relthar InauranD HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 109 E. Eacalon�s ALTER THE COVERAGE AFFORpED OV THE POLICIES HELOW- San Cly me CA 92672 Phone_ 949-492-7007 Pas: 949-492-7538 INSURERS AFFORDING COVERAGE NAIL! 'naxPEu s+ana+� Travelers Casaalt and RIxIwER a 9ln Juan Coam Task F.D. weM€.wC San211]ha Capistrano CA 92675 walsrcw o: wsuREwE: COVERAGES YNE POLICIES OF RISURANCE LISTED BELOW NAVE BERN 185UE0 TO THE INSIIREON D AROVE FOR ME POLICY PERIOD INDICATED,NOTWilH9TANDIA'O ANY REOUIRIWFNT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WNICN TR ISCERTIFICATEMAYBEIS rOOR MAY PERTAIN.THE iM9 KANCE AFFORDED BY THE POLICIES DE6CRIRED HEREIN Is 9UBJRCT TOAll THE,ERMS.EYCLUSIONS AND CONOITIONS OF SUGH POLICIES-AGGREGATE LWITS SHCIMV NUY/AVE me"REDUCED 8Y PNb CWNS. L TYwp o/ FODcr WNYlx /Qtly lac+ni .oYOY RYIwYlIX1 bMfi wlReaYt NxILLIT• OLrF P. HC 0-11R: S 1000000 A 2 COM10.iicwLVENERFL4M ¢60-33022265 11/08/02 it/DR/03 PRE s Sx=WR'G s 100000 GJIRi R.DE OxLTn xRD YJP Wxwplwxq s 5000 FPAMWI-..Ovr•xRr s 1D0000u fbxeRA.RCREVLTE s 1000000 DEN'LAccnEaFie LNRMPUES PEw PROJIA:iB-CON`1OPAOV s 1000000 ]c PUucr � we aR=.tobRR.'.atm s TNrlx,ro iE.camwlswDlE UNT NLUWIIEOMR09 BMpiOWN"INSFry ec11CIXllEP.bT09 INlvj S HREV AUT06 nOtVLYNNM S N41OVAiLD A?OS !W w'OYI'p FP�Ir b.INOE s buYp{LMpIIJTY GIRO MLrPw a:R1O/M S .Nrwro onfn TVw EArrs S µ(M OILY .GG R•�ccSRIMPPELYLPHLITY PJLH OCOISIIaNCG T OCg6 �I". .�W'OE .bWIEMTE t s DEDV'-fnlll' i REiFxron t M41YgW CYMIRIprIbNlNo nTu. OIry L wLbnw•taxlurY e L E.uI rccnENr s Nw rATPaETDRIP.1+rIJEf+IP'EcbIHR o/FL'aiwRRxpi vcLuocw e.L asEAse-EA EwtoreR s �a..xe.vas MLPRGN91CN8eeIWI E.L.asENxe-POWY{M S OTNOw OB{OP'PflVil O![IPFwLIgIIf ILOOATWNw1 VRIIIG.Fi I RCLVNOM IppFo xYiwpoRCFNBNr Ii/BORLIwONLORL Ce ti.Pioaee Holder i¢ named as an Additional Insured with respects >•o Ramal of City Space. CERTIFICATE HOLDER CANCELLATION _ s��� ixwlLx.xr MTI'F.xbW x•ixwaxR m.lco xc uRonLw wAII.TIIi Iwx/wrwn o.Tw TRFwcoI,TnFnc'MIGI NNI'wLw WRLWMWwR TR NNt 10 prS wwlTrFN xxnai rn Trr RiarFwri RaLocwwrRRp Ta rRF.'<r,BUT IwLwE TR w w wIiLL City or San Juan CaPiatrano IxroiRlooBLNxroN altwxxm oFlw•AMDIRVII TRE w•xw•Rm/ailsxi w. Atte: City7,Aa•s OfSioe eo Ade 32400 Paslanto �•'�/�'•• Saa Tv n Capistrano CA 92675 I"RRa'�w•N^6 NT•T^'E �A _ �/1 ACORD 25(]OOT/0810 ACORD CORPORATION IBM COMMERCIAL GENERAL LIABILITY POLICY NUrNVORSEME --13' c2265-TIL-02 ISSUE DATE: 10-24-02 THI RANGES THE POLICY. PLEASE READ IT CAREFULLY. CHA ST-AMENDMENT OF COVERAGE --- WHO IS AN INSURED This ndorsemeni m difies Insurance provided under the following: IAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization (Additional Insured): CITY OF SAN JUAN CAPISTRANO Designation Of Premises (Part Leased to You) PER SCHEDULE ON FILE WHO IS AN INSURED (Section 11) is amended to tion. In consideration for funding or financial m include as an insured: contributions you receive from them; A. Your members and volunteers but only with s. The ownership, maintenance or use of that respect to their liability for your activities or ac- part of a premises leased to you; or tivities they perform on your behalf; q- "Your work'for that Insured by or for you. B. Your trustees or members of the board of gover- nors while acting within the scope of their duties As respects Part C.a. shove, this Insurance does as such on your behalf; and net apply to: C- Person(s) or organization(s), whether or not (a) Structural alterations, new construction or demolition operations performed by shown In the Schedule above, but onlywith or on behalf of the person(s) or organlza- respect to their liability arising out of: tion(s); or 1- Their financial control over you; (b) Any "occurrence" which takes place after z. Their requirements for certain performance you cease to be a tenant in that placed upon you, as a non-profit organlza- premises. GN or as of ss Copyright. Travelers Indemnity Company. Page t of 1 003986 Appendix C—Insurance Forms IPOLICY NUMBER: COMMERCIAL GENERAL LIABILITY 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 ollowing:COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: 1 (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 work"for that insured by or for you. 1 CG 20 SO 1185 Copyright, Insurance Services Office, Inc. 1984 ' California JPIA Contract Guide 131 - Ayuy-co—LJ.1 v7 :aara no aa -insurance .. y bbi-Lubb r .uc Policy r: 015053846 ACORD,o CERTIFICAT OF LIABILITY INSURANCE 9129/2D03 PRODUCE* FSTAD INSURANCE AGENCYTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3553 CAMINO MRA COSTA S G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SAN CLMONTE, CA. 92672 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (949)661-6692 123 L56 INSURERS AFFORDING COVERAGE --- _-- EISURED PATRICIA HATNGATE _. .. __._— -- INSURER EAIB'ERB IN9UPANCE E7[CEANGE INSURER B PO SOX 217 INSURER C. SAN JOAN CAPISTRANO, CA 9Z67$ I INSURER D. _ INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAV E 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 T POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE EEN REDUCED BY PAID CLAIMS. maTYPE OP INSURANCENUMBER POLICY EFFECTNE POLICY EItPPAl10N DMRS LTA, GENERAL LIAMUTY i EACH OCCURRENCE 51,000,000 A COMMERCIAL GENERAL LIAMUTY 6021969 2 8/27/2003 8/27/2004 FIRE DAMAGE(AM one MJ 51,000,000 _ CLAIMS MADE Ix OCCUR MED E%P(Ay om"mn.) i PERS UK3RELLA -- - 1,000,000 PERSONAL SAWINIURV S �- GENERAL AGGREGATE -- $1,000,000 GEN.L AGGREGATE LIMIT APPLIES PER PRODUCTS-CGMP.OPAOG $110 0,000 POLICY PRO- -... LOC —._ JFCT AUTOMOBILE UAI LITY COMSMED SINGLE LMR 5 ANYAUTO - (EAe M) ALL OWNED AUTOS A _ scHEouLED AUTos 139978617 5/22/200 11/22/2003 (�PeFM»n LY INJURY $250,000 1HwREDAUTOS BODILY INJURY 5500,000 NON-0WNEDAUTOS (P�recDEeM) PROPERTY DAMAGE 5100,000 (ParxdtleM) GARAGE LMIBLITY L AUTO ONLY-EA ACCIDENT S -_—_ ANY AUTO OTHER THAN EA ACC i _ AUTO ONLY: AGG S EXCESS UABRITY EACH OCCURRENCE S OCCUR 'CWW MADE AGGREGATE 5 DEDUCTELE i RETENTION $ WORMERS COMPENSATION AND WC STA OEp _- EMPLOYERS'LABILITY (I l„S{IL,/� �� T E.L.EACH ACCIDENT S E L DSEASE_EA EMPLOYEE S 1b E.L.DISEASE-POUCYLR S OTHER DESCPoPTION OF CPEMTIIONIM=ATIONSNENICLEWEXCLUSM NS ADDED.BY ENVORSEMEMTATPECIAL PROVISIONS c— )> 10 DAYS NOTICE OF CANCELATION Ila 0 D 00 PTS CITY OF SAN JUAN CAPISTRANO AS ADDITIONAL INSURED �m CERTIFICATE HOLDER ADgTNxAL nAiUR D;wsuRER LETTER: CANCELLATION I� CITY OF SAN JUAN CAP19 O SHOULD ANI.OF THE ABOVE OESCRIBED POLIO BE CANCTUED i IW THE EXTION DATE THEREOF THE MSIANG NISURER WILL ESDEAVOR AIL_ PAYS WRITTEN COMMUNITY DEVELOPMENT AGENCY NOTICE TO THE CERTIFCAM HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 32400 PASEO ADELWTO MPOSE NO OBLIGATION OR ABILITY OF ANY NINE UPON THE INSURER, 95 AGENTS OR SAN JUAN CAPISTRANO, CA 92675 REPRESENTATIVES. AUTHOREEDREPRESENTA ACORD 25-5(7197) 0 ACORD CORPORATION 1908 MEMORANDUM TO: Jack Galaviz, Public Works Manager FROM: Meg Monahan, CMC, City Clerk 0--- RE: Swanner Ranch — Pat Bathgate as Overse br DATE: October 17, 2003 Jack — I bring this issue to your attention because you have oversight for this agreement. Pat Bathgate has not met the insurance requirements the contractor/overseer of the Swanner Ranch. She has had her various subcontractors, such as the picker, sprayer, and other, forward insurance documents (which don't meet our specifications anyway), instead. John Shaw confirmed that the insurance needs to be in the contractor's name, not the subcontractor's names. Pat's General Liability insurance expired January 8, 2003, the automobile liability expired February 22, 2003 and we also need an endorsement form naming the city as additionally insured. At this point, we need you, as project manager, to get involved and assist her in getting her insurance into compliance. As you probably know, we are very short staffed and have also taken on more responsibilities, inherited from Mechelle and Cristi. I have attached copies of sample documents she need to provide and the agreement terms that apply to insurance requirements. Cc: Amy Amirani, Public Works Director r 3 . Contractor's Responsibilities Beyond Sco a of Work. a. Any other work or labor required in the performance of the tasks enumerated in q 2 shall be provided by the City by separate agreement with that employee or contractor. b. Any work or responsibility required of Contractor by the City, beyond that set forth in q 2, shall also be set forth in a separate written agreement signed by both parties. C. The cost of materials, repairs and replacement of tools, equipment, machinery and vehicles shall be borne by the City and paid upon presentment of invoice(s) . 4. Responsibility of City. The City shall, through its Director of Public Land and Facilities, provide: a. A written statement of the duties and responsi- bilities of Ignacio Lujano. b. Written directions, criteria or specifications, if any, relating to Contractor's Scope of Work. 5. Relation of Parties. The relationship between City and Contractor shall be that of an Independent Contractor; Contractor shall, accordingly, have the right and authority, independent of the City, to: a. Establish his own work schedule. b. Establish, at his sole cost and expense, such office and office equipment and supplies as he may deem necessary for the fulfillment of his contract with the City. 2 6. Compensation. a. Contractor has been paid the sum of $9,800 for services performed from May, 1992, through June, 1993. b. Contractor shall be paid the sum of $700.00 each month commencing on July 1, 1993, and continuing for the duration of this Agreement. C. Compensation for any work in addition to that set forth in 1 2 shall be by separate agreement. 7. Liability Insurance. Contractor shall, at his sole cost and expense, maintain a policy of general liability insurance insuring his acts and activities (including motor vehicles) under this Agreement in an amount of not. less than $1,000, 000.00 Combined Single Limit. A certificate of such insurance, showing the City as an additional insured, shall be delivered to the Director of Public 1 Land and Facilities within fifteen (15) days after execution of this Agreement by the City. 8. Certification of Non-Existence of Conflict of Interest. Contractor certifies, to the best of his knowledge, that: a. No City/Agency employee or office of any public agency connected or involved with this Agreement has any pecuniary interest in his business. b. No person associated with him has any interest that would conflict in any manner or degree with the per- formance of this Agreement. C. He has no interest and shall not acquire any interest, directly or indirectly, which would conflict in any manner or degree with his faithful performance of this Agreement. d. He is familiar with the provisions of SS 87100 et seq of the California Government Code, and that he does not know of any facts related to his performance of this Agree- ment which would constitute a violation thereof. 9. Binding Effect. The entire agreement between the City and Bathgate for the management and overseeing of the Swanner Property is contained in this document. Any changes or amendments must be in writing signed by both parties. The terms contained shall, moreover, inure to the benefit of and be binding upon the successors and assigns of City and Bathgate. IN WITNESS WHEREOF, the City and Bathgate have signed this Agreement as of the date first above written. Cit of San an Capistrano 414 a(IQz� William A. Bathgatty 3 r ' �) C SPl L R 9��NI15FS'rb , P`[ ^f 11-11 - S , .a.. .... ...n. ACORDYEtC� TE� ?Fst: ABUT ���t'3� A�Ci gabya� u DATE(MM DD .°ara ra fi.a. MRA, .„,n.�n�.,M .z,t,S,J.: PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC, HOLDER. THIS ISERTIFIGATE 9966 NOT AMEND, COMPANIES AFFORDING COVERAGE COMPANY A INSURED COMPANY B COMPANY C COMPANY D xv. � �..oaaaa. 'u,c.3,r.,ra-e �a ..a P.r. ,,c¢ri'�`Y°i.�it ,a,. .v�»• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERM INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERI, 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/DDNY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGS $ j CLAIMS MADE OCCUR PERSONAL 8 ADV INJURY $ OWNER'S$CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one lire) $ MED EXP(Any one pewonl S AUTOMOBILE LIABILITY ly ' ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY !'I iPeery person) S SCHEDULED AUTOS 'I HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITYAUTO ONLY-EAACCIDENT $ NN I ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM ' AGGREGATE $ OTHER THAN UMBRELLA FORM S li WORKERS COMPENSATION AND Li WC STATU OTH - M EMPLOYERS'LIABILITY ' EL EACH ACCIDENT S THE PROPRIETOR/ INCL I EL DISEASE-POLICY LIMIT $ 111 PARTNERWEXECUTIVE -'1! OFFICERSARE: EXCL EL DISEASE EA EMPLOYEE S . i OTHER I I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS C I, MAO MAOLE3ER> s.:” , v? € s'.. CANGa GLA7ICSN .,. , .,.,a'. .o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENBEAVQA—iV DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE I 11 -1 A -11-Ii Ii...66 MPOSE 119 986MGANQ Is -aleffs OR REP� AUTHORIZED REPRESENTATIVE I� $OftKIM =' '�3& y .ro. ilQil {IK .:. Appendix Forms IF POLICY NUMBER: COMMERCIAL GENERAL LIABILITY 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. SCHEDULE Name of Person or Organization: (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 work"for that insured by or for you. ( �j t PII I i r i CO 20 10 1185 Copyright, Insurance Services Office, Inc. 1.984 California JPIA Contract Guide 131 Jaw* r NL MEMBERS OF THE CITY COUNCIL DIANE . LFF ETE JOHN WYATT MART �(� JOESOTO 32400 PASEO ADELANTO /N IOtO H"Itt DAVID M.SWERDLIN SAN .JUAN CAPISTRANO, CA 92675 lDIIIIBIII 1961 (949) 493-1 171 1776 (949) 493-1053 (FAX) INTERIM CITY MANAGER tvtvtv.sanjlancapistrano.org PAMELAGISSON FAX TRANSMITTAL TO: Dwight Holcomb FAX — 909-371-7164 FROM: Meg Monahan, City Clerk RE: Swanner Ranch — Pat Bathgate — Insurance requirements DATE: October 14, 2003 Pat Bathgate requested that I forward this information to you. Please find attached: • Example of insurance certificate required under the city's agreement with Pat Bathgate regarding the Swanner Ranch • Example of an "additional insured" endorsement form. The City of San Juan Capistrano agreement with Pat Bathgate requires that a minimum of $1,000,000 general liability insurance, insurance his acts and activities (including motor vehicles) and an additional insured endorsement, naming the City of San Juan Capistrano as additional insured, be in force. A certificate of insurance & the endorsement form, must be submitted to the city to provide proof of this coverage. This insurance certificate may be faxed — attention: CITY CLERK to (949) 493-1053, with the original, signed certificate mailed to the city clerk. Cc: Pate Bathgate �J San Juan Capistrano: Preserving the Past to Enhance the Future MEMORY TRANSMISSION REPORT 1 TIME OCT 14 '030:01 TEL NUMBER 949-493-1053 NAME CITY SSC NBR FILE DATE TIME DURATION PGS TO DEPT NBR MODE STATUS 761 32 OCT. 14 15:00 01/22 3 19093717164 EC M OK dMEMBERS OF THE CITY COUNCIL DIANE L.BATHGATE "/✓ JOHN S.GELFF WYATT HART JOESOTO 32400 PASCO ADELANTP IIDIIIIIiIp DAVIDM SWF.RDLIN SAN JUAN CAPI$TRANP,CA 9$675 Dintlflll I 1961 (949)493-1171 1776 (949) 493-1053 (FAJO P INTERIM CITY MANAGER I v rvI v.,vagi uancapislrpnn.arg PAMELA GIBSON FAX TRANSMITTAL TO: Dwight Holcomb FAX-- 909-371-7164 FROM: Meg Monahan, City Clerk RE: Swanner Ranch — Pat Bathgate -- Insurance requirements DATE: October 14, 2003 Pat Bathgate requested that I forward this information to you. Please find attached: • Example of insurance certificate required under the city's agreement with Pat Bathgate regarding the Swanner Ranch • Example of an "additional insured" endorsement form. The City of San Juan Capistrano agreement with Pat Bathgate requires that a minimum of $1,000,000 general liability insurance, insurance his acts and activities (including motor vehicles) and an additional insured endorsement, naming the City of San Juan Capistrano as additional insured, be in force. A certificate of insurance & the endorsement form, must be submitted to the city to provide proof of this coverage. This insurance certificate may be faxed — attention: CITY CLERK to (949) 493-1053, with the original, signed certificate mailed to the city clerk. Cc: Pate Bathgate ACORD �ERTIFtCATE 10 ,0ABILITY..I IN 14ANCE DATE(MM DD Y) r PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. _ COMPANIES AFFORDING COVERAGE r COMPANY --- —� — --_— -- A INSURED ii COMPANY B 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 POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DO/YY) DATE(MM/DDNY) LIMITS GENERAL LIABILITY I GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP All $ CLAIMS MADE ❑ OCCUR PERSONAL INJURY $ ER &CONTRACTORS PROT EACH OCCURRENCE $qolwNS $ FIRE DAMAGE(Any one fire) S MED EXP(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $— ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS j (Per awdenQ PROPERTY DAMAGE $ j`GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY'. III--III EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM . AGGREGATE $ OTHER THAN UMBRELLA FORM $ WC U STAT WORKERS COMPENSATION AND TQEY (MIT j OTH- ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR( ��I INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE -- - I OFFICERS ARE El EXCL EL DISEASE EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS EHICLES/SPECIAL ITEMS CEfi71FICA7 HgLCiEI CAMGELLA7EnN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL EHBEAVGR—i0 MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, AUTHORIZED REPRESENTATIVE F---000" 9 7196 s ACCRA GORPpFfRTtON 1988•�l • • Appendix C—insurance Forms POLICY NUMBER: COMMERCIAL GENERAL LIABILITY 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. SCHEDULE Name of Person or Organization: (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 11) 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 work"for that insured by or for you. y CG 20 30 1185 Copyright,Insurance Services Office, Inc. 1984 California JPIA Contract Guide 131 City o�f San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA. 92675 (949) 493-1171 Fax: (949) 493-1053 Q /FAX TRANSMISSION COVER SHEET Date: 1 To: Fax: Sender: YOU SHOULD RECEIVE-PAGE(S), INCLUDING THIS COVER SHEET. IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CALL (949) Maria Guevara From: Maria Guevara Sent: Sunday, October 12, 2003 11:01 AM To: Diane Regier Subject: Insurance Hi Diane, Pat Bathgate's Auto Insurance will expire on November 22, 2003. I'm not sending her a letter since she is already on the Non-Pay List since forever. Maria Dawn Schanderl To: Dottie Shaw Cc: Jack Galaviz; Kathleen Springer Subject: Pat Bathgate Pat Bathgate has provided the required insurance per her agreement with the City. Please release any checks if holding. I will take off Excel and Bathgate on the "formal" nonpay list at the end of the week. Thanks! . ► t;3 A GROVE SERVICE F^IJAMOOK,cA 900*8 Ffl�X��/VV�07.�22 (y/���" :�� To: DgwN From: A & A GROVE SERVICE Date: 7 /0 3 CC. Fie: NO.JW PAGES TnANSMITTED: 2— MESSA R: y�y �,e/�- Z`�.S�vrA nG� ,(�-!�47���R• C< lit/ LQ,vT— CORD CERTIFICATE LIABILITY INSURAN DOAZ o< os : .RooutxlL THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION DE Mitt Insurance Services a ONLY AND CONFERS NO RNEHM UPON THE CERTIFICATE 001 fast OSI. Avenue HOLDFFL T14M CERTIFICATE DOES NOT AMEND, IDITKNO OR Escondido CA 92025 ALTER THE COVERAGE AFFORDED 6Y THE POLICIES BELOW. Ti0-7A7_959i INSURERS AFFORDING COVERAGE INauReo JESUS AVINA .- WaLWA& ALLIED INSURANCE COMPANY A i A OWE SERVICE INSURER a, P.O. OOX Uig IN VIER C. FALLMRWK G 92028 e4URERD. E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TME POLICY PERIOD WO RATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE MUEO OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EICLUSIONS AND CONDITIONS OF SUCH POLICIES-AGGREGATE UNITS SHOWN MAY HAVE BEEN REDUCED BY PND CLAIMS. Wall-.F TTFe 0/INaYRANCf POLICY NYMMA Y LIUM D[NNMLLAWLITY _ E101ODCUARENCE s 1 000 000 X COMMEACRLUENERALLLAEEITY rat DUMC[ a1UANJ • 100 990 �IMSMADE o DCCARI NEDEV om awl a 6 N=O FPK 7E0oi97317 05/01/2002 05/01/2003 PEIeoHAL&ADVNAXW a 500 000 GENERAL ADOPUMTE a $".a" GENT.AOOREOATt LRSE6 T APPUPER: FRODUCTE•COMP OPAOG 9 1 000 000 Y rout lx ADTOAIONLL'LIMNATY COMRINFO N'AOLEUINT AN mTO MR-.90-4 • 500,000 ALLOWNED AUTOS Boot Y SCHEDULED AUTOS ISN•■NODI s A X HwDAUwS FPK 7000697117 05/01/2002 06/01/2007 HOULY PU ARY X NONOWNEOAuTOS O�am1aY10 PROPERTY OHMAGE a �ssAAMq OAIMDE LIAEIDTY AUTO ONLYFAACODENT a ANY AUTO OT/EA TYNN EAACC • AUTO CMLY: AAD a OLC[N LMDIUTY EACH OCCURRENCE a OCCU11 CLAIMS MAGE ADGAROATE a RETENTION [ I ra WORSNIS COYMNMYNRM AND larMal EMPLOYERS-UAINTY Ll.L EACH ACCIDENT • IF DISEASE-EA a fiL RgFAEE-FLLLYIANT • OTHER 1 DFMC NON Or WNMYIOWAD[A1ilONWEH1Cl[aIQCLWIOIN ADDED BY INADI KNTMMCIAL PROVISIONS :ERTIFICATE HOLDER ADDITIONAL IWWAID;IRSNRER UTTEAI CANCELLATION SHOULDANYOF THE ANOV■EEICIMM POUDISeRSCJINIlM1p EEFORS/NE ENPIRLYHm OATH THEREOF,THE IMUS DENVER VER MNL ENDEAVOR TO SNL_��OMM RROTTNI M1TN� COOIUNTY FINE PROTECTION DISTRICT NOTICE TO YRS cmIFN;ATE HOLIER NAMED TO THE LEFT.OUT PANISE TO DID ED SMALL �A510N00K� L G 92028 IRIDOa[NO ONBOAYIDN DR LNINLIry OF ANY WHO IANIN THE u1EINISw,m ADENTa OIL REFRRSENTATRRa, A MME %CORD 25.8(7/97) 0AC NOMPIORKT14M TME Jan-08-03 03 : 27P Hofstad Insurance 9496612066 P - 02 Ask PoKLy NUMDer: 015 Dae4e ACORD CERTIFICAT LIABILITY INSURANC I/Biz 03 PRODUCER ROFSTAD INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3553 CANINO NIRA COSTA STE G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SAN CLEIaNTE, CA. 92672 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (949)661-6692 123 4 i6 INSURERS AFFORDING COVERAGE IxSURED PATRICIA 13ATBGATE INSURER_A PAFIMRe INSURANCE XXCKANGS -- INSURER B PO BOIL 217 INSURER C— - - _— SAN JOAN CAPISTRANO, CA 92 75 NSURERD. _ INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAV BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI A7 O TANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY ONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT MA QLBBE ISS R MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,F�(CLUSI0 COmOITION SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE EEN REDUCED BY PAID CLAIMS. VV�� TYPE OF INSURANCE .__ ICY NUMBER 7P .-._—. MISR �...—. _—__ .—. --_ POLICY EFFECTNE POLICY EXPIRATON YITB GENERAL LIABILITY EACH OCCURRES I 000, A _COMMERCIAL GENERAL LIABILITY 01505'536 6 1/8/2002 1/8/2003 'i FIRE DAMAGE IAny ohKra) , f 1000,000 ]CLAIMS MADE X OCCUR _ _ MEDEXP(Anyone _ $p PERE IIIBRElw 000,000RSONALADV Nm $1, GENERAL AGGREGATE $ 1,000,000 .ENL AGGREGATE LIMIT APPLIES PER PRODUCTSCCMPlOP AGG $1,000,000 PIXJCV PRU LOC —. . LAUTOMOMLE IUBILITY COMBINED SINGLE UMrt $ ANY AUTO REN accitlenll ALL OWNED AUTOS BODILY INJURY A SCHEDULED AUTOS 1399786: 7 11/22/2002 5/22/2003 (Per pmn) _ 1$250,000 4 HIRED AUTOS ODDLY NJURr $ 500,000 NON-OWNED AUTOS Pu awCenq ---- -- PROPERTY DAMAGE $100,000 ' �(Per a nEenl) GARAGE ILIABN-ITY A_UTOONLY-EAAOC(DENT E -- ANY AUTO OTHETHAN EA ACC $ AUTO UTO ONLY. AOAGG $ EXCESS WT"BILEACH OCCURRENCE _ ITf__ _ OCCUR L_I CLAIMS MADE AGGREGATE _ E _ DEDUCTIBLE _ RETENTION $ VVORKERS COMPENSATINI AND WC STA,W T IDRS H- EMPYELIABILITY TORY 6_ EL.EACH ACCIDENT f EL DISEASE-EA EMPLOYEE $_ ! E.L.DISEASE-POLICY LIMB f OTHER DESCRIPTION OF OPERATIONSILOCATION&VBSCLEWEIRCLUSI NO ADDED TY ENDORSEMENTNSPECIAL PROVISIONS 10 DAYS NOTICE OF CANCELATION CITY OF SAN JUAN CAPISTRANO AS ADDITIONAL INSURED CERTIFICATE HOLDER ADDITIONAL IN D: INSURER LETTER: CANCELLATION SHDULD ANY OF THE ABOVE DESCRIBED POLICIES M CANCELLED BEFORE THE EXPIRATION CITY OF SAN JOAN CAPIS O 30 DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 WRRTEN CONNIMITY DEVELOPMENT NCY NOME TO THE CERW CATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 32400 PASEO ADELANTO IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR SAN JOAN CAPISTRANO, CA 92675 REPRE6TirtATIVEs. AVTHOII�O REPRFSENTATNE ACORD 25.5(7N7) 0 ACORD CORPORATION 1988 Jan-08-03 03 : 26P Hofstad Insurance 9496612066 P . 01 Date: 01108/03 FROM: HOFSTAD INSURANCE AGENCY Phone(949)661-6692 Fax(949)661-2066 No.Of Pgs including this cover page 2 TO: DAWN SCHAND RAL RE: LIABILITY INSUR kNCE FOR PATRICIA BATHGATE IF YOU HAVE ANY QUESTIONS OR NEED ANYTHING ELSE PLEASE LET US KNOW. THANKS, JERI Fax (949)493-1053 3553 Camino Mira Costa,Ste G San Clemente,CA 92672 FARMERS Jan-20-03 04 : 12P Hofstad Insurance 9496612066 P . 01 LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Juan Capistrano, California 92675 ATTN: DAu)N_ 5ovHANAF_ til A POLICY INFORMATION Endorsernerng 1 Insurance Company =/� LtU ;Policy Numb r 2 PolicyTerm(From) .� 3 (To) i i0 `;Endorsement Effective Date 3. Named[nsured , 4 Address ofNamedInsured .2q3/ in 1is{iaho ,SAdJ JWgN Qt7f3iST,FA,eJO _ 5 Limit of Liability Any Die Occurrence/Aggregate S r 000r ons oaoi o00 General Liabilitv Aggregate (Check one:) Applie "per location/project" ✓ Is twit the occurrence limit n. Deductible of Self-Insur d Retention (Nil unless otherwise specified): 5 �25D Coverage is equivalent t Compr hensive General Liability form GL0002 (Ed 1/73) Comm rcial General Liability "claims-made" form CG0002 8 Bodily Injury and Property Damage Coverage is- claims-made" V "occurrence" If clai s-made, the retroactive date is B POLICY AMENDMENTS !'his endorsement is issued in consideration of the policy premium. Notwithstanding any inconsistent statement in the policy to which this ndarsenri !s arached or any other cradoi sement attached thereto, it is agreed as follows. I INSURED. The City anc the Community Redevelopment Agency, its elected or appointed officers,officials,employees and volunteers are inch ded as insureds with regard to damages and defense of claims arising from; (a) activities performed by or on beha f of the Named Insured, (b)projects and completed operations of the Named Insured,or(c) premises owned, leased r used by the Named Insured. CONTRIBUTION NO REQUIRED. As respects: (a)work performed by the Named Insured for or on behalf of the Qry, or(b) projects sold iy the Named Insured to the City, or(c)premises leased by the Named Insured from the CitN, the insurance afforded by this policy shall be primary insurance as respects the City, its elected or appointed officers, officials, employees or v lunteers;or stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coq rage. In either event, any other insurance maintained by the City, its elected or appointed officersofficials, emplc yees or volunteers shall be in excess of this insurance and shall not contribute with it SCONE OF COVERA 3 E. This policy, if primary, affords coverage at least as broad as. I i Insurance Servi es Office form number GI-0002 (Ed. 1/73), Comprehensive General Liability Insurance anu Insurance Servi es Office form number GL0404 Broad Form Comprehensive Generai Liability endorsement, oi. i2; insurance Ser ices Office Commercial General Liability Coverage, 'occurrence" Corm CG0001 or "cWws- madc' form C D002; or, Jan-20-03 04 : 12P Hofstad Insurance 9496612066 P . 02 • • (3) If excess,affords overage which is at least as broad as the primary insurance forms referenced in the preceding sections(l)and ( ). 4. SFVERABILITY OF IN EREST, The insurance afforded by this policy applies separately to each insured who is seeking coverage or again;t 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. Any failure to comply with reporting provisions o the policy shall not affect coverage provided to the City and the Community Redevelopment Agency. its elected or app)inted officers, officials,employees or volunteers. 6. CANCELLATION NOT CE. The insurance afforded by this policy shall not be suspended,voided,cancelled,reduced in coverage or 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 shcwn in the heading of this endorsement. C. INCIDENT AND CLAIM REP RTING PROCEDURE Incidents and claims are to be reported to th insurer at ATTN: A t (Title (Department) �rrner Tn ur _. (Company) -3`$Sc,3 II t/ { 7a� (Street Address) ig!n Q 41- (City) (State) (Zip code) C (0& I — b c- — (Telephone) D. SIGNATURE OF INSVRERO AUTHORIZEDR N VE THE INSURE I, _-- d� —g—c,46" 3 ___ .—(print/type name), warrant that I have authority to bind the below listed insurance company and by my signature he eon do so bind this company. 7SIGNATUA ' IjO REPRESENTATIVE ujred on endorsement furnished to the City) ORGANIZAI'ION' Ga_Krnkjr "LY1 1TLE__ _ ADDRESS: .SS3_��rn_a�__ tf y�� __ S C • TELEPHONE. Dawn Schanderl From: Cindy Russell Sent: Friday, January 03, 2003 5:05 PM To: Dawn Schanderl Subject: RE: 1/7/2002 Non-pay& Non Compliance Updates Dawn, the overseer contract for Swanner Ranch belongs to Public Works. Thanks, Rv55Cll v X=0 Di -----Original Message----- From: Dawn Schanderl Sent: Friday,January 03, 2003 4:45 PM To: Diane Regier; Dottie Shaw;Jack Galaviz; Karen Crocker; Kathleen Springer; Lt. Davis; Lynnette Adolphson; Michelle Noreillie Cc: Al King;Amy Amirani; Bill Huber;Cindy Russell;Julia Silva; Meg Monahan;Tom Tomlinson Subject: 1/7/2002 Non-pay&Non Compliance Updates << File: NON COMPLIANCE LIST.wpd >> << File: NON-PAY LIST.wpd >> 1 32400 PASEO ADELANTO j/�` R101ellitl SAN JUAN CAPISTRANO, CA 92575 • t"11I,tt1961 MEMBERS OF THE CITY COUNCIL (949) 493-1171 1776 CO LEE CAMPIANE L. BELL TE (949) 493-1053 (FAX) JOHN S.GELFF iV1P1V.sanjuancapistrano.OTg HART DAVID • • DAVID M.SWERDUN CITY MANAGER GEORGE SCARBOROUGH November 20, 2002 s Pat Bathgate 2\ P.O. Box 217 San Juan Capistrano, CA 92693 RE: Compliance with Insurance Requirements- Overseer Services-Swanner Property The following insurance documents are due to expire: ' VGeneral Liability Certificate 11/22/2002 ' V General Liability Endorsement naming the City of San Juan Capistrano as additional insured. Please submit updated documentation to the City of San Juan Capistrano, attention City Clerk's office, 32400 Paseo Adelanto, San Juan Capistrano, CA 92675 by December 2, 2002. If you have any questions, please contact me at (949) 443-6310. Sincerely, p� Dawn Schanderl Deputy City Clerk cc: Diane Regier onw+usE la San Juan Capistrano: Preserving the Past to Enhance the Future Dawn'Schanderl To: Kathleen Springer; Jack Gaiaviz Subject: Bathgate Insurance FYI: Received certificate but still short the on endorsement for. Thanks 09/16/2002 14:00 9092965622 INSURANCE PAGE 01 xia t1 B:I DATE SitMIOUMYI .dw J09/16102 V PROMIXER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE J B K Insurance Services HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 27349 Jefferson Ave Ste 108 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Temecula CA 92590- COMPANY (909) 696-9609 A GOLDEN EAGLE INSURANCE CORP INSURILD COMPANY DWIGHT HOLCOMB 5 6cr. ------------jpd.C%A'1� 1445 E. Ontario Ave #2 COMPANYV C Corona CA 92881 COMPANY 909) 371-0364 D wg 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 HE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, "CLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS BHOWIY MAY HAVE BEEN REDUCED BY PAID CLAIMS. Copo,,yff,,ECTM POLWYEWHIATION LTR TYPE OF ININUIMM POUCY NUMBER DATEDIAMMUfM DATE PWtWtM LIMITS A SUNDIAL LIMIUTY OFNERALALIGREGATE s2000000 X COMMERCIAL GENERAL LIABILITY FRP604269-02 08/13/02 08/13/03 PnDDLjcTu-comPiop AGO s1000006 CI-AIMS MADE X OCCUR �PERWNAL&ADVINJURY $1000000 OIANERN&CONTRACTOW9 PROT EACH OCCURRENCE 6.1000000 FIRE DAMAGE(AnY wa fl'81 9 100000 MED FXP(Any WO Pff" i S 5000 AUTCWMILF LIABILITY COMBINEDVINVUFLIMIT $ ANY AUTO ALLOWNEDAUTOB BODILY INJURY SCHEDULED AUTOS (Parpmwn) HIRED AUTOS BODILY INJURY NON MNM AUTOS (Per w6denj PROPERTY DAMAGE 6 NARABE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: "� . :�, � ,� �,�: EACH ACCIDENT S AGaREnATE 11; EXCESS LIABILITY EACH OCCURRENCE S _HUMSWLUL F011M -AaGREGATE _$ OTHER THAN UMBRELLA FORM a 7 7 WORKERS COMPENSATION AND IMPLOYEAW LKNUTY EL EACH ACCIDENT 9 THE PROPRIETOR/ INCL EL DISLAOL-POLICY LIMIT PARTNIFRIVEXECUTNE (Wriem ARE. FIE= EL DIREAW-EA EMPLOYEE I OTH" ---------- DESCRIPTION Or OPERATIQNSALOCATIONSAF11HRWILESISPECIAL MUS PROJECT: SWANNER RANCH IffN 00 �p WNOOW MY W THE M.VL ORICININED POLICIES BE CANC1111ED BEFORE ME EXPIRATION DATE THEREOF. THE HIBUINQ COMPANY WILL ENDLAWN TO MNL 10_MVIL WHIMIN NOYCE To THE CERTIFICATE HOLDER NAMED TO THE WE", CITY OF SAN JUAN CAPISTRANO NOT FAHXR&TO MAIL HUGH NOTICE SHALL IMPOSE NO OBUICATION OR UABILITY AWN DAWN SCHANDERL, DEPUTY CITY CLERF or ANY vjwo UPON THE COMPANY, ITS AqFN ON-REPREMENTAMM SAN JUAN CAPISTRANO CA 92675 A AUZ A;Cw l'gg ig g � M JUL-22-02 TUE 4, 06 PM VPnUA OFFICE E0 NO. 71_4Fa�C2n5 p 2 ACOFtD_„ CERTIF{CAT OF LIABILITY INSUR CE 03/04/2 OZ PRODUCER (760)347-5552 FAX (760)347-2858 THIS-CERTIFICATE ISISSUED pSAMATTER OFINFORMATION Coachella Valley Insurance Service, Inc- ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR License 170542476 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 81-S57 Dr. Carreon (Blvd #08 INSURERS AFFORDING COVERAGE Indio, CA 92291 T INSURED 1/TCtOr SS Grove Service INSURER A: Financial Pacific Insurance CO Victor Zapata INSURER State Compensation Ins._ -und 315 Old Stage Court INSURER Fallbrook, CA 9ZO28-0000 INSURER INSURER COVERAGES 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- IN TYPE OFINSURANCE POLICY NUMBER POLICY EE ECTIVE P CY EX T LRRfiB Jj_R D gwDq TY !?RTE M /D GENERAL LIABILITY 161S56H OS/26/2001 08/26/2002 EAGROCCURRENCE 1 1 000 0 COMMERCIAL GENERAL LIABILITY FIREDAMAGE(Arty one brei S _ 50 OQ CLAIMS MAGE OCCUR MEO EXP(MVana person) _S 5 001 A X PERSONAL AADVILIJURY S 1.000,0 GENERAL AGGREGATE t 1 000,00( GERL AGGREGATE LIMIT APPLIES PER PRODUCTS•COMNOPAOG X I,DDO,00 POLICY D FE4 LOC AUTOMOBILE LIABILITY 1615566 08/26/2001 08/26/2002 COMBINED SINGLE LIMIT ANY AUTO LF.a Idw) -- 1 1 0 00 0010 ALL OWNED AUT06 BODILY INJURY X &CHEDU1FDAUTD9 (Par pwwO 1 X HIRED AUTOS BODILY INJURY � X NON-OWNED AUTOS (Pwe ,darn) PROPERTY DAMAGE S (Per GARAGE LIABILITY AUTD ONLY.EAACCIDENT / ANYAUTO OTHER THAN _EA'CC S—_ AUTO ONLY AGG 1 EXCESSLIABKITY 212098 08/26/2001 08/26/2002 EACNoccuRRENce _ a 4,000 000 OCCUR O CLAIMS WOE AGGREGATE S �.._ DeoucnaLE _ s RETENTION 1 WORKERS COMPENSATION AND 150964901 07/01/2001 07/01/2002 X TORrtBAlrs ER EMPLOYERS'LIABILITY EL EACH ACCIDENT 2 _ 1 No,OO B E L.DISEASE-EA EMPLOYEE / y 1 000,00 ELDISFASE-POLICYLINT 1 1.000.00 OTHER DESCRIPTION OF OPEMTIONSILOGAnONSNEHICLESIFKCLUSIONS ADDED BY ENOORSEMENTISPEGAL PROVISIONS TJ 0 days Notice Of Cancellation is applicable for Non-Payment of Premium. CERTIFICATE HOLDER ADDITNINALUisuRED;INSURER LETTER, CANCELLATION BHDULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE IRSUING COMPANY MnLL ENOEAVOR TO MAK The Villa Park Orchards Association30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attention: Patty BUT FAILURE TO MAIL SUCH NOTIC LL APPOSE NO OBLIGA w921TY P. 0. BOX 339 OF ANY KIND UPON THE COMP ,R AOENTSORREPR ENTA 9. Orange, CA 92858 AUTHORIZED REPRESENTATWE Tina Jeffers IN — — � (PACCAD OORFAWION 1989 JUL-22-02 1UE 4'. 00 PM VPOA OFF '"F FAY Uti. 7'.403942"F o THE VILLA PARK ORCHARDS ASSOCIATION INC. MEMSER OF SUNKIST GROWERS INC- P.D. BOX 339 ORANCE, CALIFORNIA 92666 LARRY S. LEIC14TFUSS SKANAS huldaer•Cano.l M•naS.r 9w.1ar - Slyd Suka Cal Ore - VII-H) Pala Srava FACSIMILE COVER SHEET FROM FAX NUMBER: (714) 639-4106 DATE SENT: / ~�L TINE SENT: TOTAL NUMBER OF PACES INiCLUDIAC WM SHEET: TO: -NU2n SctipN�Yrl VAXWmER: 9y9�`/93'/Qs COMPANNT `7/ 0� Sti � y fk'�-cn119 FROM: �[.If_e ISP I�G�, f TJSS �, OOYJUYTS: - - - - - - - - - - - - - - - - - - - - IF YOU SAVE "Y QUESTIONS OR DO POT WEIVE ALL OF THE FACES, PLEASE CALL SEEDER AT (714) 679-7610. - Y".'.__� ... THE EXPIRATION DALE FISEED HEREON APPLIES IF IN PRFMNM HAS BEEN PAID. EVIDENCE OF INSURANCE-STATE OF CALIFORNIA WILLIAM SATHGATE - Poliry Number: 97 13997-86-37 PATRICIA SATHGA_ TE - - - EHetNve Dae: 05-22-2002 Ai, PO SOX 217 - Expiration gate: 11-22-2002 sN JN CAP CA 92693-0217 - a ilw, Mekkle l.g.No: JT4RN70D6H0031740 fiti+ 11 Year. 1967 - Make: TOYOTA - Mladef: PU MID fli Yry nk FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA ,an authorized Califomia Insurer, in compliance with the California Financial Responsibility Act, certifies that it has issued a policy in an amount not less than that required by the California Financial Responsibility Law for the described motor vehicle. KEEP WITH Agent Name: sen s Hofstad VEHICLE Phone No: (949) 661-6692 941 NERD NEYENSE SIDE QREfMLAT. A70E030t r The California Department of Motor Vebicles (DMV) now requires proof of insurance when registering your vehicle. On the back side of this page is the T DMVscopy of the Evidence of Laurance form. Please provide this form to the DMV when registenngyour vehicle. .:,A V Nl 4 � a 1 Ili n r • NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST H FARMERS INSURANCE EXCHANGE DATE MWEO h �IAC8�91ME— PWCY NUMBER em� 97 13997 86 38 69 FORD PU 05-21-02 PREMIUM WE�Q� QITIp� . 97 15 356 04-25 212.20 AGERT4i ' EN S OFS AD PHONE 949 661-6692 Beaeuee of rwnpeYmM of PrenYum,Y�ere hereby notified that dl o mqs extended to you under the above / deeorired policy M oencelled effeadve at 12:00 NOON(12:01 AAL In CA,OR,TX,WA,OK,VA and Fire only I/ e r pollcba In AR,VA and ID)on die date-wen here but only ea respeobthe witereete d the Mortgag"or O%w �r fit{{ inbmbahown. �3 otdA 12 N�nr IN CA, OR, STOA9 ATr4j-,VK aND IRE ONLY ,JUNE D5 s 02 IN CA, OR, TX, 1MAltt11f11UE SND FIRE ONLY POLICIES IN AR,VAAN0 M OWN Nanned lQ� �� 62 6 I CITY OF SAN JUAN CAPISTRANO EMPLOYEE WILLIAM BATHGATE 03A1303N 324 PASEO ADELANTO PATRICIA BATHGATE SN JN CAP CA 92675 29931 CMNO CPSTRANO SN JN CAP CA 92675 A1203101 2t 120311-98 NOTICE OF CANCELI "TION OF MORTGAGEE OR OTHER "EREST H FARMERS INSURANCE EXCHANGE P01 11 RhMHEH bAI MINI 1) 97 13997 86 37 87 PU 2WD 05-24-02 4MIUM DUC 97 15 356 04-30 353 .00 AGENT BEN S HOFSTAD PHONE 949 661-6692 Because of nonpayment of premium,you are hereby notified that all coverage extended to you under the above described policy is cancelled effective at 12:00 NOON(12:01 A.M.in CA,OR,TX,INA,OK,VA and Fire only policies in AR,VA and ID)on the date shown here but only as respects the interests of the Mortgagee or other interestsahown. COVERAGE STOPS AT 12:00 NOON(12:01 A.M. IN CA, OR, TX, WA, OK, VA AND FIRE ONLY JUNE 08, 02 POLICIES IN AR,VA AND ID)ON Named Mortgagee Insured or Otr CITY OF SAN JUAN WILLIAM BATHGATE Intereat CAPISTRANO EMPLOYER PATRICIA BATHGATE 324 PASEO ADELANTO PO BOX 217 SN JN CAP CA 92675 SN JN CAP CA 92693 25-1203 11-93 A1203101 'Nov'15-01 01 : 28P Hofstad Insurance 9496612066 P . 02 is Policy Number: ilm MC0- R-A CERTIFICAT OF LIABILITY INSURANC 12/21%2000 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3553 CAKWO MRA COSTA STL G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SAN CLEMFNT6, CA. 92672 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. fi61-6692 12323 6 INSURERS AFFORDING COVERAGE - - -..I SU- -PER p_ - -YAiORRS INSUmmci GRDIIE IMWREO IN PATRICIA BATNGATE INSURERS P.O. BOX 217INSURERC SAN JOAN CAPI$TRANO, 92675 INSURER D._ _ �INSURERE COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAV BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWI I HSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY ON TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE D OR MAY PERTAIN,THE INSURANCE AFFORDED BY TH POLICIES DESCRIBED HEREW IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE EEN REDUCED BY PAID CLAIMS. EFFEGTVET POUCYEkPIRAnON TYPE OF"MUR NCE P NUVIEER L11/TS DENERAL UAMUTY I EACH OCCURRENCE_ s 1.000,000 A COMMERCIAL GENERAL LIAMUTY 1505384 11/10/2001 ; 11/10/2002 rpmce"Ell DE(Arry orl6M1 E1,000,000 CLAIMS MADE OLY.UR rv/meperconi _i S PERS IAAffiTtELLA _ E aovlNJURY J$ 1,000,000 I GENERAL AGGREGATE S 1,DOG,060 GEML AGGREGATE IJMfi APPLIES PER I PRODUCTS-COMMPAGG S1,000,000 POLICY r— PRO- —_ LOG ._ AMTOEwwLE LLABIUTY COMBINED SINGIE LIMIT S -�ANY AUTO -(ES�Oert1I ALLOWNEDAUTOS I BODILY INJURr A — SCHEDULED Auros 1399786 7 C 38 i 10/30/20011 4/30/2002 I(Pe,PRrtm) ,5250,000 HIRED AUTOS BODILY INJURY I S 500,000 -0 NONWNED AUTOS L(Per eCOCee11 I ---- -- - - - - I PROPFRTY DAMAGE S 100,000 F (P«ecaamt) rQ AO9 DA&LITY it AUTO ONLY-EA ACCIDF NI $ ----- ANY AUTO 1 OTHER THAN EAACC S AUTO ONLY AGG S EXCESS UAiLITY _ EACH OCCURRENCE S OCCUR �__ CIAIMSMADE I I AG(SREGATE III S 1S DEDUCTIBLE ) J S RETENTION $ I L WORKERS COMPEIOATIOM AND WC ST AH 5 1 - ER EMPLOYERS UABIUTV - E L.EACH ACCIDENT 5 �EL DISEASE-EAEMPLOYEE S EL DISEASE-POLICYLIMIT S OTHER DESCRIPTION OF OPERATMONSAOCATIONMEISCLMEXCLL! S ADDED BY ENDORSEMENT)SPECIAL PROVISIONS 10 DAYS NOTICE OF CANCZLLATION FOR NOW PAYbMNT CITY OF SAN JDAN CAPISTRANO AS ADDITIONAL INSURED CERTIFICATE HOLDER ADDITIONAL RISURI 0. IwLIRER LETTER, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED ro ES BE CAI ELLER BEFORE THE ESPWAnON CITY OF SAN JUAN CAPISTFU NO DATE THEREOF, THE ISSUING IIIEURER WILL ENOEAVOR TO MAL 30__ DAYS WRITTEN CCTMONITY DLVEIAPMRTTT JIUCM NCY NOME TO TME CERTIFICATE I MR NAMED TO THE LEFT,SUT FAILURE TO DO SO SMALL 32400 PASO ADELANTO IIH OSE NO OBUBATNN+ LIABILITY OF ANY FIND WON TAE INSIMER ITS AGENTS OR SAN JUAN CAPISTRANO, CA. 92675 REPRESERUTIVES. _ __, __. AUTHORQEDREPRESENTA E ACORD 25-5(7!871 _ ®ACORD CORPORATION 7888 Nov- 15-01 01 : 28P Hofstad Insurance 9496612066 P, 03 • LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Juan Capistrano,California 92675 ATTN: DguJtU SeNAN pE L_� A. POLICY INFORMATION F,ndonementtt 1. Insurance Company_ G ,PolicyNumbpr 2. Policy Term(From) (To)_ _ , i0 ;Endorsement Effective Date__ /O ��p/ 3. Namedlnsured_ �,� 4. Address ofNamed Insured _ 9 ",-� _ �� � SA�_JugN CC.r1P:si,PlJ.tJo 5 Limit of Liability Any O e Occurtence/Aggregate $ /�p�rsp� General Liabili Aggregate(Check one:) Applie "per location/project" ___ ✓__ __,_ Is twicA the occurrence limit ti. Deductible or Self-Insurcd Retention(Nil unless otherwise specified): $___, 7 Coverage is equivalent i Compr hensive General Liability form G1-0002 (Ed 1/73) Comm rcial General Liabditv"claims-made" form C00002 8 Bodily Injury and Property Damage Coverage is: 'claims-made" occurrence"V "occurrence" If clai s-made. the retroactive date is 8 POLICY AMENDMENTS Chu endorsement is issued in consideration of the policy premium. Notwithstanding any inconsistent statement m the policy !,i wha:h this endorsement is attached or any other endo sement attached thereto, it is agreed as fo!lows: I INSURED. "he City anc the Community Redevelopment Agene}. :u elected or appointed officers,official,,employee, and volunteers are included as insureds with regard to damages and defense of claims arising from, tO activate performed by or on tiehz If of the Named Insured,(b)projects and completed operations of the Named Insured, or tet prem,ses owned, leased 3r used by the Named Insured CONTRIBUTION NO- REQUIRED. As respects_(a) work performed by the Named Insured for or on heha!t of the Cty or(b)projects sold by the Named Insured to the City,or(c)premises leased by the Named Insured trout the ( w, the insurance afforded b this poltcy shall be primary insurance as respects the City, its elected or appointed officer., cdfcia6,employees or v lunteers,or stand in an unbroken chain of coverage excess of the Named Insured'., ,,heau.e,) L:nderhtng primary co erage. In either evert, any other insurance maintained by the City, its elected ur appouc:! ifticrrs,otfictn'. , empl Nees or volunteers shal! be :n excess o[th:s tnsurancr and%tial: not contribute w nh it JCOPL O1F C'OVERA E. Thi, policy. if primary. affords coveriige at least as broad as t I � Insarance Sen ccs Office Ibrm number GL0002 (Ed I'i;t. Comprehensive Gener;d ).adtiht} fn,�rense una Insurance Sery ccs Office !orm mm�ber(iL0-704 Brond Dunn Comprehenvve Ucneral l.inht6h endor,ucent t_'t In,unruc Ser icee Office Commercial General Liabilnj Coverage, "occurrence" form t 60110 .•t Lts maJc" form (- i000_'.or, 'Nov- 15-01 01 : 29P Hofstad Insurance 9496612066 P . 04 (;) Ifexcess, affords coverage which is at toast as broad as the pt rnary msurnnce loans referenced in ffic nietc_nr_ sections(1) and 2). 4 SEVERABILITY OF INTEREST. The insurance afforded by this pokey applies separately to each. m,wed �..7,. seeking coverage or agair st whom a claim is made or a suit is brought, except with respect to the Compar» , limii .a liability. 5. PROVISIONS REGAR ING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to c,n^pl� with reporting provisions f the policy shall not affect coverage provided to the City and the Community Rcde<e;opnicw Agency, its elected or zip ointed officers, officials,employees or volunteers 6. CANCELLATION NO ICE. The insurance afforded by this policy shall not be suspended,voided,cancelled,rethi,ed in coverage or limits except after thirty(30)days' prior written notice by certified mail return receipt requested has heen given to the City. Such notice shall be addressed as shown in the heading of this endorsement. C INCIDENT ANDN D E incidents and claims are to be reported to tIr a insurer at (Title (Department) Y�flHer -Tn.5u.YR-tlL, ___-..--- .. - -- (Company) - �f �s3 rn: D -fes tn os-40- (Street Address) G'? -(City) (State) (Zip code) C1'EC ----- (Telephone) D. SIGNATURE OF INSURER Of AUTHORIZED REPRESENTATIVE OF TH@INSURER (prirf type name), warrant that I haee authonn to bind the heft,„ ' ,Ivd insurance company and by my signature h reon do so bind this co4rwre-d a SIGNATIIREPRESENTAIIVF (Original sn endorsement furnished to the Cnr ORGANIZ.AMON: GL✓.NQr'$_ L1/''1�_S Yytj-, P _ tiTITLE \ ADDRESS ,3553 �l�rn� lla--- sfa. sL __ �. C._. TF.LE.PHt)NI�: CCI y� ,/G+t¢1^ (O oo� • FARMERS COMPANY NAME: FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA AN INTER-INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY PART I CERTIFICATE OF INSURANCE INSURED'S NAME&ADDRESS: POLICY NO: 97 13997 -86 -38 WILLIAM BATHGATE POLICY EDITION: 03 PATRICIA BATHGATE EFFECTIVE DATE: 10 -30-2001 29931 CMNO CPSTRANO EXPIRATION DATE: CONTINUOUS UNTILCANCELLED SN JN CAP CA EXPIRATION TIME: 12:01 A.M. Standard Time 92675 - ISSUING OFFICE: P. O. BOX 4820 AGENT: Ban S Hofstad POCATELLO, ID 83205 AGENTNO: 97 15 356 AGENTPHONE: (949) 661-6692 DESCRIPTION OF VEHICLE Year 1Aaka- - --Model - - - - -Vehiole IGenliioatbn Number fad 1969 FORD FORD PU F25YRF26833 COVERAGES *ENTRIES IN THOUSANDS OF DOLLARS. (SEE REVERSE SIDE FOR COVERAGE DESIGNATIONS) - Uninsured MobxM - .. - Madoelf -I Conwrebommel CoUnnom Towing Bodily InjuryP.D. Bed In - P. . - No Feut DeduclPols -- Deductible PNomAuto i .' . NOT COV +: 250 1500 ) 100 15 ! 30 ' COV XXX ! xxx NC 1000 1000 NC 1 NC - Eeoh j Eaoh Eaoh j Each XXX XXX Ueb. Medgel Person! Owumnoe Person! Occumnoa NOT COV This certificate is subject to all of the terms,conditions and limitations set forth in the policy(ies)and endorsements attachedto ft. It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previously issued oertiflcates. PART II ADDITIONAL INSURED ENDORSEMENT E1136 2nd Edition We provide the coverages indicated by "COV; or the limit of the Company's liability, on the above Certificate of Insurance.We provide this coverage in respect to the vehicle described above,to the person or organization named below as an additional insured. This coverage applies only: (1) while the named insured is the owner,or has care,custody,or control of the above describedvehicle,and (2) when liability arises out of the acts and omissionsof the named insured. This ooveragedoes notapply: (1) where liability arises out of negligence of the additional insured,its agents,or employees,unless the agent or employee is the named insured,or (2) to any defeot of material,design or workmanship in any equipment of which the additional insured is the owner, lessor,manufacturer,mortgagee,or beneficiary. If any court shall interpret this endoreementto provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibilitylaw of the state,province,or territory where the named insured resides,as applicableto the vehicle described above. If there is no such law,our limit of liability shall be$5,000 on a000untof bodily injury sustained by one person in any one occurrence and subject to this provision respecting each person,$10,000 on account of bodily injury sustained by two or more persons in any one occurrence.Our total liability for all damages because of all property damage sustained by one or more persona or organizations as the result of any one occurrenceshall not exceed$5,000. The insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attached to R.This endorsementdoes not increasethe limits of the poficy. Upon cancellationor terminationof this policy or policlesfrom any cause we will mail 15 days notice in writing to the other Interestshown below. CITY OF SAN JUAN 324 PASEO ADELANTO )� SN JN CAP CA 92675 - AUTHORI SIGNATURE 91-1136 2ND EDITION 4-97 U H-99 E1136231 . FARMERS' COMPANY NAME: FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA AN INTER-INSURANCE EXCHANGE, HREAMEBLLED THE COMPANY PART I R7)%#1fiQF INSURANCE INSURED'S NAME&ADDRESS: POLICY NO: 97 13997 -86-37 WILLIAM BATHGATE CITY CLFI{r POLICY EDITION: 03 PATRICIA BATHGATE DEPT.PT HFi NT EFFECTIVE DATE: 04-30-2001 PO SOX 217 Cl7Y (N "'AN EXPIRATION DATE: CONTINUOUS UNTIL CANCELLED JUAN CAPISTBANp SN JN CAP CA EXPIRATIONTIME: 12:01 A.M. Standard Time 92693 -0217 ISSUING OFFICE: P. O. BOX 9016 AGENT: Ben S Hofstad CARLSBAD, CA 92018 AGENTNO: 97 15 356 AGENTPHONE: (949) 661-6692 DESCRIPTION OF VEHICLE Mala Model Yahbk-IdeMillookum Number.. 1987 TOYOTA PU 2WD JT4RN7OD6H0031740 T COVERAGES +ENTRIES IN THOUSANDS OF DOLLARS. (SEE REVERSE SI DE FOR COVERAGE DESIGNATIONS) uninemred Morodct Meda+alr Oompmhsmdve - Coitaics Bodily 1niVry P.D, In P.D No Fault- Deduawle paducdble Toienerg Nori.Aura • •I e ♦ • I COV wl 250 1500 100 250 1500 ! COV XXX XXX 5,000 240 500 - .—kyr NC NC Eeoh Each Eaoh Each XXX XXX 500 L,OV Uab. Medical Pemoo Coourmnoe Person Oooumnoe This certificate is subjectto all of the terms,conditions and limitations set forth in the policy(ies)and endoreemerlteattachedto it.It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previously issued certificates. PART It ADDITIONAL INSURED ENDORSEMENT E1136 2nd Edition We provide the coverages indicated by 'COV,' or the limit of the Company's liability, on the above Certificate of Insurance.We provide this coverage in respect to the vehicle described above,to the person or organization named below as an additional insured. This coverage applies only: (1) while the named insured is the owner,or has care,custody,or control of the above desoribedvehicle,and (2) when liability arises out of the sots and omiesionsof the named insured. This coverage does not apply: (1) where liability arises out of negligence of the additional insured,its agents,or employees,unless the agent or employee is the named insured,or (2) to any defect of material,design or worknianahip in any equipment of which the additional inaured is the owner, lessor,manufacturer,mortgagee,or beneficiary. If any court shall interpretthis endoreemerttto provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibilitylaw,of the state,provinoe,or territorywhere the named insured resides,as applicableto the vehicle described above. If there is no such law,our limit of liability shall be$5,000 on account of bodily injury sustainedby one person in any one occurrence and subject to this provision respecting each person,$10,000 on account of bodily injury sustainedby two or more persons in any one occurrence.Our total liability for all damages becauseof all property damage sustained by one or more personsor organizationeas the resultof any one 000urrenceshall not exosed$5,000. The insurance afforded by the policy describedabove is subject to all terms of the policy and any endorsementsattached to it.This endorsementdoes not increasethe limits of the policy. Upon cancellatlonor terminationof this polioyor policlesfrom any causewe will mail 15 days notice in writing to the other Interestshown below. CITY OF SAN JUAN 324 PASEO ADELANTO SN JN CAP CA 92675 - AUTHOR SIGNATURE 91-1136 2NDEDITION 6-97 H99 E1136MI P. O - ox 9016 CARL: ,D, CA 92018 CITY OF SAN JUAN 324 PASEO ADELANTO SN JN CAP CA 92675- COVERAGE DESIGNATIONS COVERAGES-- Indicated by"COV"or the limit of Company's liability against each coverage."NC'or"NOT COV" means"NOT COVERED." "MAX"means"Maximum Deductible." BODILYIWURY -- Bodily Injury Liability COMPREHENSIVE - Comprehensive Car Damage P.D. Property Damage Liability COLLISION - Collision-Upset UNINSURED Benefits for Bodily Injury(including property NON-AUTO - Comprehensive Personal Liability- MOTORIST damage coverage if policy issued in New Each occurrence. Mexico)caused by Uninsured Motorists Medical Payments to Others- MEDICAL - Medical Expense Insurance,Family Medical Each Person. Expense,and Guest Medical Expense- Damage to Property of Others- See Policy Provision. See Policy for Limits per occurrence. If policy contains the E-550 No-Fault TOWING - Towing&Road Service Coverage. Endorsement or No-Fault Coverage D,Auto OTHER - One or more miscellaneous coverages Medical Expense Coverage does not apply. added by endorsement to the policy. NO-FAULT - See Endorsement E-550(Illinois E-2250) or Coverage D if applicable. LOSS PAYABLE PROVISIONS (Applicable only if lienholder is named,and no other Automobile loss payable endorsement is attached to the policy) It is agreed that any payment for loss or damage to the vehicle described in this policy shall be made on the following basis: (1) At our option, loss or damage shall be paid as interest may appear to the policyholder and the lienholder shown in the Declarations,or by repairof the damaged vehicle. (2) Any act or neglect of the policyholder or a person acting on his behalf shall not void the coverage afforded to the lienholder. (3) Change in title or ownership of the vehicle, or error in its description shall not void coverage afforded to the lienholder. The policy does not cover conversion,embezzlement or secretion of the vehicle by the policyholder or anyone acting in his behalf while in possession under a contractwith the lienholder. A payment may be made to the lienholder which we would not have been obligated to make except for these terms. In such event,we are entitled to all the rights of the lienholder to the extent of such payment.The lienholder shall do whatever is necessary to secure such rights. No subrogation shall impair the right of the lienholder to recover the full amount of its claim. We reserve the right to cancel this policy at any time as provided by its terms. In case of cancellation or lapse we will notify the lienholder at the address shown in the Declarations. We will give the lienholder advance notice of not less than 10 days from the effective date of such cancellation or lapse as respects his interest. Mailing notice to the loss payee is sufficientto effect cancellation. The following applies as respects any loss adjusted with the mortgagee interest only: (1) Any deductible applicable to Comprehensive Coverage shall not exceed$250. (2) Any deductible applicable to Collision Coverage shall not exceed $250. 91 11362ND EDITION 4-97 E1136232 M. 1 FARM LAK* Of1iRA If Ot OCTOR i c"ff 1310 rr.Ls a rwdr M^e1� yef a �s� �+ . iw Pis ei• pa wµrota epAre�sl MAi eF��� momh 2!r 2001 Abrc11 26, nvrlw. aeSe11• �d, d fare F�dR~'asd „ McYM�Mrd .r WMATION DALE in w~r+ede^�rM e"10 s di *7r`f'r er eio. VECTOR H. 1edSltsS a ssweeeres� r rrrwr sM1r •Pnr Imber DBA:VICTOR'S GROVE SERVICE •O °f ° ~ * pd►n Cale Seam-towwear r7 r�"s Are 715 OLD STAGE COURT I+es' t ~ }t e�dw ham`:• ' a Aw f e 60 FALfJRO01LG 17015 N Fiwd �itefekhw sr pAaa M r�►�°1OI yrpn ed hovirsB wr she "hewer"a1 1M Lobar Code and deposlkd a Surey eww ydea� ei ery sorra' 1�m W, gond w Twre CrtlScde in she tum of $10,000.00 is hereby licensed to seed PZ. Lbw Code Secssm' co�rMrcr dw but.rsacl Is Foran Labw coy+Irtclor for rhe period dmiIie vied hercw,Dense moy nal be lromlernd or ossipred� / ® olrr rs vue rm Rn ,raw sort t.aoa caw�sstotEe • 1 �r t p4 STATE P.O.LOX 420807,SAN FRANCISCO,CA 941424)807 , COMPONDATION r '•� rNe1Up ANCE 4 FUND CERTIFIWO OF WORKERS'COMPENSATION INSUF"CE BAT 1. 2111111111111 roudDYle�u40DeR: IM9649 - 99 0EPrrWICATE•IIXPIRE8: 7-1-0Z -• { r- ! JOB: AL:. OPEUTIUW �4 � L ' f This is to Certify that we have issued a valid Workers' Compensation Insurance policy in a form approved by the Cafifornie i Insurance Commissioner to the employer named below for the policy period indicated. i This policy is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer. We will also give you TEN days'advance notice should this policy be cancelled prior its nomtel expiration. AI This certificate of insurance is not an insurance policy and does not amend, extend or alta the coverage afforded by the x f policies fisted harem. Notwithstanding any requirement, term, or condition of wry contract or other document with ,y T respect to which tt116 certificate Of (tgprance may be issued or may pertain, the insurance afforded by the policies l described herein is subject to elf the tailings,exclusions and conditions of such policies. - I ^WTRVR1ZLD REI'RE9ENTATIVE , PREa1DENT EMPLOYER'S LIABILITY LINT IRCLUDINE DEFERS£ COSTS: 01,6W,16,1110 PER OCCORRERCE. .y T • t EMPLOYER t VICTOR'S GROVE 5FRVIC£ t y- 913 OLD STAKE COURT ; FALLMROOR CA 92028 RB I on for a Farm labor Contractor or U.S. Department of Labor Labor Contractor Employee 6rnpployrnernt alandans Administration to of Registration Welts and Mow dMolon and Seasonal Agricultureliflli Protection Act Persons are not required to respond to this collection of information unless it displays a currently validOMB No.: 12i$-Ml OMS controlnumber. FVIrm: 04�,7DM c. I To Be Complete Ar ALL Applicants irrUtrctlonabetoNo Farm Labor Contrsow(PLC)orForm Labor Conbaot mmpl"w of Regis radon Islay 1j illsis ad unless a catmisod fam Ku hunn2apa(M U.s.c.tact at.6"4 Appllcaaon for Certificate of Registnden roe: 4. Give Address to#AW Notices and Dommrlenls OmW Os Sent(Ad~nw'A+crvde a Po ea.): MiirfarN ❑ IMA ® Renewal Vviod MledFsderar-State LJ MW ❑ Ranewaf `fir 315 OfID STAG$ CT, Tois of Certificate XJ PLC ❑ FLCE City:FALLBROOK StateC�ZIP Code: 92fT 8 - Fbrson Completing Application: (Praase PON) 5, Will You Drive a Vahlole to Transport Workers? (To be oamprMdbyan 7niJwdWCwp&anq ZAPATA VICIN M. 29 No ❑ Ves If"Yes-Readinstruoticne tllmw paerl fFh# and Comphftthe FOWwlagt Onvoes Lianas Nb.: _ (Anaall copy d Amiss,(v oppIcAt0 n) Phice of Residents(A ',' o Aar Not or a PO.Sox) State; --- ,9�aet: 315 QLD S T&U Date Issued, -- - - ` Expiration toss: "- FALLBROOK "T:XAZipd;ode: 92028 Clatre Endorsements: Restrkikrnr Teepho to Number Social S"rlly Number, 6 731 - 0426 / 5/5/3 /-/1 /51-)312 !9 /4 ) flsight: 5 ft. 6 In. ColororEysa: Brown 6. Rave you boars convicted within the past 5 years, under State or Fed"law,of any of the following crimes? Bala: ❑ Mlale ❑ Fern". A. Any crime MWft to gambling, or to the sols.dNrtw- ' tion or powssabn of alcoholic beversgas.In connedlon PIN,d Birth(Ata, Dar;tsar): Mar 29, 19 5 7 wlbp a irlcMMRt{b any Perm labor contracting al9NM1s T ❑ `lira loll No (a) UnRW States Citizen: *8 ❑ No (if N, ao to(b)) B. Any fefaty Involving robbery. bribery, sxtordon, am. bazulement,f,Fllnd larceny.burglary,anon.tldolatbq of If naturalized citizen, ive date: narcotics Isiss.Wkwder, rope,ups"with kftl to* 8 _ assault which Itlacts gdevous bodily Injury,plaaYhnbn. psonags,orwvlii aigorharboring indlviduabilivfhave orltsnd wo upril�lad states Iklbs y. &I Alan Registntlon No.. T— ❑ Yes Iql No (Aasch copy of Card to appWaOM) I:r (If'lie:to a of any W ltw above, sista crime and 9"4M and place of conviction,) Aar Epfplfatlon Date (N any): — copy od Mbl judgment In the case to the eppNaglon,R In your possession. spanner or mlwaprsanwo IN ouaWon meq be punrahobfa by Mea or (u.s.code,t7r'r. t l� f) ae.AOA y _ s r U ARE APPLYING AS A FARM LABOR CONTRACTOR,CONTINUE WIT"PART II ARE APPLYING ASA FARM LABOR CONTRACTOR EMPLOYEE.SKIP PART It AND GO QIRECTLYTO PART NI m Labor Contractor Employee is a parson who performs(arm labor contracting activities solely on behalf of a(specri Labor Contractor holding a va4d Gari ficate of Registration and is not an independent Farm Labor Contractor who be requ)red to register under itis Act/n tNsl her own right.) _ I To Be Completed by Farm Labor Contractor (FLC) Applicant ?. The Applicant is alien. (deco One) } ]J C9 Individual ❑ Corporation ❑ Partnership ❑ Other(Spoclty) 7 ' It e Corporation,Give legal Name,Address,Telephone Number, Date and State of Incorporation. (PfcFasp Pdhr) 1` I Name of Appticar (Legal Nanw of Carporaom) - — ---- —-- (Area Code) (Number) - _ _ g„ - (C4y1 -- - — —fsrerl (ztP code) Date of Incorporation_ -.-- --- Social Security Employer Identification No. (lf nano,emir'Ni;i V �.. ,Ir State of Incorporation. t- _. _ Slate Unemployment Insurance Reporbnp No. (k Non9,Enlar W"7 r q ' 8. Check Each Activity to Be Performed Involving Migrant and/or Seasonal Agricultural Workers for Agricultural EmploymenC Hecrud to Hire ❑ Furnish ❑ Transpon ❑ sok t R Employ V9 Pay 1 9. Give the Greatest Number of Migrant andf or Seasonal Agricultural Workers That Will Be in the Crews) at Any Time _170__ rl The intended farm labor contracting aCtivitles will begin approximately-__ Januar— Y 02�) 2001_ (Month.Day,141 Describe your method of operation(rSpsdfycrops,agocuhufal acliviq,places of employment,location,arc) The business is entirely picking citrus fruits. The location or 4� site where we pick is on the northern part of San Diego County and south of Riverside County. Hiring is done on the site thru recommend- 1 abiel 19 of 1:12e Flekd Per---. 10. Will You Provide Transportation for Your-1Nakars? :' f [] Yes (Give number, type and seating capacity of vehicles used to transport migrant and seasonal agriculture)workers.) iW No (Explain how workers get to the work site.) ` ( 090d 84.1? . �S r 11. Will You Own or Control Any FacilityI or Real Property Which Will Be Used try Migrant Agricultural Workers in the Crews)at Any Tana? _ ❑ Yes (Submit statement identifying all housing to be used No (Give the name and address of all persons who and proof that such housing meets all applicable own or control housing to be used by Migrant Federal and State safely and health standards 1 Agricultural Workers in the crew.) • i;i s I CERTIFICATION f I oartily that compensation Is to he received for the intended farm labor contractor services and that all { repweerNNtons made by me in iM4,app{icatlon are true to the beet of,my knowledge and belief. r, ' .i Applicant's Soldtillithili T&pyanrer men IndfWdiatq statement of Inglntion to Comply with Housing Requirements of the Migrant and Seasonal Agricultural Worker Protection Act ` I' Section 102(3)of the MSPA requires that an applicant for a certificate of registration with authorization to house migrant i, 14 agricultural workers shall file a statement identifying each facility or real property to be used by the applicant to house , any rnigrant agricultural worker during the period for which registration is sought. If the facility or real property Is or wiq W9N[ be owned or controlled by the applicant, such statement shall provide documentation showing that the applicant is in compliance with all substantive Federal and State safety and health standards with respect to each such facility or real property. I hereby declare that I wig not house migrant agricultural workers in any facility or real property I own or control until I have submitted all necessary written evidence and have been issued a Certificate of Registration with housing q authorized. I understand that I may then house migrant agricultural workers only in facilities or real property which has s been authorized by the Secretary of Labor. i Signature of Applicant r Authorization of the Secretary of Labor to Accept Legal Process i i The following authorization is executed pursuant to Section 102(5) of the Migrant and Seasonal Agricultural Worker Protection Ad. "1 do hereby designate and appoint the Secretary of Labor, United States Department of Labor,as my lawful agent to accept service of summons in any action against me at any and ail times during which I have departed from the jurisdiction in which such action is commenced t or otherwise have become unavailable to accept service,and under such terms and conditions as are set by the court in which such action has been commenced" 'y C Signature of Applican . 6 .,p ® NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST H FARMERS INSURANCE EXCHANGE POLICY NUMBER OAU MI IED 97 13997 86 38 69 FORD PU 08-29-01 1 AFMIUTA F1UE 97 15 356 08-05 266 . 06 AGENT BEN S HOFSTAD PHONE 949 661-6692 Beoauae of nonpayment of premium,you are hereby notified that all coverage extended to you under the above deaodbed polioy is cancelled effective at 12:00 NOON(12:01 A.M.in CA,OR,TX,WA,OK,VA and Fire only O poficies in AR,VA and ID)on the date shown here but only as respeote the interests of the Mortgagee or other _•]O ,` a interests shown. j COVERAGE STOPS AT 12:00 NOON(12:01 A.M. 4 IN CA, OR, TX, WA, OK, VA AND FIRE ONLY SEP. 13, 01 5 POLICIES IN AR,VA AND ID)ON )I ttgagee X, msu<sc: 0 (ed orcOOther CITY OF SAN JUAN interest WILLIAM BATHGATE CAPISTRANO EMPLOYEES " I PATRICIA BATHGATE 324 PASEO ADELANTO { 29931 CMNO CPSTRANO p SN JN CAP CA 92675 SN JN CAP CA 92675 -l/ KS prl 25-1203 11 96 A12031 O1 • FARMERS ' COMPANY NAME: FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA AN INTER-INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY PART I CERTIFICATE OF INSURANCE INSURED'S NAME&ADDRESS: POLICY NO: 97 13997-86-38 WILLIAM BATHGATE POLICY EDITION: 03 PATRICIA BATHGATE EFFECTIVE DATE: 04-30-2001 29931 C14NO CPSTRANO EXPIRATION DATE: CONTINUOUS UNTIL CANCELLED SN JN CAP CA EXPIRATION TIME: 12:01 A.M. Standard Time 92675- ISSUING OFFICE: P. O. BOX 9016 AGENT: Ben S Hofstad CARLSBAD, CA 92018 AGENTNO: 97 15 356 AGENTPHONE: (949) 661-6692 DESCRIPTION OF VEHICLE Make -- - - - Model Vehicle Idehekioation Number 1969 FORD FORD PU F25YRF26833 COVERAGES *ENTRIES IN THOUSANDS OF DOLLARS. (SEE REVERSE SIDE FOR COVERAGE DESIGNATIONS) Uninsured Motorist- -I Medoom- - Comptshemivo Collision Towing BotlB Iri i P.D. . Bodily Ipiuly P:D: - - - - No Fauk Deductible Dedualible Non•Auto _ _ t .i ! NOT COV 250 ++ 500 1100 250 ! 500 COV XXX } XXX 5,000 240 500 Othei— NC NC Eaoh I Eaoh Each 1 Each XXX XXXUab. Medical Peron Owurmnoe Person 1 Coeurrenoe NOT COV i This oertiticateis subjectto all of the terms,conditions and limitations set forth in the policy(ies)and endoreementsattaohedto it. It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previously iesued oertifioatea. PART 11 ADDITIONAL INSURED ENDORSEMENT E1136 2nd Edition We provide the coverages indicated by 'COV; or the limit of the Company's liability, on the above Certificate of Insurance.We provide this coverage in respect to the vehicle described above,to the person or organization named below as an additional insured. This coverage applies only: (1) while the named insured is the owner,or has care,custody,or control of the above describedvehicle,and (2) when liability arises out of the acts and omissions of the named insured. This coverage does not apply: (1) where liability arises out of negligence of the additional insured,its agents,or employees,unless the agent or employee is the named insured,or - -- (2) to any defect of material,design or workmanship in any equipment of which the additional insured is the Owner, lessor,manufacturer,mortgagee,or, beneficiary. If any court shall interpretthis endorsementto provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibilitylaw of the state,province,or territorywhere the named insured resides,as applicabieto the vehicle described above. If there is no such law,our limit of liability shall be$5,000 on account of bodily injury sustained by one person in any one occurrence and subject to this provision respecting each person,$10,000 on account of bodily injury sustained by two or more persons in any one occurrence.Our total liability for all damages because of all property damage sustained by one or more persons or organizationsas the result of any one occurrence shall not exceed$5,000. The insurance afforded by the policy described above is subject to all terms of the policy and any endorsementeattached to it.This endorsementdoes not increase the limits of the policy. Upon cancellationor termination of this policy or policiesfrom any cause we will mail 15 days notice in writing to the other interestshown below. CITY OF SAN JUAN 324 PASEO ADELANTO SN JN CAP CA 92675- AUTHORIZED S URE 91-1136 2ND EDITION 6-97 04-23-2001 A-96 E1136231 P. O, )X 9016 CARLSu"D, CA 92018 CITY OF SAN JUAN 324 PASEO ADELANTO SN JN CAP CA 92675- COVERAGE DESIGNATIONS COVERAGES-- Indicatedby'COV'or the limit of Company's liability against each ooverage.'NC'or'NOT COV' means'NOT COVERED.' 'MAX'means'Maximum Deductible.' BODILYINJURY - Bodily Injury Liability COMPREHENSIVE - Comprehensive Car Damage P.D. - Property Damage Liability COLLISION - Collision-Upset UNINSURED - Benefits for Bodily Injury(including property NON-AUTO - Comprehensive Personal Liability- MOTORIST damage coverage if policy issued in New Each oocumence. Mexico)caused by Uninsured Motorists Medical Payments to Others- MEDICAL - Medical Expense Insurance,Family Medical Each Person. Expense,and Guest Medical Expense- Damae to See Policy for Property of Otheuoccurrence. See Policy Provision. If policy contains the E-550 No-Fault TOWING — Towing&Road Service Coverage. Endorsement or No-Fault Coverage D,Auto OTHER — One or more miscellaneous coverages Medical Expense Coverage does not apply. added by endorsement to the policy. NO-FAULT — See Endorsement E-550(Illinois E-2250) or Coverage D if applicable. LOSS PAYABLE PROVISIONS (Applicable only If lienholder Is named,and no other Automobile loss payable endorsement Is attached to the policy) It is agreed that any payment for loss or damage to the vehicle described in this policy shall be made on the following basis: (1) At our option,loss or damage shall be paid as interest may appear to the policyholder and the lienholder shown in the Declarations,or by repair of the damaged vehicle. (2) Any act or neglect of the policyholder or a person acting on his behalf shall not void the coverage afforded to the lienholder. (3) Change in title or ownership of the vehicle, or error in its description shall not void coverage afforded to the lienholder. The policy does not cover conversion,embezzlement or secretion of the vehicle by the policyholderor anyone acting in his behalf while in possession under a contractwith the lienholder. A payment may be made to the lienholder which we would not have been obligated to make exceptfor these terms. In such event,we are entitled to all the rights of the lienholder to the extent of such payment.The lienholder shall do whatever is necessary to secure such rights. No subrogation shall impair the right of the lienholder to recover the full amount of its claim. We reserve the right to cancel this policy at any time as provided by its terms. In case of cancellation or lapse we will notify the lienholder at the address shown in the Declarations. We will give the lienholder advance notice of not less than 10 days from the effective date of such cancellation or lapse as respects his interest. Mailing notice to the loss payee is sufficientto effect cancellation. The following applies as respects any loss adjusted with the mortgagee interest only: (1) Any deductible applicable to Comprehensive Coverage shall not exceed$250. (2) Any deductible applicable to Collision Coverage shall not exceed$250. 91-11362ND EDITION 4-97 E1136232 • • FARM E RS COMPANY NAME: `�Q� - 3 FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA `-=>l,C?f�PU NE-k AN INTER-INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY PART I CERTIFICATE OF INSURANCE INSURED'$NAME&ADDRESS: POLICY NO: 97 13997-86-38 WILLIAM BATHGATE POLICY EDITION: 03 PATRICIA BATHGATE EFFECTIVE DATE: 03-09-2001 29931 CMNO CPSTRANO EXPIRATION DATE: CONTINUOUS UNTIL CANCELLED SN JN CAP CA EXPIRATIONTIME: 12:01 A.M. Standard Time 92675- ISSUING OFFICE: P. O. BOX 9016 AGENT: Ben S Hofstad CARLSBAD, CA 92018 AGENTNO: 97 15 356 AGENTPHONE: (949) 661-6692 DESCRIPTION OF VEHICLE Year - MotorModel Vshick.Identification Number. - 1969 1 FORD FORD PU F25YRF26833 COVERAGES *ENTRIES IN THOUSANDS OF DOLLARS. (SEE REVERSE SIDE FOR COVERAGE DESIGNATIONS) Uninsured-Motorist Madcoll Gmnprahenew - Collision t QT*luit" P.D. _ 6oaB-In .O - No Fault D&IW W# ' - Deduolibk - - Towing : Na-Auto « « * « • NOT COV e 250 + 500 100 250 500 , COV xxX XXX 5,000 240 500 Other NC NC Each I Eaoh EaahFach xxX i XXx Ueb. I Medioel Person t Ooouaence Person! Owurt nos NOT COV i This certificate is subject to all of the terms,conditions and limitations set forth in the pokoy(iss)and endorsementsattachedto it. It Is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previouslyissued certificates. PART 11 ADDITIONAL INSURED ENDORSEMENT E1136 2nd Edition We provide the coverages indicated by 'COV; or the limit of the Company's liability, on the above Certificate of Insurance.We provide this coverage in respect to the vehicle described above,to the person or organization named below as an additionalinsured. This coverage applies only: (1) while the named insured is the owner,or has care,custody,or control of the above describedvehicle,and (2) when liability arises out of the acts and omissions of the named insured. This coverage does not apply: (1) where liability arises out of negligence of the additional insured,its agents,or employees,unless the agent or employee is the named insured,or (2) to any defect of material,design or workmanship in any equipment of which the additional insured is the owner, lessor,manufacturer,mortgagee,or beneficiary. If any court shall interpret this endorsement to provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibilityiaw of the state,province,or territorywhere the named insured resides,as applicableto the vehicle described above. If there is no such law,our limit of liabilityshall be$5,000 on account of bodily injury sustainedby one person in any one occurrence and subject to this provision respecting each person,$10,000 on account of bodily injury sustained by two or more persons in any one occurrence.Our total liabilityfor all damages becaussof all property damage sustainedby one or more persona or organizationsas the result of any one 000urrenoeshall not exceed$5,000. The insurance afforded by the policy describedabove is subjectto all terms of the policy and any endorsementeattached to it.This endorsementdoes not increasethe limits of the policy. Upon cancellationor termination of this pollcy or policiesfrom any cause we will mail 15 days notice in writing to the other interestshown below. CITY OF SAN JUAN 324 PASEO ADELANTO SN JN CAP CA 92675- AUTHORRED St URE 31-1136 2ND EDITION 4-97 02-15-2001 A-96 E1136231 P. O. E 9016 CARLSBAD, CA 92018 CITY OF SAN JUAN 324 PASEO ADELANTO SN JN CAP CA 92675- - COVERAGE DESIGNATIONS COVERAGES-- Indicated by'COV"or the limit of Company's liability against each coverage."NC' or*NOT COV' means'NOT COVERED.' "MAX'means'MaximumDeductible." BODILYINJURY — Bodily Injury Liability COMPREHENSIVE — Comprehensive Car Damage P.D. — Property Damage Liability COLLISION — Collision-Upset UNINSURED — Benefits for Bodily Injury(including property NON-AUTO — Comprehensive Pomona)Liability- MOTORIST damage coverage if policy issued in New Each occurrence. Mexico)caused by Uninsured Motorists Medical Payments to Others- MEDICAL — Medical Expense Insurance,Family Medical Each Person. Expense,and Guest Medical Expense- Damage to Property of Others- See Policy Provision. See Policy for Limits per occurrence. If policy contains the E-550 No-Faun TOWING — Towing&Road Service Coverage. Endorsement or No-Fault Coverage D,Auto OTHER — One or more miscellaneous coverages Medical Expense Coverage does not apply. added by endorsement to the policy. NO-FAULT — See Endorsement E-550(Illinois E-2250) or Coverage D if applicable. LASS PAYABLEPROVISIONS (Applicable only If lienholder Is named,and no other Automobile loss payable endorsement Is attached to the policy) It is agreed that any payment for loss or damage to the vehicle described in this policy shall be made on the following basis: (1) At our option, loss or damage shall be paid as interest may appear to the policyholder and the lienholder shown in the Declarations,or by repair of the damaged vehicle. (2) Any act or neglect of the policyholder or a person acting on his behalf shall not void the coverage afforded to the lienholder. (3) Change in title or ownership of the vehicle, or error in its description shall not void coverage afforded to the lienholder. The policy does not cover conversion,embezzlement or secretion of the vehicle by the policyholder or anyone acting in his behalf while in possession under a contractwith the lienholder. A payment may be made to the lienholder which we would not have been obligated to make except for these terms. In such event,we are entitled to all the rights of the lienholder to the extent of such payment.The lienholder shall do whatever is necessary to secure such rights. No subrogation shall impair the right of the lienholder to recover the full amount of its claim. We reserve the right to cancel this policy at any time as provided by its terms. In case of cancellation or lapse we will notify the lienholder at the address shown in the Declarations. We will give the lienholder advance notice of not less than 10 days from the effective date of such cancellation or lapse as respects his interest.Mailing notice to the loss payee is sufficient to effect cancellation. The following applies as respects any loss adjusted with the mortgagee interest only: (1) Any deductible applicable to Comprehensive Coverage shall not exceed$250. (2) Any deductible applicable to Collision Coverage shall not exceed$250. gt-11362ND EUMON 4-97 E1136232 0 9 �& FARM E RS - COMPANYNAME: F&RMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA AN INTER-INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY PART I CERTIFICATE OF INSURANCE INSURED'S NAME&ADDRESS: POLICY NO: 97 13997-86-37 WILLIAM BATHGATE POLICY EDITION: 03 PATRICIA BATHGATE EFFECTIVE DATE: 01-23-2001 PO BOX 217 EXPIRATION DATE: CONTINUOUS UNTIL CANCELLED SN JN CAP CA EXPIRATION TIME: 12:01 A.M. Standard Time 92693-0217 ISSUING OFFICE: P. o. BOX 9016 AGENT: Ben S Hofstad CARLSBAD, CA 92018 AGENTNO: 97 15 356 AGENTPHONE: (949) 661-6692 DESCRIPTION OF VEHICLE Year Maden--- --.Yehiok ldenlflkatpn Number 11987 TOYOTA PU 2WD JT4RN70D6H0031740 COVERAGES *ENTRIES IN THOUSANDS OF DOLLARS. (SEE REVERSE SIDE FOR COVERAGE DESIGNATIONS) UnIneumd Motoriet :Me -- Oomprelreneive CoiMalon.- . Bodily Inlury PM, -Butla -No Fadi DedudW* ---oeduotiIA0 Ta�� * ' *!�* * I *I .COV *i 250 15001100 250 500 COV XXX XXX 5,000 240 500 -'Odtar _ NC NC Eaoh Each Eeoh l Each XXX + XXX 500 COV Uab. i Msdioei Peron Owurrenoe Person i Ooounenoe This oertfticateis subjectto all of the terms,oonditionsand limitations set forth in the policy(ies)and endorsements attaohedto it. It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previouslyissued certificates. PART II ADDITIONAL INSURED ENDORSEMENT E1136 2nd Edition We provide the coverages indicated by 'COV,' or the limit of the Company's liability, on the above Certificate of Insurance.We provide this coverage in respect to the vehicle described above,to the person or organization named below as an additional insured. This coverage applies only: (1) while the named insured is the owner,or has care,custody,or control of the above describedvehiole,and (2) when liability arises out of the acts and omissions of the named insured. This coverage does not apply: (1) where liability arises out of negligence of the additional insured,its agents,or employees,unless the agent or employee is the named insured,or (2) to any defect of material,design or workmanship in any equipment of which the additional insured is the owner, lessor,manufacturer,mortgages,or beneficiary. If any court shall interpretthis endoreementto provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibilitylaw of the state,province,or territorywhere the named insured resides,as applicableto the vehicle described a Bove. If there is no such law,our limit of liability shall be$5,000 on account of bodily injury sustained by one person in any one occurrence and subject to this provision respecting each person,$10,000 on account of bodity injury sustained by two or more persons in any one occurrence.Our total liability for all damages because of all property damage sustained by one or more persons or organizationsas the result of any one ocourrenoeshall not exceed$5,000. The insurance afforded by the policy described above is subjectto all terms of the policy and any endorsementsattaohed to it.This endorsementdoes not increase the limits of the policy. Upon canceliationor termination of this policy or policiestrom any cause we will mail 15 days notice In writing to the other Interestshown below. CITY OF SAN JUAN 324 PAED ADELANTOCC SN JN CAP CA 92675- AUTHORIZED SI URE 911136 2ND EDITION 4-9] 01-24-2001 A-98 El136231 P. O. P 9016 CARLSBAa , CA 92018 RECEIVED AN 31 4 14 PM '01 CITY CLERK DEPARTMENT CITY OF SAN JUAN CAPISTRANO CITY OF SAN JUAN 324 PASEO ADELANTO ON JN CAP CA 92675- COVERAGE 0MGNAMONS COVERAGES—Indicated by"GOV"or the limit of Company's liability agaitlst each ooverage.'NC'or'NOT COV' means'NOT COVERED.' 'MAX'means'Maximum Deductible.' BODILYINJURY — Bodily Injury Liability COMPREHENSIVE — Comprehensive Car Damage P.D. — Property Damage Liability COLLISION — Collision-Upset UNINSURED — Benefits for Bodily Injury(including property NON-AJTO — Comprehensive Personal Liability- MOTORIST damage coverage if policy issued in New Each owurrenoe. Mexico)caused by Uninsured Motorists Medical Payment&to Others- MEDICAL — Medical Expense Insurance,Family Medical Each Person. Expense,and Guest Medical Expense- Damage to Property of Others- Ex Ps P See Policy for Limits per occurrence. See Policy Provision. It policy contains the E-550 No-Faun TOWING — Towing 8 Road Service Coverage. Endorsement or No-Fault Coverage D,Auto OTHER — One or more miscellaneous coverages Medical Expense Coverage does not apply. added by endorsement to the policy. NO-FAULT — See Endorsement E-550(Illinois E-2250) or Coverage D if applicable. LOSS PAYAELE PROVISIONS (Applicable only H Iienholder Is named,and no other Automobile Ices payable endorsement Is attached to the policy) It is agreed that any payment for loss or damage to the vehicle described in this policy shall be made on the following basis: (1) At our option, loss or damage shall be paid as interest may appaar to the policyholder and the Iienholder shown in the Declarations,or by repair of the damaged vehicle. (2) Any act or neglect of the policyholder or a person acting on his behalf shall not void the coverage afforded to the Iienholder. (3) Change in title or ownership of the vehicle, or error in its desuription shall not void coverage afforded to the Iienholder. The policy does not cover conversion,embezzlementor secretion of the vehicle by the policyholderor anyone acting in his behalf while in possession under a contractwith the Iienholder A payment may be made to the Iienholder which we would not have been obligated to make except for these terms. In such event,we are entitled to all the rights of the Iienholder to the extent of such payment.The Iienholder shall do whatever is necessary to secure such rights. No subrogation shall impair the right of the lienholderto recover the full amount of its claim. We reserve the right to cancel this policy at any time as provided by its terms. In case of cancellation or lapse we will notify the penholder at the address shown in the Declarations. We will give the Iienholder advance notice of not less than 10 days from the effective date of such cancellation or lapse as respects his interest.Mailing notice to the loss payee is sufficientto effect cancellation. The following applies as respects any loss adjusted with the mortgs.gee interest only: (1) Any deductible applicable to Comprehensive Coverage shall not exceed$250. (2) Any deductible applicable to Collision Coverage shall not exceed$250. 91-1136 21,10 EDITION 657 E 1136232 • • FARMERS FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST MORTGAGEE OR OTHER INTEREST: DATE MAILED: 01-24-2001 CTY OF SAN JN _ CAPISTRANO _- CANCELLATION DATE; 32400 PSEO ADLN - - SN JN CPS CA 02-08-2001 - 92675- EFFECTIVE At 12:01 A.M. AGENT: 97 22 370 POLICYNUMBER : 97 11121-52-84 HOUSEHOLD NUMBER: 012174054 VEHICLE YEAR 1992 REGAL & DESCRIPTION NAMED INSURED: HOWARD LARNARD You are hereby notified that all coverage extended to you under the above described policy is cancelled effective at the date and time above. Your loan with this policyholder may have expired;however, this notice complies with the provision of our policy. FARMERS INSURANCE GROUP OF COMPANIES REGIONAL OFFICE P. O. BOX 9016 CARLSBAD, CA 92018 c o a n rrn rn 7 2 O 25-0007 3-% 01-24-2001 A0007101 THIS PAGE LEFT INTENTIONALLY BLANK. ® NOTICE OF CANCF' LATION OF MORTGAGEE OR OTHF 'NTEREST 2/21�of "H J t FARMERS INSURANCE EXCHANGE t l l � �f POLICY NUMBER 10 —1 1 '�Ir.�c(/)-� 1�E� 97 13997 86 37 87 PU 2WD 02-16-01 PREMIUM DUE 97 15 356 01-23 323.70 AGENT BEN S HOFSTAD PHONE 949 661-6692 Because of nonpayment of premium,you are hereby notified that all coverage extended to you under the above A uTd described policy is cancelled effective at 12:00 NOON(12:01 A.M.1n CA,OR,TX,WA,OK,VA and Fire only policies in AR,VA and ID)on the date shown here but only as respeote the interests of the Mortgages or other mterestsahmn. ed res ns _. m- 0"I()e�m COVERAGE STOPS AT 12:00 NOON(12:01 A.M. IN CA, OR, TX, WA, OK, VA AND FIRE ONLY MAR . 03, 01 T1n 15 ,POLICIES IN AR,VA AND }(ID)ON -Named 6-ees C97"1r w r 1 � )/ Mortgages Irwured: or Other WILLIAM BATHGATE h InterestJUAN PATRICIA BATHGATE reQ�IV2O' CAPISTRANOCITY OFNEMPLOYER PO BOX 217 3 -3 324 PASEO ADELANTO SN JN CAP CA 92693 SN JN CAP CA 92675 25-1203 11-% A1203101 • • FARMERS" T1017101 Dec-21 -00 01 : 14P Hofstad Insurance 9496612066 P . 02 Policy N ACORDCERTIFICATE OF LIABILITY INSURANCE 12/2DIAT/E2000 PROOIICER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION — 1553 CAMINO MIRA COSTA S G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SAN CLEM113 E, CA. 92672 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (949)661-6692 123 456 INSURERS AFFORDING COVERAGE INSURER A_FAMORS INSURANCE GROUP INSURER B' _,-- P.O. BOX 217 _INSURERC: SAN JUAN CAPISTRANO, Ch 92675 INSURERD: _ INSURER E. COVERAGES T[IE POLICIES OF INSURANCE LISTED BELOW HA E BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF AN CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY T E 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. INS — _...___�_. POLICY EFFECTIVE POLJCYEIVIRATION I_ TYPE OF RMURVCF OUCY NUMBER UMTS r EIERAL UAMLITY EACH OCCURRENCE S 1,000 1000 A COMMERCIAL GENERAL LIABILITY 15053846 10/19/2000 IO/19/2001 FIRE DAMAGE(Any NM1 ) -51,000.000 CLAIMS MADE ®OCCUR MED EXP IAny onSpgSonl S PER$ DMBRLLLA_ PERSONAL 5 ADV INJURY S 1,000-.-C 0 GENERAL AGGREGATE S1,()DO,000 GEN'LAGOREGATE LIMIT APPLIES PER'. PRODUCTS-COMPpP AGG SS OO,000 _-_ _ — —_-. 'POLICY F-1 PRO- LOG -�- WTOIAGBILE MABIUTY '.COMBINED SINGLE LIMIT $ ANY gUTO IE��cddenp ALL OWNED AUTOS BODILY INJURY A SCHEDULEDAUTOS 139978 37 6 38 10/9/2000 3/9/2001 1papN ) $250,000 — — 1$ 500,000 HIRED AUTOS BODILY INJURY _ NON-OWNEOAUTOS I (P°rd°M) PROPERTY DAMAGE ,$$00,000 P.IcdEmD "GARAGE LIABILITY AUTO ONLY-EAACCIDENT 1S ANY AUTO OTHER THAN EAACC iS AUTOONLY —AGGGG S EXCE53 LIABILITY EACH OCCURRENCE $ _ OCCUR C CLAIMS MAGE AGG S r--A f: DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND i TWORY,4IMIT.S ER .. EMPLOYERS UABIUTY i £L EACH ACCIDENT S E L DISEASE EA EMPLOYEE $ _ E.L.DISEASE-POLICY OMIT S OTHER DESCRIPTION OF OPERATIONSILOCATIONBIVENCLESIEXCL S ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 10 DAYS NOTICE OP CANCELLATION FOR NON PAYMENT CERTIFICATE HOLDER ADDITIONAL.INSU11 D; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAMCEILEO BEFORE THE EXMRATON CITY OP SAN JUAN CAPISTWNO DATE THEREOF,THE ISSUING INSURER WILL ENOEAVOR TO MAR.30 DAYS WRITTEN COk*MITY DEVELOPMENT AWNCY NOTICE TO THE CE GTE HOLDER NANEO TO THE LEFT.BUT FN WRE TO DO SO SMALL 32400 PASEO ADELANTO IMPOSE NO OR MIA N OR LIABILITY OF ANY KIND UPON THE INSURER R3 AGENTS OR SAN JUAN CAPISTRANO, CA. 92675 REPRESENTATIVES. AUTHONBEO REFIRE TATIVE ACORD 26-S(7167) ACORD CORPORATION 1988 Dec-21-00 01 : 14P Hofstad Insurance 9496612066 P . 01 • Date :12-21-00 FROM : BEN HOFSTAD hone (949)661-6692 Fax(949)661-2066 No. of Pgs including this cover page '3'Z TO:DAWN SCHANDE RL RE:INSURANCE FOR WILLIAM AND PATRICIA BATHGATE HERE IS THE FORM f OR THERE INSURANCE. IF YOU NEED ANYTHING ELSE PLEASE LET ME KNC W THANKS BEN HOFSTAD HOFSTAD INSURANCE AGENCY 3553 CAMINO MIRA COSTA,#G SAN CLEMENTE, CA 92672 Dec-21-00 11 : 50A Hofstad Insurance 9496612066 P .02 lei • LIABILITY ENDORSEMENT CITY OF SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San Jua Capistrano California 92675 ATTN: SCNgr, DejeL .A. POLICY INFORMATION Endorsement# I. InsuranceCompany 2iMe" „J J ;PolicyNum er 2 PolicyTerm(From) �o r oo (To) /a o ;Endorsement Effective Date ro I 0 3 Named]nsuredtli A + G13 f 44 f— _ 4 Address ofNamed Insured Z!rq3t 6ovitlwcp w a 5. Limit of Liability Any O e Occurrence/Aggregate $ 1.oeo,ppo / I t soo, et- O General Liabilit, Aggregate(Check one:) / Applies "per location/project” ✓ Is twice the occurrence limit G. Deductible or Self-IRSURd Retention (Nil unless otherwise specified): $ Z.$CJ 7_ Coverage is equivalent to: Compr hensive General Liability form GL0002 (Ed 1/73) f/ Comm rcial General Liability "claims-made" form CG0002 _ 8 Bodily Injury and Propemy Damage Coverage is: "claims-made" "occurrence" Ifclai s-made,the retroactive date is B. (POLICY AMENDMENTS Ibis endorsement is issued in consideration f the policy premium. Notwithstanding any inconsistent statement in the policy to which this andorsemenl is attached or any other endo sement attached thereto, it is agreed as follows: I INSURED. The City and the Community Redevelopment Agency, 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 beha f of the Named Insured,(b) projects and completed operations of the Named Insured,or(c) premises owned, leased r used by the Named Insured '. CONTRIBUTION NO REQUIRED. As respects: (a)work performed by the Named insured for or on behalf of the City:or(b)projects sold y the Named Insured to the City;or(c)premises(eased by the Named Insured from the C nt , the insurance afforded by this policy shall be primary insurance as respects the City, its elected or appointed officers, officials,employees or v lunteers: or stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary cov ratite. in either event, any other insurance maintained by the City, its elected or appointed officers. officials, emplcyees or volunteers shall be in excess of this insurance and shall not enmribuie with it SCOPE OF COVERAGE. This policy, if primary, affords coverage at least as broad as: I I1 Insurance 5ervi es Office form number GL0002 (Ed. 1!73), Comprehensive General Liability Insurance and Insurance Servi 'es Office form number-GI-0404 Broad Form Comprehensive General Liability endorsrmeni Or. ('_) Insurance Sery ces Office Commercial General Liability Coverage,"occurrence" form C60001 or "claim.- madc" form C60002, or, 0ec-21 -00 11 : 50A Hofstad Insurance 9496612066 P . 03 • (3) If excess, affor s coverage which is at least as broad as the primary insurance forms referenced in the preceding sections (1) a (2). d SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to each insured who i5 seeking coverage or ag inst 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. Any failure to comph with reporting provisions of the policy shall not affect coverage provided 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 nut be suspended,voided, cancelled,reduced in coverage or limits except after thirty(30)days'prior written notice by certified mail return receipt requested has been given to the City. Suck 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: A&-WsXT (Title) (Department) (Company) 3553 i6toltma t"WA- COGI A dk(i' (Street Addre s) (City) (State) (Zip code) -------- ------- (Telephone) D SIG NATURE OF INSURER DR AUTHQRIZED REPRESENTATIVE OF THE INSE I _-TW? _ ACA-71.4nQ .-_ _(prim/type name), warrant that I have authority to bind the below listed nlsur.mce company and by my signature hereon do so bind this company. SIGNA (Original signature req d on endorsement furnished to the City) i,lU,:ANIZA IION w.HIAi ....! svn4h. _ TITLE AtoWa't _.----- . -- auuRl.sti 3553 (4m,#4Moi ilf�15r44--4 (V- 6.6, _ TELE 131ION F 32400 PASEO ADELANTO I Ll 'i..i MEMBERS OF THE CITU COUNCIL SAN JUAN CAPISTRANO,CA 92675 nnuuITO DIANE L.BATNGATE CCHN GR CAMPBELL (949) 493-1 171 If 1776 1961 JOHN GREINEq (949)493-1053 (FAX) V76 DAVID HART � � DAVID M.SWERpLIN A� AJ CITY MANAGER •iYr�r�l/I• GEORGE SCARBOROUGH October 10, 2000 William and Patricia Bathgate P.O. Box 217 San Juan Capistrano, California 92693 Re: Renewal of General Liability and Endorsement Form(Overseer-Swanner Property) Dear Mr. & Mrs. Bathgate: The General Liability Certificate of Insurance, regarding the above-referenced agreement, is due to expire on October 19, 2000. 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. Please forward the updated certificate and endorsement to the City, attention City Clerk's office, by the above due dates. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Kathleen Springer, Public Works DgUO USE IS San Juan Capistrano: Preserving the Past to Enhance the Future Dawn Sdianderl From: Silvia Cintron 2 Sent: Tuesday, March 21, 2000 3:41 PM To: Dawn Schanderl Subject: RE: Bathgate -----Original Message----- From: Dawn Schanderl Sent: Tuesday, March 21,2000 2:48 PM To: Silvia Cintron Subject: RE: Bathgate Thanks for your help. Did you happen to touch base with Merchants Building Maintenance? I spoke with Robin of Merchants, she said she would call and have the new certificates sent away. -----Original Message----- From: Silvia Cintron Sent: Tuesday, March 21, 2000 2:38 PM To: Dawn Schanderl Subject: Bathgate Monday, 3/20/00, 1 called Pat Bathgate regarding her auto liability insurance notice of cancellation. She said that due to Bill's health, he isn't driving so they've cancelled the insurance for his 69 3/4 Ton pick up Truck. I told her that we still needa an up to date policy for their other vehicle as well as reflecting the change. I asked her to have her insurance fax the insurance certificate to us ASAP, she said she'd give her insurance man a call. Thanks, Silvia 1 Dawn Setanderl From: Silvia Cintron Sent: Tuesday, March 21, 2000 2:38 PM To: Dawn Schanderl Subject: Bathgate Monday, 3/20/00, 1 called Pat Bathgate regarding her auto liability insurance notice of cancellation. She said that due to Bill's health, he isn't driving so they've cancelled the insurance for his 69 3/4 Ton pick up Truck. I told her that we still needa an up to date policy for their other vehicle as well as reflecting the change. I asked her to have her insurance fax the insurance certificate to us ASAP, she said she'd give her insurance man a call. Thanks, Silvia i *** UNSUCCESSFUL MEMORY TRANSMISSION REPORT *** • TIME : OCT 22 '9 14:17 TEL NUMBER : 949-493-1 NAME CITY OF SAN JUAN CAP NBR FILE DATE TIME DURATION PGS TO DEPT NBR MODE STATUS 230 33 OCT.22 14:16 00/00 0 3487773 M 50 *** THIS TRANSMISSION WAS UNSUCCESSFUL. RE—TRANSMIT BEGINNING WITH PAGE 01 *** facsimile TRANSMITTAL to: Hofstad Insurance Agency Attention: Ben fax #: 348-7773 M. William and Patricia Bathgate-Agreement with City of San Juan Capistrano overseeing Swanner property: Ben I have not received the renewal on the Bathgate's general liability certificate of insurance which expired on August 12, 1999, along with the general liability endorsement form naming the City of San Juan Capistrano as an additional insured. Would you please fax to my attention the above two(2)documents. Thank you for your attention to this matter. Dawn M. Sehanderl date: October 22, 1999 pages: 3 including cover sheet. From the desk of... Dawn M. Schanderl facsimile TRANSMITTAL t0: Hofstad Insurance Agency Attention: Ben fax #: 348-7773 re: William and Patricia Bathgate-Agreement with City of San Juan Capistrano overseeing Swanner property: Ben I have not received the renewal on the Bathgate's general liability certificate of insurance which expired on August 12, 1999, along with the general liability endorsement form naming the City of San Juan Capistrano as an additional insured. Would you please fax to my attention the above two(2)documents. Thank you for your attention to this matter. Dawn M. Schanderl date: October 22, 1999 pages: 3 including cover sheet. I()1.? - Y { G C� //� Fro a deskerl � v nJ Dawn M.S Clerk Deputy Cityity Clerk City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (949)443-6310 Fax: (949)493-1053 ® NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST H FARMERS INSURANCE EXCHANGE POLICY M1MFJkH DA*E MPo�EIJ x S I�V IA C1MH a+� 97 13997 86 38 69 FORD PU 07-23-99 -I/a n^� - ^ _ fRIAUM WE •`OI"',`-(lY •,�/� 97 15 356 06-30 305. 10 AGENT BEN S HOFSTAD PHONE 949 661-6692 Because of nonpayment of premium,you are hereby notified that all coverage extended to you under the above described policy is cancelled afteobve at 12:00 NOON(12:01 A.M.In CA,OR,TX,WA,OK,VA and Fire only policies in AR,VA and ID)on the date shown here but only as respects the interests of the Mortgagee or other iatarestsshown. COVERAGE STOPS AT 12:00 NOON(12:01 A.M. IN CA, OR, TX, WA, OK, VA AND FIRE ONLY AUG. 117, 99 POLICIES IN AR,VA AND ID)ON ) � Named Mortgagee Insured: or Other / .. WILLIAM BATHGATE Interest CIT terestCITY OF SAN JUAN PATRICIA BATHGATE CAPISTRANO EMPLOYEE PO BOX 217 324 PASEO ADELANTO SN JN CAP CA 92693 SN JN CAP CA 92675 25-1203 11-9a vv ( I l need GL 32400 PASEO ADELANTO MEMBERS OF THE CRY COUNCIL SAN JUAN CAP I STRAND,O 92675 COLLENE CAMPBELL JOHNR (949)493-1171 immune WATT HART HART (949)493-1053(FAX) nnuuRr 1961 GILJONES 1776 DAVID M,SWERDLIN ER August 5, 1999 •� � CITVMANAGGEORGESCARBOROUGH Mr. & Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, CA 92693 Re: Renewal of General Liability Certificate of Insurance and Automobile Liability Reinstatement Notice (Overseer Services - Swanner Prooerty) Dear Mr. & Mrs. Bathgate: The General Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on August 12, 1999. 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 the City approved endorsement form to submit to your insurance company; however, your insurance company may provide their own endorsement form. I have received a cancellation notice regarding your automobile insurance to take effect on August 7, 1999. Please have your insurance agency send me a reinstatement notice. Please forward the updated certificate and the endorsement form to the City, attention City Clerk's office, by the above due date, and the reinstatement notice as soon as possible. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Silvia Cintron, Public Works DOUG USE Is AB San Juan Capistrano: Preserving the Past to Enhance the Future CE - STATE OF CALIFORNIA THE EXPIRATION DATE EV C x M y LISTED HEREON APPLIES jf} ONLY IF THE PREMIUM HAS BEEN PAID I y + 197 �, 69 Ford PII 3 ""'P "°• F25YRE26833 Elm"OR► 1/26/00 D• a'P , an authorized 1 alitomia at CInsu, I mpliance ed a ith the policy ino California ramouFinancial t a otalless then Responsibility Acl,sceAHlea,t �s s$ 26 required by, t CaliComia;Financial Responsibility Law for the described motor Vehicle. . BEN HOFSTAD. AGENT + 97-15-356 (949)661-6692 • William and Patricia Bathgate 29931 Camino Capistrano San Juan Capistrano,...CA 92693 ® KEEP THIS CERTIFICATE IN YOUR AUTOMOBILE AT ALL TIME` READ REVERSE SIDE CAREFULLY O:IA130321 ranee 9496612066 P. 02 Nov-16-99 o s a nsu 'c■7{WII 1 DAYS MERoofry) J4011H6/89 FROoyDER Hofstad Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3669 CAMINO MIRA COSTA STE G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SAN CLEMENTE,CA 92672 HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES. AFFORDING COVERAGE +714)6014562 COMPANY FARMERS INSURANCE EXCHANGE CODE: SUR DOPE: A INSURED WILIJAM A AND PATRICIA SLATHGAl E COMPANY B P.O.BOX 217 CI'1MPANY C SAN JUAN CAPISTRANO,CA 92676 - -- - -- - --- --- - - f,CddaA.'ry b - THISISTO CERTIPY THAT THE POLICAES OFINS ANCE LISTED BELOW HAVE BEEN OWED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOU . TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EY THE POLICIES OESCRISED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY S. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. TYPEMRIIbURANCc CY MVAIscR Fa1DYEFFro7we FOUCYE7VIRATEN/. (:NITS LTR DATE 041NOWn DATE S.M'OOfYY) GENERAL LIABILITY - ^F,T�_=FAA.AGG'rRE6"APE g 1,AMQ,DOB I❑I GOMMEG.GVA NVR& I.AWL I'I'/ .T?MPIOP.AaG E- 1.5!90.400 10hAlKk; MAUt �Q,ilp.,i;1iN! I'F4;gpryA.AA(Ib' IN:_;_!HY TJtYNEH'S& nN t RA::TDR S TIRO) EACb DCn:URRENCE ., y 1,000.000 A i.�. Pols LNRbrows .. _.. 18063648 ( 10119N9 10111080 c N-eAarp..,E � � - MtDEY.f'(ArY orae perocrz} g AU'{t;rMGHIIE LIABkJTV ^1aW ;AMFi1NFD 91fdtitF'IMlt g v ANY AUH) ... ... ._ AI.L 6WA+ 0 AT,W6 139978837 38 7123M V23ft o%ia;.r lNdvk�� . .. ...' .... 240000 A :Q �.p pn;ennt _ SS:Mt.YUI fD AUTOS IR D AUTOS "JIIY IN IURY �nn�NON-Ok"I I)AI� (i)p. tPp KCIgRM, S . Eli FRUPER'.Y DAMAGE GARAGE LPNLITY I AUTO ONLY-EA.AOCIDt7l g I ANY AUVi 1Tl iLk THAN AUTO UNLY EY AGOPEOATE S ��E^^X''C�ESS.LUIRILITY EACI,-X)CJRRO,ICL t__, "a'AEGATE IUMORE.4A POR"e � /JITR:R TxAN I'M FORM S iSiA fUTORYi.iMIT4 - WDRCERb DOMPNRCATHRI AND .0..__.. . . ......,. :.r EMPLOYERS'LIABILITY ! FACH ACCIDENT S _ TW RROPRE.T6R! i r111NL1 � - UIbEA.�6-IxRiL:Y tIMfT S PARTNEASRF. TIYE Air. TIFFI(:kiR4 ARF. �.L.1_ : [J44FAfil=-FI.M1f.N fMPLO'fF[ $ OTHER I GEfCRVTfOR OF OKRATA9NSAOCA7IONSNBNNLE8IiPf6 IYEATS CITY OF SAN JUAN CAPISTRANO MOULD ANY OP THE ASOVE oEbCMED POLICIES of DAROMLw "FORE THE EXPIRATION DATE TN®IEO►, TNt ISEUEIG COMPANY WILL ENDEAVOR TO ML COMMUNITY DEVELOPMENT AGENCY 16 DAYS WRRTEN ROTIDE TO THE COUMATE HOLDER NAMED TO THE NETT, 32400 PASCO ADELANTO BUT FALURa To AWL SUM RPTWU SHALL*NPO" RIO CBUDAYIOH OR LMSKrtY 0/ ANY N UMN THE COMPANY, ITS "SUITS OR REPRESEHTATRIfb. SAN JUAN CAPISTRANO,CA 92678 44im I ! oaaaooaaaaeo 0000aeooa.ano nnooaeaeonon 1rr ® NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST nn( InlI� ARMERS INSURANCE EXCHANGE vnuiueEa oMa U 97 1399 097 86 38 69 FORD PU 2-18-00 PREMIUM DUI 97 15 356 01-26 271 .80 AGENT BEN S HOFSTAD PHONE 949 661-6692 1 1\ /'i-a Because of nonpayment of premium,you are hereby notified that all ooverage extended to you under the above l V described polioy is oenoelled effective at 12:00 NOON(12:01 A.M.In CA,OR,TX,WA,04YA and Fire only X i'�1 r , 1 policies AR,VA and 10)on the date shown here but only as rppeots the interests of the Mojtgages or other T 17� / intereshshown. COVERAGE STOPS AT 12:00 NOONA.M. IN CA, OR, TX, WA, OK, VA AND FIREIRE ONLY MAR. 04 , UQ W POLICIES IN AR,VA AND ID)ON Named Mortgagee Insured: or Other Interest WILLIAM BATHGATE CITY OF SAN JUAN PATRICIA BATHGATE CAPISTRANO EMPLOYEE PO BOX 217 324 PASEO ADELANTO SN JN CAP CA 92693 SN JN CAPS CA 92675 _! t 25-120311-SB P1203101 Nov- 16-99 10 : 10A Hofstad Insurance 9496612066 P . 01 facsimile TRANSMITTA to: � fax #: 949-"l-2 re: Patricia and Bill Bathgate Thank you for faxing the endorsement, 1 still need an scord certificate for the general Hal Ality. 'Would you please fax one to me. Thanks a in. You have been most helpful. date: November 5, 1999 pages: I ineludin cover sheet. i From the desk of... Dawes M.5ehaaderl Deputy city Clerk City of San.Nan Capistrano 32400 Paseo Adelanto San Juan Capistrano,CA 92615 (949)4143-6310 Fav(949)499-1053 Nov-15-99 11 : 19A Hofstad Insurance 9496612066 P .O3 LIABILITY ENDORSEMEN'r CiTY OF SAN JUAN CAPISTRA'NO TI kC7 KY SEs' .01MMU,NITY REDEVELOPMENT AGENCY 32400 Phren .Adelanto Sari Juan Capistrano,California 926?5 XI-M t ndutsementr; i r auratie(..'ompartti 4F WWAay__ S' e.H .__ ._._.. __..._...,...,P' Ircy Nkint Cr_. i P.[iiy 'rrmtliom) t[y q *4 —.(i, l i4�.t9� Et �r.,cntentFtleurveDtu o t7jT"t d Ad<iressoNwnedInsarc _ 4'L3f_._ q�L+n_Le_ e12rrrA;�+"- __ �+ T✓n.-a - yII,C^ „a - �"�43 5 Limn cf Liability Any C ne OccurrenceiAggrelptt $_ eneral Liabtli v Al%regatc(Check one;} G nppljs "per Ietcaticntpro)ect" _Is mice mi the occurrence iimit �. Deduct.ib'e or -4elf-insur .d kcienrron I Nil unless otherwise specified 7. ,'I Corriagc I ell urvalent Ill Comp,^ltenslve Ceneril Liability form (31,11002 tEd t;? C onarnmia) C,eneral liability "cla-m.-;Wade'- 'orm CCOW-, k Bodily Ir:jmti and Props 1.1 Damage C'oaerage is, calms-made" itclad is-made--.he retroactive date .s _, I'C)I [CY AvIFNI)'4iF;!STS r i aidorv. r¢.nf is ksued in cnnsideratian,.f fhe pole} premium. Nom atistandinz any inconsisterar statrrnent Sri the poilcy to iN n '!-. :ir,; vncur>aaWnr is t'ulchad or ally other endo sement atached thereto, it tz agreed as follows INSURED, Pw(-rt,ar;r thcl' «nnsnih Redne opnrtw Alov:e,- 'ts elected r-r xppoirneti otf>cer-,trri u.d, c1g,lav-e" n.a v r t.ee•; arc rnchder. c, ins,rredr; w;th %gar.l t; damages ;:rid cefensc it china ttnao n: ncfna. raw .:c- ti:r.c c,erf'urrrud ; ofonhen: C(t tae Named Insured. (bi prvjec-ra ar .ek-xqieteki opktatt,mol the Nam .d Ltsurc�,rr t.; 1cd. 'iti.<ed )I a wd hr Narne..7 lne'ri%'d. C()NTRIBL-1'ION N'tY REC)CIRED. Al rwaccss t,f oak I> to;rtie i i?y dte Named in,it=ea for e , rah Ir cfi( C'.r;. • w 'i-p.nlea;cokf IN l.e. �arncd ir.+arcd:�the^ r +d, :v lei i crrils<s le-iced he Lc t4ainu;= =ruur .1 .loa. rtt� nt 'n; irr rice afturdcd h air, polr -shall be primar , .n,uranca rs rc pecu d c C'¢y, its elected or pp.iete :+f i:cr_ ;lard rn an unbroken drain t ove,nge�-vu,l,I l z tir_ned h _trr�d's :rh_r ,r r_ : €War c•ru�c itr erther .Dent. 3nv< otaer ins,],]!',ill c uaaira.curcd [IN the (:tv or aprrow , ' eriipicveeN or soluntee- _l,ck`s in pace„ W , Jiisur,net aae sha'i r of coTW:bw° `+C(WL 01- CON F'RA A. 'k(!- p,.iliey r Limn;^,. of t :ls .c e't 9, hw.rd u, In5e r:es;--rra' 7„nnr;-un:>crt}ION:';Ld- 1 "a: hums nsr.eia,-nei;aI-iall,-ht. _i=,arasee lrrvi rs*-`fr'r�e inrm r amber GLi-10-1 B:,Iud Fo.^.ir (.cmI ir-?itu�ivc( t _ra'. Lei'+ I,ts crld�,t,r-rr_r ,r . li=:.ui;.r_c Srry yes r��;ice f_iin. neau�al Gc-xi i t.,e'o l''-ie l occ-rn;r- r.ccurrmi�.” : >nn c c ir :%i : . a_i rr'm?i" 'Will C'r rUi+J Nov-15-99 11 : 19A Hofstad Insurance 9496612066 P . 02 • �. .;e. cess, ailt> ds arocr at,. a7icl r<a; least 3a�:rrr as fisc ur inlan r,;..ur un,� �„rma retdmn .� 1r, tl;,,pt- .e,rinsr ,Q-, t=.)a d{<). -4. SF:VEIL1E311.1TY OF INTEREST. `Clic insurance itTordca bN 1111, pollcy appl,c, >eparateh .ctit- .a=.a,rc 1 ,:ho �; -eer, r l. ro,cray. -.r a� wrist whom a cla-m K:rade ora suit.is brought. c'NC ,pt ,t 1,i 1 iC 11% 1(..1 rpm11.;. . mr, ni iahihr. PROVISiONtS itEC. DiNC THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Ang lailuic t, tmnp :vial: reporting provisiu s o3 the policy shall not a't''w coverage pro v(ded to the C ty and l:F�t.a;nmuniry IZede1elc:prtcnr .Ae:enc , as;fecaed or ppoinfed otficers, orficaals,emplovees or volunteers. b CANCELLATION N )TICE. The 1nsr,rance afforded by this policlt l ai,not he sospvnclui-t tirotd¢d •ancelll:J, r�:lcrri rr;-,c,ncriti«or limits e. cept after thirty C30)days prior wrtten notice by cert.-fled mail rc 1.,i.r.celpi t.c,uested ii,ts h,c t.'1 ills City. Suc t ruxice shall be add%ssed as shown In the heading of this endorsement I.L•1:112I �IAti " LN(rStS�f113-I ,1=.1ae:as surd c'atm� .1re r� be reported t tbs insurer at ATTN. a P,de r;llep:�mwit0 pLY!ti �!S ...1wviW , orupany) {Zip co&e ..... rr�lepr�::,e; F ItFPRL'NlLAML: XIL0If.itit._I;FR 1 "fyg"j 4¢r-%-%A6 _ _ 1pnnL'rvpr name), wanmc,thal k hive euthor :o 6t 1 ,h: 6r:1 ,., :rr,:,l _1 rzu1[c s n' 17rirn cr i ' s -t si;:i,n.Ur r hurco(1 ti,.,.I) [)h.j till,ton_pary 'MCNA le" (Cir1 `-tat >igr st 1rc rey= ell tm rt.ior>u_acnt lucnlshr�il to die 1."Itx i !.t A Sviltr!�t- .. Tll -. Nov-15-99 11 : 18A Hofstad Insurance 9496612066 P. 01 • Dat FROM: BEN HOFSTAD Phone (949)661-6692 Fax (949)661-2466 No» c f Pgs including this cover page TO : RE- Fax # ' 3- KXSTAD INSURANCE AGENCY 3553 CAMINO MIRA COSTA, #G SAN CLEMENTE, CA 92672 lIi,T� _ I 10 _ COMPANYNAME: FARMERS INSURANCE EXCHANG�f Cl50`S�.ANGELES, CALIFORNIA A14 INTER-INSURANCE EXCHAN E, HEREIN. CALLED THE COMPANY PART I N Z3 'IERTI'FICATE OF INSURANCE INSURED'S NAME&ADDRESS: POLICY NO. 97 13997 -86-38 WILLIAM BATHGATE - POLICY EDITION 03 PATRICIA BATHGATE EFFECTIVE DATE. 01-22-1999 PO BOX 217 - EXPIRATION DATE: CONTINUOUSUNTIL CANCELLED SAN JUAN CAPISTRANO EXPIRATION TIME. 12:01 A.M. Standard Time ISSUING OFFICE: P. O. BOX 9016 AGENT Hen S Hofstad CARLSBAD, CA 92018 AGENT NO 97 15 356 AGENTPHONE: (714) 661-6692 DESCRIPTION OF VEHICLE L __ Year Mal% _ Model Vehicle IdentAlaetion Number 1969 FORD FORD PU F25YRF2G833 COVERAGES *ENTRIES IN THOUSANDS OF DOLLARS. (SEE REVERSE SIDE FOR COVERAGE DESIGNATIONS) Uninsured Motorist M'6cal/ Comprehensive Collision Tmin Bodily Injury P.D- No Foult Deductible Deductible 9 Non-Auto .��—._.. Bodil ly njury._ PD.. .i NOT COV 250 500 100 250 500j COV Xxx Xxx 5, GC() 240 500 _ Other NCS ! NC Eaoh Each Eaoh Each Person I Occurrence Person Oxurrence XXX j XXX COV Liab. Medwnl This oertificateis subjectto all of the terms,conditions and limitations set forth in the policy(ies)and endorsementsattachedto it. It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previouslyissued certificates, PART II ADDITIONAL INSURED ENDORSEMENT E1136 2nd Edition We provide the coverages indicated by 'COV," or the limit of the Company's liability, on the above Certificate of Insurance.We provide this coverage in respect to the vehicle described above,to the person or organization named below as an additional insured. This coverage applies only: (1) while the named insured is the owner,or has care,cu stody,or control of the above describecivehicle,and (2) when liability arises out of the acts and omission s of the named insured. This coverage does not apply: (1) where liability arises out of negligence of the additional insured, its agents, or employees, unless the agent or employee is the named insured,or (2) to any defect of material,design or workmanship in any equipment of which the additional insured is the owner, lessor,manufacturer,mortgagee,or beneficiary. If any court shall interpret this endo rsementto provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibilitylaw of the state,province,or territorywhere the named insured resides,as applicableto the vehicle described above. If there is no such law,our limit of liability shall be$5,000 on account of bodily injury sustained by one person in any one occurrenoeand subject to this provision respecting each person,$10,000 on account of bodily injury sustained by two or more persons in any one occurrence.Our total liability for all damages because of all property damage sustained by one or more persons or org an ization s as the result of any one occurrenee onall not exceed$5,000. The insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attached to it.This endorsementdoes not increase the limits of the policy. Upon cancellation or termination of this policy or policies from any cause we will mail 15 days notice in writing to the other Interestshown below. CITY OF SAN JUAN CAPISTRANO EMPLOYEE 324 PASEO ADELANTO SN JN CAP CA 92675- AUTHORIZEDSI URE 91-1136 2ND EDITION 6-97 01-26-1999 A-98 E1136231 P. O. if 9016 CARLSBAD, CA 92018 CITY OF SAN JUAN CAPISTRANO EMPLOYEE 324 PASEO ADELANTO SN JN CAP CA 92675- COVERAGE DESIGNATIONS COVERAGES-- Indicated by"COV"or the limit of Company's liability against each coverage.'NC'or"NOT COV` means"NOT COVERED." 'MAX"means"MaximumDeductible.- BODILY INJURY - Bodily Injury Liability COMPREHENSIVE - Comprehensive Car Damage P.D. _.. Property Damage Liability COLLISION -- Collision-Upset UNINSURED - Benefits for Bodily Injury(including property NON-AUTO - Comprehensive Personal Liability- MOTORIST damage coverage if policy issued in New Each occurrence. Mexico)caused by Uninsured Motorists Medical Payments to Others- MEDICAL - Medical Expense Insurance, Family Medical Each Person. Damage to Property of Others- SeePolicy licy Provision.Expense,and Guest Medical Expense- See Policy for Limits per occurrence. See Po If policy contains the E-550 No-Fault TOWING -- Towing&Road Service Coverage. Endorsement or No-Fault Coverage D,Auto OTHER -- One or more miscellaneous coverages Medical Expense Coverage does not apply. added by endorsement to the policy. NO-FAULT - See Endorsement E-550(Illinois E-2250) or Coverage D if applicable. LOSS PAYABLE PROVISIONS (Applicable only if lienholder is named,and no other Automobile loss payable endorsement is attached to the policy) It is agreed that any payment for loss or damage to the vehicle described in this policy shall be made on the following basis: (1) At our option, loss or damage shall be paid as interest may appear to the policyholder and the lienholder shown in the Declarations,or by repairof the damaged vehicle. (2) Any act or neglect of the policyholder or a person acting on his behalf shall not void the coverage afforded to the lienholder. (3) Change in title or ownership of the vehicle, or error in its description shall not void coverage afforded to the lienholder. The policy does not cover conversion,embezzlement or secretion of the vehicle by the policyholder or anyone acting in his behalf while in possession under a contractwith the lienholder. A payment may be made to the lienholder which we would not have been obligated to make except for these terms. In such event,we are entitled to all the rights of the lienholder to the extent of such payment.The lienholder shall do whatever is necessary to secure such rights. No subrogation shall impair the right of the lienholder to recover the full amount of its claim. We reserve the right to cancel this policy at any time as provided by its terms. In case of cancellation or lapse we will notify the lienholder at the address shown in the Declarations. We will give the lienholder advance notice of not less than 10 days from the effective date of such cancellation or lapse as respects his interest.Mailing notice to the loss payee is sufficientto effect cancellation. The following applies as respects any loss adjusted with the mortgagee interest only: (1) Any deductible applicable to Comprehensive Coverage shall not exceed$250. (2) Any deductible applicable to Collision Coverage shall not exceed$250. 91-11362NDEDITION 4-97 E1136232 i COMPANYNAME: FARMERS INSURANCE EXCHANGE, LOS AgbtlrH" i7.ALIFOENIA AN INTER-INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY `i I PART Alh4II OF INSURANCE INSURED'S NAME&ADDRESS: - POLICY NO 97 1399'/ -86-3 / WILLIAM BATHGATE POLICY EDITION 03 PATRICIA BATHGATE EFFECTIVE DATE 01-22-1999 PO BOX 217 ' EXPIRATION DATE: CONTINUOUS UNTIL CANCELLED SAN JUAN CAPISTRANO EXPIRATION TIME 12:01 A.M. Standard Time ISSUING OFFICE: P. 0. BOX 9016 AGENT: Ban S Hofstad CARLSBAD, CA 92018 AGENTNO 97 15 3S6 AGENTPRONE. (714) 661-6692 DESCRIPTION OF VEHICLE YearMake Model Vehicle Idenhfloation Number 1987 TOYOTA PU 2 W JT4P.N70D6H0031740 COVERAGES ENTRIES IN THOUSANDS OF DOLLARS. (SEE REVERSE SIDE FOR COVERAGE DESIGNATIONS) Uninsured Motorist Medical/ Comprehensive 0.11 on Towing Bodily Injury [1 P.D . god I ' No Fault Deductible Deductible Non-Auto i 250 ! 500 100 250 i 5005 : COV XXX XXX 5, 000 240 500 COOkher--- -- NO NO Each Each Each Each xxx XXX 500 Liab. Medical Person 1 Occurrence Person Occurrence COV This certificateis subjectto all of the terms,conditionsand limitationsset forth in the policy(ies)and endorsements attached to it. It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previouslyissued certificates. PART II ADDITIONAL INSURED ENDORSEMENT E1136 2nd Edition We provide the coverages indicated by 'COV,' or the limit of the Company's liability, on the above Certificate of Insurance.We provide this coverage in respect to the vehicle described above, to the person or organization named below as an additional insured. This coverage applies only: (1) while the named insured is the owner,or has care,custody,or control of the above describecivehicle,and (2) when liability arises out of the acts and omissions of the named insured. This coverage does not apply: (1) where liability arises out of negligence of the additional insured, its agents,or employees, unless the agent or employee is the named insured,or (2) to any defect of material,design or workmanship in any equipment of which the additional insured is the owner, lessor,manufacturer,mortgagee,or beneficiary. If any court shall interpretthis endorsementto provide coverage other than what is stated in the Certificate of Insurance, then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibilitylaw of the state,province,or territorywhere the named insured resides,as applicableto the vehicle described above. If there is no such law,our limit of liability shall be$5,000 on acoountof bodily injury sustainedby one person in any one occurrenceand subjectto this provision respeotingeach person,$10,000 on acoountof bodily injury sustainedby two or more persons in any one occurrence.Our total liabilityfor all damages becauseof all propertydamage sustained by one or more persons or organizationsas the result of anyone occurrenceshall not exceed$5,000. The insurance afforded by the policy describedabove is subjectto all terms of the policy and any endorsements attached to it.This endorsementdoes not increasethe limits of the policy. Upon cancellationor tsrminationof this policy or policiesfrom any causewe will mail 15 days notice in writing to the other interest shown below. CITY OF SAN JUAN CAPISTR.ANO EMPLOYER. 324 PASEO ADELANTO SN JN CAP CA 92675- 11 AUTHORIZED SI URE 91-1136 2ND EDITION 49) 01-26-1999 A-98 E1136221 P. O. L 9016 CARLSBAD, CA 92018 CITY OF SAN JUAN CAPISTRANO EMPLOYER 324 PASEO ADELANTO SN SN CAP CA 92675- COVERAGE DESIGNATIONS COVERAGES-- Indicated by"GOV*or the limit of Company's liability against each coverage.'NC'or"NOT COV' means"NOT COVERED.' 'MAX'means'Maximum Deductible.' BODILY INJURY - Bodily Injury Liability COMPREHENSIVE - Comprehensive Car Damage P.D. Property Damage Liability COLLISION Collision-Upset UNINSURED - Benefits for Bodily Injury(including property NON-AUTO - Comprehensive Personal Liability- MOTORIST damage coverage if policy issued in New Each occurrence. Mexico)caused by Uninsured Motorists Medical Payments to Others- Expense Insurance, Family Medical Each Person. MEDICAL Medical Ex Ps Y Damage to Property of Others- Expense,and Guest Medical Expense- See Policy for Limits per occurrence. See Po See Policy Provision. If policy contains the E-550 No-Fault TOWING - Towing&Road Service Coverage. Endorsement or No-Fault Coverage D,Auto OTHER -- One or more miscellaneous coverages Medical Expense Coverage does not apply. added by endorsement to the policy. NO-FAULT -- See Endorsement E-550(Illinois E-2250) or Coverage D if applicable. LOSS PAYABLE PROVISIONS (Applicable only if lienholder is named,and no other Automobile loss payable endorsement is attached to the policy) It is agreed that any payment for loss or damage to the vehicle described in this policy shall be made on the following basis: (1) At our option, loss or damage shall be paid as interest may appear to the policyholder and the lienholder shown in the Declarations,or by repair of the damaged vehicle. (2) Any act or neglect of the policyholder or a person acting on his behalf shall not void the coverage afforded to the lienholder. (3) Change in title or ownership of the vehicle, or error in its description shall not void coverage afforded to the lienholder. The policy does not cover conversion,embezzlement or secretion of the vehicle by the policyholder or anyone acting in his behalf while in possession under a contractwith the lienholder. A payment may be made to the lienholder which we would not have been obligated to make exceptfor these terms. In such event,we are entitled to all the rights of the lienholderto the extent of such payment.The lienholder shall do whatever is necessary to secure such rights. No subrogation shall impair the right of the lienholder to recover the full amount of its claim. We reserve the right to cancel this policy at any time as provided by its terms. In case of cancellation or lapse we will notify the lienholder at the address shown in the Declarations. We will give the lienholder advance notice of not less than 10 days from the effective date of such cancellation or lapse as respects his interest.Mailing notice to the loss payee is sufficientto effect cancellation. The following applies as respects any loss adjusted with the mortgagee interest only: (1) Any deductible applicable to Comprehensive Coverage shall not exceed$250. (2) Any deductible applicable to Collision Coverage shall not exceed$250. 91-11362ND EDITION 4-9] E1136232 Jan-76 9cJ 10 : 59A Hof st.acl In�:ur-.5 n<-a� ')4'3(T617066 11 . 07 �/!rf�y(1,(�I;y�IILY� E�� /y� ��11�y�1��, -.-. A.,, �- �B1y� •.. AA�11lII. 'Co 7 77 l" Y IM 7� OAT[pM Du /J 10RT198 PRODUCES Hotalad Insurance Agency TWS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3663 CAMRYO MIRA COSTA STE O ONLY AND CONFERS NO RIGHTS UPON THE CFRTIFICATE SAN CLYLMFWF,CA 82672 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- , COMPANIES AFFORDING COVERAOE 17141.8882 Ix)MI-ANv FARMERS B4SlNiANCC EXCHANGE aaoe- aw none. A NwNep WILLIAM A AND PATRICIA BATHGATF I I MPANY R P.O.BOX 217 :OMPANY C SAN JUAN CAPISTRANO,CA 92876 i'(WPANY D OOVINkAftS — - ------ THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE I IST!O BELOW HAVE BEEN ISSUED TO THF INSURED NAMED ABOVC FOR THE POI R;Y PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION Of ANY CONTRACT OR OTHPR DOCUMENT WITH FITO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THP INSURANCE AFFORDED BY THE POLICIES O LSOX1R7FD HEREIN IS SUBJECT TO Al I TIIT TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LINITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CD TYPE OT NEDIWIDE POLIO'E NwNER TNIT&( HiOTINi arriannoffr1 LTR I OATL IABaDOMrI DATP PIBEpO'S'T'} GMMAL LMLOIY GENERA, A(.f.Rf(TAUT 3 1,000,000 El 1COMMERCIAL Gf-NFRAL L46C ,) 1LITY PMODUIS ( MPA%'Na; 5 1,000,000 ElkLAIMS MADE El l-:CUR PFRBONN 8 ADV IN,UEEY S 1,000,000 Fl G AT6 CONTRACTOR'S PROT I ACII(X:CUNRl NCI 3 1,000,000 L:1 A li pars umUlalla _ - 16063848 8112!88 81121!8 r IRI DAMNR IA"onA 1.A) I — ME1)1XP(Anyma4R^'M) 5 AUTOMOBILE LIAWLITY (/IMRINF TI y,NUl 1 :IMI! y ANYAU0 *©' ALL o ED AMOS 13911179637 A 38 IF1L19 7123199 RUDDY INJURY 3 280000 A 0 $(ntUULED Auros m.,wo h) HIREDAUl06 NUUAY N")Rv 660000 NON-OWNED AUTOS El 11W IP(R I r IAMA(.[ s 100000 DAD R LW M ALM)ONE Y 1 A ACX'ITT NI S ANY AUTO MIT n THAN AII(U ONI ❑ I N I I AG(IIIT NO j 15 AGGNE GAIL S MOEM LL Lin 1 ACH OC(ORRI NCL S +�UMRRELLA FORM AURRI 11An $ OT4FR THAN UMRRFI I A FORM 5 'NOIIRMIa ODOaN{ATM)E ARD —__— �'I WAIT fLORY II MIM ENnoYMr LMILBm (Arr.Accra ll N 5 THF MnPRIFTOR/ INCL (IISf ASI rRa N1Y;IMIT 3 PARTNERSIE_XECUUVE El 0FFICFR6 ARE Q EXCE INSFASf 1N]-1MPIUYn, S OTHER D[ECIIMTNA OI OFEEATIONaROCATMNEIDEMIOI FJYEFNSMI ITEM[ CITY OF SAN JUAN CAPISTRANO SNOULO ANY OF TNF AEOMF ww*lnM POLIOE.O SL CANOrI I FD BEFORE TME EXPIAATIOM NIT! THEREOF, TME TWINY OOMNNr Y ENONAYUA IU ATAN COMMUNITY DEVELOPMENT AGENCY 16 DAYS NRRTI NOTION TO PML CLRTrIOATF HOIYtAI NAMED TO TM6 LLPT. 32400 PASFO ADELANTO EUT rA1LDNC TO Wit SUCH NOTION SMALL MFOae NO ONE MAIM ON LINEAm OF AMY MIND RFGN TME COMPANY, ITA "MTA ON mrit"EMTATMN SAN JUAN CAPISTRANO.CA 926715 AMTMORINID RLINEa[ AYIME ® NOTICE OF CANCE 4TION OF MORTGAGEE OR OTHEf ITEREST H FARMERS INSURANCE EXCHANGE POLICY NUMBER UAI E MAILED 97 13997 86 37 87 TOYOTA 12-28-98 PREMIUM DUE 97 15 356 12-01338. 40 A,6EMfi' BEN S HOFSTAD PHONE 714 661-6692 t'J fes-' Because of nonpayment of premium,you are hereby notified that all coverage extended to you under the above described policy is cancelled effective at 12:00 NOON(12:01 A.M.In CA,OR,TX,WA,OK,VA and Fire only W -- policies in AR,VA and ID)on the date shown here but only as respects the interests of the Mortgages or other U ubterestashown. W COVERAGE STOPS AT 12:00 NOON 12:01 A.M. IN CA, OR, TX, WA, OK, VA AND FIRE ONLY JAN . 12� 99 /-f `1, POLICIES IN AR,VA AND ID)ON Named x Insured: / ` or Other WILLIAM BATHGATE merest CITY OF SAN JUAN PATRICIA BATHGATE CAPISTRANO EMPLOYER PO BOX 217 324 PASEO ADELANTO SN JN CAP CA 92693 SN JN CAP CA 92675 25-1203 11-99 A1203101 ® NOTICE OF CANCEr 4TION OF MORTGAGEE OT'HE< 'ITEREST H FARMERS INSURANCE EXCHANGE POLICY NUMBER G 1 -2 97 13997 8 38 69 FORD PU 12-28-98 - PREMIUM OUC 97 15 356 12-01 273. 70 AGENT BEN S HOFSTAD PHONE 714 661-6692 Because of nonpayment of premium,you are hereby notified that all coverage extended to you under the above described policy is cancelled effective at 12:00 NOON(12:01 A.M.In CA,OR,TX,WA,OK,VA and Fire only policies In AR,VA and ID)on the date shown here but only as respeotsthe interests of the Mortgagce or other interests shown. "NOCA,, OR, TX, A,STOPSAOK,, VA12:00NAND FIRE ONLY JAN . 12r 99 � POLICIES IN AR,VA AND ID)ON G c; t i Named _ Mortgagee Insured: W or Other WILLIb'M B,.+THGA'f'E ; 4 q 5 interest CITY OF SAN JUAN PATRI6 A BATHGATE � CAPISTRANO EMPLOYEE PO BOX 217a csJ lV�Ct I 324 PASEO ADELANTO SN JN CAP CA 92693 SN JN CAP CA 92675 25-1203 11-98 A1203101 Jan-25- 99 10: 59A HofstlyaI t ntur-nnc-P 1 20f.f. P - (la CM OF SAN JUAN CAPL4'lWO COMMO iM MMEV=PMENT AGEMCY 324N Paras AddaM Son JOrn CAP! &Mfr.Cawmak 92675 AT1'Nt c1.4a.+►J 56h%,rj De2L A. POLICY INF RMAT[ON EwbrlCaw1# 1- Iastuaaee C0IlVamy__TI`ae+1-!, _1S :Pofiey Npm �1So5�37�y6 2. 1'olby'i"eta(Ntum1) (Io} rx en EffectiveDate, d` r, . 4 AddmwvfNmmdh=ed 2gR31 I �. Limit of Liability Any(Inc tocla=oeIAggregate (!seam Liability Aggregate(Check me) Applies*'per W-xt,0alptMWr f� Ie twioe the occvalsnes limit 6. DedretMe or Self-tmsmed PAIM ton(Nu makes o"Mvrtae specified): S__250 7. Cevatltgeisogvh 4%to: Compreheatve om"Lt*WW tbtm GLQ=(Hd 1173) Commetoiai cmuw4 Liability"cldms-made"fom Co0002 8. Bodily fujtuy mni Prupaty Damagg Coverage is: "c1a6tia-made" If claims-made,the retroactive date is B. PO This endorsement is issued inconsideration of the pobcv piemi= Notwtthstaodmv anv i000naiaput statement in the policy to w htch this cudVj*rUWut is att&�LWJ 01 a4y otbe.cud jbcweuj ww hod ItM=w.it Ix■p--d as follows: 1. MURED. The Cih and the Community Redevelopment Agencyits elected or appointed OfFO s,officials-eanploI ms mud wIuctecrs aec iuvludal as a umdr with regard to demeae:s and defer or claims arlst" ftmM (a) acttM s performed by or on behalf of the Named Insured.(b)projects and completed operations of the Named Inswed or (c) premises owned.leased or used by the Named Insured. 2 CONTRIBUTION NOT REQUIRED. As teapaem:(a)work performed by the Named Invued for or on behalf of the City;or(b)projects sold by the Named laaued to the Citi or(c)premises leaaaed b. the Named Insured from the City. tho insurance afrarded by this polier than be primary Inaureo.-< w respevu dre Cirv, its cloorrat ur appointed onct;ers- oC>eiats,empl"z or vollmteem:or stand in an uakoktn chain of coverage carne"of the Named lnstned's sched&d underhiag prunan coverage. In either event any ofber imtrmoe mamatamed by the Cit.,,its elected or appointed oMv as. offloials e.mpleyteoa or volvntcCta shall be in Wroo/a of this iustaanaa end sha wo wdulbute with it 3, SCOPE OF COVERAGE.. llait policy, 11'primary.alforns Co%'erape at least a-- broad as (1) blenrauce Scayioes Office fn.m number UL0002 (Ed. 1^3) rotpprcbenarve Giemsa! Liability Iaurraccc and Insurance Servioes office)orm number GH)404 Broad Form Cormprehm%ive General I-iabiliry ender :int. or (2) las>nmmmSenimi()ffieaConvuervialGeneral J.iabihn Co%crape, occurrm.c' form(-G(h)0l or ciaz -I vic' t'nrm C.60007:nr Jan-26 99 11 : OOA Hcf%t. ct 11 . 04 GEC-20 I H— ll:`.iZ POI6 'L1 " "^? f (3) If mmem affords w%.wge which is at Ieast as bread as the prffian msuranoer forms refexeaced in the ptwodiatr sections(I)and(2)- 4. SEVERA$ILTTY OF INTEREST. The iirstim=afforded by this policy applies sepatasly to eaeb insulvd whb is seeking coverage or against wbnm it claim is made or a wit is brought exoept with respect to the Company's Icon nt liability. pROVISIONS REGARDING THE INSURED'S DUTMS AFTER ACC.'YAENT OR LOSS. Any fel2ma to oouply ,Avh cepostmg provisions of the poLcv shall not affect co%rrage provided to the City and the Community Rcti vclvpmeat Agmy.Its elected or sppoioted officers-officials.euplocees or vobmtwn 6. CANCELLATi0N NOTICE. The mmumise afforded by this policy rhail not be auapended.voided,canatlcd. zvd=d is aowre{e or limits except atter thirty(30)days'prior written notWe by cant ed mail I-I- reoatpt equated has been given to the City. Such notice shall be addressed as shown is the heading of this eodorsefflent. C MCUDVNT Incidents and claims are to be reported to the nnanrtr ear (Title) (aPerimfat) {Compaay) .._ IaS�A # Cy (Sheet Address) (City) (Stat) -- — (Zip"e) 7 (Telephone) D SIGNATURE OF LVSURER ORA FATIVL-OF THE ll`i$11 JL r. 3v>a ods+nom __.(prnaa/typc name), warrant that I have jalftnty to bind the below Itbled Insurance compa>0.v and by my signs=hereon do so bmd this opmpst}'- SI(tN OFA RppftSENTATI IS tetheCiecl { OtsemeDt furmahed ORGANIZATION: / r n/tLF. ADDRESS ..3 ,"o Ali C t _ lY _ TFLEPHONI;. w�� Oct 22=9.8 **74.= 26P Hofs ct InsuY-anc0 9496612066 P . 02 PReoucER Halsted IDturana Agency THE CERTIFICATE M ISSUED AS A MATTER OF INFORMATION 3667 CAMMO MIRA COSTA STE G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SAN CLEMENTE,CA$2672 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDWO COVERAGE (7141661-6012 COMPANY FARMERS INSURANCE EXCHANGE CODE: aup OGEt: A IROIREo WILLIAM A AND PATRICIA RATHGATE CCtM8IPANY P.O.901(217 COMPANY — C SAN JUAN CAPISTRANO,CA 92576 -- COMPANY D _ _ TH151S TO CERTIFY THAT THE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIROWIENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS GERTIPICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE ArrOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCK POLICIES- LIMITS SHOWN ANY HAVE BEEN REDUCFO BY PAID CLAMS. TYPE OF IMOIRARW -_�---POlE7Y YIAY11 - �EFrucTRIV IOLIOY EOHEATEIIL l IMITS LTR MYSUtJUMYI OATS PRRIoG'YYl EANEIIALLW6IN GFNFRAI AGGREGATE = 1,688,666 El C OMWL..RCIAL GENERAL LIABILITY PROOOOTS COMPAIP AGG j 1. OF'1 AIMS MADE �0 1CCCUN PFN60NAL A ADV INJURY 1 1,0=,000 CANNFR'S A CONTRACTOR'S PROT EACHOCCURRENDE 3 1,868888 A %`• part umhrNlt _ _ 16663648 11111121911 W12188 FIRE OAMAGF(Any on*F Ile) 1 W12 MFD FXP(Aoy AUTOMOBILE LIABILITY { COMNNFC 91NGIf llMll 1 ❑l ANY AUTO ALL 0w 13 AUTTYS 12987=37838 1013118 413190 0001,YINJURY S 260800 A 0JONO�NUDAUTOS OULEO AUTDS (Pei pelmn7 AUTOS I BOCILY INJURY y 600M IwNdm PROPERTY UAWCE S 1886=YtIr/ AUTOONLY EA A(d,IDTNT i ANY AUTO OI HEN THAN At ITO ONLY —. .—.... -. ..__ EA6M A(A.IUFNT iJ AGGRC Gl111 A =ONES LYIRLRY FACH OCCURRFNCF I UMBRELLA FORM AGGREGATE S OTHER THAN LINRRELLA FORM SONERRS CA--ft VON AND � STATUTORY LIMITS RIMLOYNEW lMRa1TY EACH ACOI)FNT i !THE 1`fUN41lETORI 1'"1'INCL PARIIJEHSIFXECUTIVE 311 UCSF--- POLICY LIMIT l OTTICFRGARF EXCL - -- -- _ U16EAGE.EACH EMPLOYE[ __- I OTMER GRSGRE'TENI Or OEM11T1OMSAOCATORMYEHICLEtIEPlOW ITEMS, CITY OF SAN JUAN CAPISTRANO WOIILO ANY Or THE jUII 0"MIRED IOLIGNI!aE CAfOtl11121' RRFORT TRF EXIMPATOII EATS THEREOP, TNS SURSIM, C AMY Y L MOMIASII TO SAA. COMMUNITY DEVELOPMENT AGENCY 16 _- OAYa YIRRTMI MySe M THE GERTRIGAW IIOLGRE NA D TO THt LP7T. 32406 PASEO ADELANTO RYT FARYEE TO TML sYON 0OTEIR 1HALL WWE SO ORLEIATRIN OS LARtRY OF ANY U"M THE OON E ST. RS A TB OR REN TATNEt. SAN JUAN CAPISTRANO.CA,22976 AYTNORERP R EENTATMi _�_. Oct-22'-48 k)4 : 27P Hofs d Insurance 949661PO66 P . 03 LUBUM ENDORSENMT • CITY OF SANT JUAN CA?1STBANO COMMUM ffREDYVELOPNZKrA(;ENCY 3UN Panes Adtdamfo San Jnap Capieftm.Ca Reids 92ti'TS AM' D*wQ 5eAQfa AItEL- , A, Fsdeaaa11101110 i. lmiamceCompmy ;P6iieyNpmb _ tSOS3?%- 2, Yodel Teem vioai) z _(Io) ,z t f!®eta Effective Da4� as' 3. NaMd11,&m A 4. Adds of Naned lnstaed z .0 4 V s Limit of L1ab8ity Aly Ons thimar mot/AggregaRe S 1 AO Good LiabA0 Asptrate(Check os«) Applies"pea loeahodpevjeot" Is Mice the occurrence omit 6. I7eauotlble a sell-lavanea Retention(1lIItmkea otttawus spsoifred): $ 2So 7, Csverw is squbvissit to: Compaheasive Gena LtdMW form GL0002(Ed 1/73) ✓ Cmmemial Genn d Liability"clalma made"form CWM - 8. Bodily Injury and property Damage Coverage is: . -fie. _ - If clahm-made,the retrowwc daft is — 8. This endorsement is!=ad in consideration of the policy premium. Nomffistaodin4 my inconsistent statement in the policy to wbich this eudui scwcut is atter-[Wd o, any otlw.-ry lvravuuvr au--had dmreto,it to agreed as follows: I. INSURED. The City and tht:Commtmity Radmelopmmt Agency.its elected or appoiatad ofiioers,offioish.empioy'ees and voluw=rs ate iuvIudol as imumb sslth regard to dsa,ages and defense of clalma ariclag fM= (a) septettes performed by or on behalf of the Named Insured,(b)projects and completed opersdow of the Named Insured or(c) premises owned.leased or used by the Named Insured. 2 CONTR>Blfl'M NO'r REQIIIRED. As respects: (a)work performed by the Named]muted for or on behalf of the CIIy;or(b)projects sold by the Namod Inaored to the Circ;or(c)premises leased bv the Named Inured from the City. the inaurmcc afforded 1mr this policy ahail be primary imanrance a,ieapmL%the City,its clotted or appvIDnd officers, ofhcial%empio res or volimteas:or stand In an unbroken chain of coverage cxww of the Named luttaed's scheduled ttnderilml;primal wverage. In either emu any other i11mwe mamiamed by the Cin,its elocted or appointed officers. o R1oials.ae;plevees of vobmtectf sha11 be in aireess of this iaseuance Mrd 1b411 uoi contribute will;it. 3. SCOPE OF COVERAGE. This policy, if primary.affords coceraer at least as broad as. (1) lnsmmce Sere-ccs Office form number GL0002 (Ed. Ir,3),Compreheaatvc General Liability Imimmoe and Intiaaaee Servile.Office form number GL0404 Broad Form Comprehmsive General Liabdit'y endor.mrril. or. (2) lasvrmce Sen-lees Office Commercial General Liabilin Coc erape, 'ooeurrciac' form CG0001 or "clank-aadc form CM007.;or 0ct-22298 &4 : 27P Hofs d Insurance: 9496612066 P - 04 IU-57 FF'GII TU 0 (3) Ifexccat affords coverage which is at kW as broad n the przmary insareaoc fwros referenced in the preoedmg seroma(i)and(2). ST. The irtmum affotdod by th»policy-appllss sepcatdv o each mswod who ss a. SEVERABII.17'1r OF pVfERE a o).im is mads ot•a stilt is brow except with MsPoct to the Compsnys trait n• ssaking coverage or against wham liability. _ 5- PROVISIONS REGARDIv IGTfIE�got affect coverage provided o the City and the Commuolty Rodetelopment w&,e ottmS prmiuons of?bx P°Uc. txs or voltmtaars. Agency,he elected or sppoated of icem officials.employms 6. GANCIZ.LA?ION NOIiCE Ties iramom afforded by this poiicy Wnd not be a"a"I'ded Voide4 catsxHsd tedttccd is coverw or limb except ager th)rty(30)days'Priorwriuetr notice by otatiGed Mair cotta►• a4b has�d1' given to the City- Such notice shall bo ad&ascd as shown a the lxsdlar of this endorsement. C. Inoidems and claims ace o be repotted to the in=M ai' ATTN: (Title) (Company) SSS C.acxtii h r7 P41 e'4 las/-4 # G (Sheet Address) S9 tJ_ � wt err`} IF (City) (State) (Zip code) (Tclepbone) Su ncp(r N$URE D � Rau0dUZEP1 O qpe �a�s+, (pr. name), warrant thar I have aathonty to bm4 the below 11suo instuance compim wad by my tigmMae-hereon do so bad this 001111pe4y- SIGNPAM.rn OF A ItEFNbSFNIATIVFs on endorsement ftuaisbed to the C LI � r TITLE. OAGANVATIO14 'l�af1 Mem "fit"3 tit TELEPHONE. / nREss � 3 Gty"'n� )MI,r� �Z Jrw., 32400 PASEO ADELANTO j. MEMBERS OF THE COUNCIL p OLLENECAMPBELL SAN JUAN CAPISTRANO,CA 92675 '� I,� JOHN GREINERINER (949)493-1171 1011.11,1111 MATT HART (949)493-1053(FAX) ' mMuun 1961 GILJONES 1776 DAVID M.SWERDLIN CITY MANAGER September 8, 1998 GEORGE SCARBOROUGH Mr. & Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, CA 92693 Re: Renewal of General Liability Certificate of Insurance and Endorsement Form (Overseer Services - Swanner Property) Dear Mr. & Mrs. Bathgate: The General Liability Certificate of Insurance, regarding the above-referenced service, expired on August 12, 1998. 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 18, 1998. If you have any questions, please contact me at(949) 443-6310. Thank you for your cooperation. Very truly yours, ' jLal Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Silvia Cintron, Public Works (�fX 't 1 2I• " - I DRUG USE (JI IS AB San Juan Capistrano: Preserving the Past to Enhance the Future BURNS &ILCOX INSURANCE SERVICES, 'INC. ` 1601 DOVE STREET, SUITE #205 NEWPORT BEACH, CA. 92660 RECEIVED ACKNOWLEDGEMENT L REPLY L TRANSMITTAL FORM NOY I q I 47 Pil 137 J 1 CITY OF SAN JUAN CAPISTRANO DCII 17 324 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 DATE : 11-12-97 FROM: TONY LAZALDE INSURED: WILLIAM A. & PATRICIA BATHGATE POLICY # (IF APPLICABLE) : CLS496300 WE ENCLOSE THE FOLLOWING: APPLICATION _X_ ENDORSEMENT # 1 CERTIFICATE - BINDER ORIGINAL POLICY AUDIT OTHER: INVOICE INCOMPLETE, NEED WE ARE ENCLOSING THE ORIGINAL SL-2 AND D-1 FORMS . ENDORSEMENT # _X_ PLEASE FIND COPY FOR YOUR FILE SEND REPLY TO: BURNS & WILCOX INSURANCE SERVICES, INC. 1601 DOVE STREET #205, NEWPORT BEACH, CA 92660 TEL: (714) 224-0100 FAX: (714) 224-0111 DATE(MM/DD/YY) TIFICATE OF 10/17/1997 P RdDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BURNS & WILCOX INSURANCE SERVICES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1601 DOVE STREET, SUITE 0205 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NEWPROT BEACH, CA 92660 COMPANIES AFFORDING COVERAGE COMPANY A SCOTTSDALE INSURANCE INSURED COMPANY WILLIAM A. & PATRICIA BATHGATE B P 0 BOX 217 COMPANY SAN JUAN CAPISTRANO, CA 92675 C COMPANY 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. CoPOLICYEFFECTIVE POUCYID(PIRATION LIMITS LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMI DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLS496300 10/17/1997 10/17/1998 PRODUCTS-COMP/OP AGO S 1,000,000 =Cl-AIMS MADE OX OCCUR PERSONAL&ADV INJURY $ 1,000,000 OWNERS&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one fire) $ 50,000 I MED EXP(Any one person) $ N/A 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 S AUTO ONLY:H ANY AUTO OTHER THANEACH ACCIDENT IS AGGREGATE $ IXCEBB LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE IS OTHER THAN UMBRELLA FORM S WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS'LIABILITY EACH ACCIDENT S THEPROPRIETOR/ nopRIETO INCL DISEASE-POUCY LIMIT $ PANEFENECUTIVE OFFICERS ARE. EXCL I DISEASE-EACH EMPLOYEE 1 IS OTHER I I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED WITH RESPECTS TO THE OPERATIONS OF THE NAMED INSURED ONLY. *10 DAYS FOR NON- PAYMENT OF PREMIUM 'ION -CA ................ .... . .......... .. .... 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 MAIL 324 PASEO ADELANTO 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, SAN JUAN CAPISTRANO, CA 92675 - BUT FAILURE TO MAIL SUCH NI SHAM IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE j 0 rl 11/12/1997/AVLI FROM : INSURANCE • PHONE NO. Oct. 01 1997 03:29PM P2 PRODUCER Hofstad In- -once Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 9669 CAMINO NIRA COSTA STE G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEOdYYI SAN CLEMENTE.CA 92872 HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE (7141661$892 COMPANY - _ wv�: A FARMERS MISURANCE EXCHANGE INSURED WILLIAM A AND PATRICIA BATHGATE COMPANY B P.O.BOX 217 COMPANY C SAN JUAN CAPISTRANO,CA 92876 ___ .. ..._ COMPANY D THIS IS TO CERTFY THAT THE POLICIES OF INSURANCE LISTED MUM ALIVE BEEN ISSUED TO THE INSURED NMED ABOVE FUR Y/E POLICY PERIOD INDICATED, NOTWITHSTANOMIC ANY REQUIREMEW, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUIENT WITH RESPECT TO WMIC"THIS COTTIPICATE MAY ME ISSUED OR MAY PERTAIN, THE MSINANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS $USJECt TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS Or SUCH PO"S- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. LTR TYPE OP MwIRAMI H'ONCY NIINREI[ p Pm TI�DN LILNIS OTTIENAL LMBM.T' CCMro.,AC R RATE S 7,000,000 COMMERCIAL(RilEZULL LIF,BADY PRODUCTS-CQPXR+AGG LAIYS MADE ®OccuR. PERSONAL A ADY.INJURY OJVNER'S A CONRNACTOR'S PROT EACH OCCURRENCE 1 IN A Pers laTlbf-Na 10087046 0112197 1912= FIRE DAMAGE(MY one flol MED Ow ww orle PeIeoIN s AUIDMOBrtE LInBKDY COMBINED SPFCIE LIMO f ANY AUTO .._. 0 ALL OW IE D nUTOU 139972637 JL 30 10X3187 4000 BODILY INJURY s 260000 A SClffOl1LED ILLDA4 IP°r HIRED ADLDS GODLY INJURY NONOMMEDAIRCG (Pet eoonenO f 600000 PROPERTY DAMAGE s 1000!0 LLARANE L111aILIR _T AUTOONLY-EAACCIDENT f ANY AUTO OFFER THAN ALDOONLY: _.. EACH ACCIDENT S AGGREGATE f ffLIAmum EACH OCCURRENCE S UMBRELLA FORM AGGREC,AIE S OCHER TUN UMBRELLA FaMA - --- $ INDRImF$aoMPL3MATLHMTwrA gcwnrrDRr LARDS U�Tn EACH ACCIDENT f THE PRO13110K NT I-1 NICL DISEASE-POUCY LMR S PARTNFJi3A�XECIIIIYE �--1 �L - OFFICERS AHE' DLSEA.6 EACH EMPIpYEE f OTHER OBfCRIRgN OIORRATl1INS/LOCATIdN$ANRIIGiR16ElR9AL Rtia CITY OF SAN J W N CAPISTRANO OMMSD ANY W THE AROW Dp2110Ee rouCM M CAMCEL UM MORE THE MPMATRMI MTF TRP1FeP, TIM LSSYMO CLrANY WILL 1191101MVOR TD MAL COMMUNITY DEVELOPMENT AGENCY 1s MTs IMLITIM NOTICE TO TNF CWTV"'M IIOLRER 11111111110070 TILE LEST. 32400 PASEO ADELANTO BUT FAILURE M MAIL$NOR■DTI@ ML 41110' ND DaLIRATLDN M LIARRY m AIRY KN21 UPON THE COIVANY, ITS AIMMM OR REPRFA6RATR1011. SAW JUAN CAPISTRANO,CA 92676 AL/TLIBRTED ATNF FROM : INSURANCE • PHONE NO. : • Oct. 01 1997 03:30PM P3 I MSELM ENWASEMFxT CITY OF SAN JUAN CAPLS' WO COMMUNITY REDEVELOPMENT AGENCY 3200 Paaeh AAetapmo Sam Jnm Capielrneo,CAMmuis 92679 ATTN: v SLhAN A ell— . A. POLICY WFORMATTON EndotaenoutN I- Wsurmcecompany TAO.ww'n. .estew.,Lig -'Po1icyNpmber_ tsos3r% 2. 1'ohay'l'erm(From) BIL (fo) 12- f— Effearve Dace _ _- % tz Q6 3. Named hmaed f I t 4-44%014-4-w- 4 A+I-w-4- Address of Named boxed 11-tA41.1> '7L4*- Gs�ot s fw4.te 420^3 5. Limit of Liability Any One UwwrewdASgro6ate S 1,00 _/ 4600010010, General Liability Aggregate(Chuck one:) Applies"pe[k+eatiodptojeat" Is twice the occurrence 11mit 6. Deductible or Self Insured Retention(Tml unless otherwise specified): S 2S O 7. covetags is equivslont tp: Comprehensive C=ffsl LWOW fotm OL0002(Ed i!/3) Commemdd General Liability"claims-made"form CCWM S. BoJily lWuxy and Fmptaty Damage Coverage is: •claims-made" ••oecsrlencd. If claims-made,the renaactive data is 8. PO This endorsement is ismed in consideration of the policy premium. Notcnthstaudmg any incml9istenT sudement in the policy to which this cuduzscmcut is attached of aav orris;;eu"xbau a atua:bal thcrchr,it for agreed as followa: I. INSURER The City and the Community Redevelopment Agency.its elected or appointed officers,otTieisl&emphoyees and volunoms, arc imlWO as ins rals with regard w damages and ddense or eldms arising tram; (a) 86-ma performed by or on behalf of the Named Insured.(b)projects and completed operations of the Named latmed_or(c) pramtses owned,leased or used by the Named booted. 2- CON AMU71ON NOT REQUUIED. As respects:(a)work performed by the Famed Insured for or on bcbalf of the City;or(b)projects sold by the Named Inamed to the City;or(e)premises leased by the Named Waxed from the City. the 'nsu nor afforded by this policy-shalt be primary iwmraawe the Chv,i6 elected or appoiumd olfimr, o$ciats empioyees or volunteers or stand in an mbrokea chain of coverage etccss of the Named lanes scheduled underlying prianary coverage. In rather:event,aW other irLctamee nmtamcd by the City,its elected or appointed officem effioiaL emptoyees or voluaboa s shall be in excess of this irstaanec and shall uor wuuihrta with A- 3. SCOPE OF COVERAGE. This policy,if primary.affords coverage at least as broad as: (1) Insoranca Services Office form number GL0002(Ed. 1,71).Comprehensive General Liabiiity Insurance and Insurance Services office form number GLO404 Broad Form Comprehensive General Liab&y eadorsen=. or (2) Inarmce Servioes otffcc Commercial General Liabilin Coverage,"oecunrnx'form CG0001 or"claims-made" forst C(X=2;or FROM INSURANCE . PHONE NO. Oct. 01 1997 03:30PM P4 EFuri TO • ;'73 r.0- (3) If excess affords oasvMe which is A least as broad as the primary msmance forms refereaced in the pre dmg; mcdons(1)and(2). 4. SEVERABELXrY OF MEREST. The instuance ad'otded by this pobry applies separately to each inwed who is seeking covetage or against whom a claim is made or a suit is brought except with tespect to the Company's limit of liability. 5_ PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCWX?4T OR LOSS. Amy Wait to comply with reporting prmisin»s of the policv shall not affect coverage provided to the City and the Community Redevelopment Agency,its elected or appointed officers.official&employees or volunteers 6. CANCE11 A'IJON NOTICE. llre ittstttanm afforded by this policy shall not be suspended,voided,cauvelled,redwed itr coverage or limits owept after tiny(30)days'prior seism notice by o ztdw mail rearm receipt mquexed has been given to the City. Such notice shall be addressed as Shown in the heading of this endorsement. C- WCID NT A_"CLAIM REPORTING M=DURE Iacide=and claims are to be reported to the iasttm at: (Title) (Daptaaamt) Er-S. -h Styw�c-r (company) Z(c,3yf �cX.�u U44,10t ll� (ShM Address) (City) (sidae) (zip wde) -7o j - 3ti,8 - '7"770 (fekphone) D SIGNATUR'E1 Of LNSURFR OR AUTflORUMREPREALU&IIVE OF THE INSUREK i, lSv~ kb�si -(prtiatftvpe name)* warrant that I have anthonty m bind the below lWk asurnace compW and by my aigrtatum hereon do so bind this cmaMv. SI($V OFA - REPRE.SENTATWS ( senicut fttrmahed to the City 1 ORGANIZATION: �A'd--Ie43 —.h.3 TrME ADDRESS: 2(07 1 C-ACLdt> U�a�� IL ljo • V rEI EPHOrtE: I4) 3t�8-7770 onus use � f MEMBERS OF THE CITY COUNCIL is OE CAMPBELL JOHN OHNHN GR fi ` ImfAev01nHART WYATT HART 61.A 1961 GILJONES 1776 DAVID M.SWERDLIN CITY MANAGER GEORGE SCARBOROUGH September 29, 1997 Mr. & Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, CA 92693 Re: Renewal of Automobile Liability Certificate of Insurance (Overseer Services - Swanner Property) Dear Mr. & Mrs. Bathgate: The Automobile Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on October 3, 1997. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. Please forward the updated certificate to the City, attention City Clerk's office, by October 15, 1997. If you have any questions, please contact me at(714) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Silvia Cintron, Public Works 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 0 (714) 493-1171 FROM : INSURANCE • PHONE NO. • .Jul. ?1 1990 11:3ROM PP ' ���� i ' n t .! TI;.. .w{�,. ,... `, r .r � ' •yPi y.�'4.,�p wyY '�l yyr.},N'jr'}�k" jf'.. OIITE IINIOWY'rI ,A '/ AIWA+ iil+V'{'.{*►'A Y'u ��a ',�! BH7/0i PQODUTcx Mafistad Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3663 CAMINO MIRA COSTA STE G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SAN CIJ_MENTE.CA 92672 HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDIW COVERAGE 7Jr692 COMPANY FARMERS INSWIANCE EXCHANGE CODE_ wB CDDE- A WWRFO WILLIAM A AND PATRICIA BATHGATE COMPANY B P.O.BOX 217 COMPANY C SAN JUAN CAPISTRANO,CA 9Z673 - - --- _" --- -. - - COMPANY D THIS IS TO�CERTVY THAT THE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN MMJFD TO THE INSURED NAMED ABOVE POR THE POLICY PEi1100 INDICATED, NOTWITHSTANDING ANY RCOURMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUAFJlT WITH RESPECT TO WHICH TEAS CERTIFICATE MAY BE ISSUED OR MY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUB.ECT TO ALL THE TR'RAis. EXCLUSIONS AND OONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAD CIABLR- ETA TYPEMIaWRwHC! POlAY11Y11/OI POLICY iFFGCTDAe PDI.ICY FAIRwT108� oxm peeDDNYI BATE BBBDDIYTI 4EBERAL LMMITY - .. _. _ GENERAL AGORMATT s 1.000,000 COMMERCIAL cENERµIUBRM FRODtX:Ts•COMPpP_ mm—mm ®oCGUk. PLABONAL 8 ADV(MANY 1.eoo fj OWNERO a cANTRACTORS PROT EACH OCTA-RRENCE _— A ® pets unhreBa _ 1606204 SM297 W12AM FIRE DAMAOE(my 0I.FAQ) MED EXP II111YOM p..,wJ f AuTomMLE LABILITY ANY MRO ODMNNIED SWILL LIMIT s ALL OWNED AUTOS 729975637 A 30 4MAIS 1613100 ODDLY INJURY S 260M A ❑ sCHEIX m AUTOs LPN�s_°A) HIRED MJi05 BODILY MwALY NDN-0NMED AUTOG I (P-—worAI _ f.. 600000 PROPERTY DAMAGE f 100000 OAawae uABam AUTO ONLY-EA ACCIDENT S ANY AUIO I OTHER THAN ADIO ONLY ❑ _EACH____ i EACH ACCIDENT $ AGGREGATE f -... known LAMILRY -. LEACH OCCIIkWmCE f UMBRELLA FORM AGGitEGATE f OTHER THAN UMBRELLA FORM s �COMPXIWAT1 wTw STAI'IfTORY LIMBS PIMP LMBILT/ EACH ACCIDEM__ 7;--THTOR/E PROPRIEPMRI£A41EXHXIIVE DLSEASE-POI-1t'YLMDOFFICERB ARF: DISEASE•EACH EYROYEE DCVCSIP O OPDlIIIATpByLaaTWiIVIMIDL6>yapELi1ALDm IM CITY OF SAN JUAN CAPISTRANO OMDOLD ANY OF THE ASWE 011!20 OED ►Docs W CAMCELAO REIORE TIL 6kP TM DATE THEARLOF, TMP WUIWQ � A/E). 13�TO MAL COMMUNITY DEVELOPMENT AGENCY -!3--"Y*alAITTRI NDTIDP TO THE CCDT11 W HOLMR MArEn TOTME WPT. 3240 PASEO ADELANTO MY PAV AB TO LAE, w NOTOE A L BfME NO MuswT1M ON uAOL1rY OF ABY IDYD 0!011 1Mi GAY, na AYlNTi OR IIEPIIBfBITATwIEa. SAN JUAN CAPISTRANO,CAE SM76 wurxon�a aa'EOOITwTNE -- -- FROM INSURANCE PHONE NO. : Jul. ''1 1990 11 :39AM P.3 LUBU TY ENDORSE dEff my OF SAN JUAN CAMTRANO COMMUNM REDEVELOPMENT AGSYCY 3240D Puree AddW10 Sm Jane Caphamo,CalWask 92673 AT1W- `044.su $l�tAry DeQlr . A. POLICY hNFOR46= I- Iastmonce compmy !!4�"ten a .T«suw+wa� Policy N{mb tSo 53 t y6 2. Polley fetmt(1Yom) a To) ix FReetivei?ttte,,," B 'J 3. Nttmadlotad 111 A t a4*i&4A- 4. AdtaasaWamed lastaad_ zae�l �yo G�•+}+b^•o siws.,a r2 3 s. r.b�terLi,bvayAtsyOneaacaarmearA�e3emea ►,000,ew� I taP �O�o• (3mad Liability Aagttigate(Coed`one:) Applin"pa bodWWVrVjmr ✓ It mice floe otxvnsmx limit 6. Dedvetmh or sen-Immed Remmon cNit�a otaerwsse speci5ed). s 2So �. co�.�.a•gnaw.a<c�: comtprehmslvo Gen"Lld V=y lo>m GLUM(SA tf73) ✓ Comic"General Liab&y"claims-made"form CGWM 8. Dvdily Lowy teal rmperty Damaa&c Coverage is: .claiawasade" If elaiw-made,the reaoal.d"ddc is $. EPLKYA This endorsement is issued is consideration of the policy prevaiuta Notwitl>stliar any iaconsisleat statement is the polios to which this cwlvirauwat u-It alL xl of 44Qv othet cwlvtearamt attachdl dwrcto,it is agreed as follows: 1. lIVMTZD. The City and the Community Redevelopment Agency,its elected or appotdted Of5bem ollzciais.emPloyees and vobunccas m< itatWkrl ru i urt;tls with rctyard m damaees and ddbm or claims aditg 118M (a) actitldes performed by or on behalf of the Named]asared,(b)Peojecn and completed opera ions of the ALemd hmt&to(c) premises owned.leamd or used by the Named 1wored. 2_ CONTRISDTIONNOT REQUIRED. As respects'(a)work performed by the Nzaed lavaged fer or an behalf of the City;or(b)projects sold by the Named laaorod to the:City;or(e)promises leased by the Named Insured firm the City. the insnraneo afforded Iry this policy d aR be pay insurance as resp�is the City,ib ckctcd or appoituad officers, alficts&tmployees or volutdocm or stood in an sabtoksn chem of coverage excess of do Named(msimd's sehedaled undah mg primary coverage. In tither event any other imismce maintained by the City,its elected or appointed officers. offioiaL---smployeos or vohaataers sha0 be in axe w of this ittmtmca and sh.11 not waAtivuac`r:ih it 3. SCOPE OF COVERAGE. This policy,if primary.afforos coverage at least as broad as. (i) 4worance Seroioee Offer tot.number GL0002(Ed. 1,173).Coz*"^Me General Liability Instance and hmar oce Services Office form number OL0404 Broad Form Comprcbcasive General Liability■adors.-ment. or. (2) Ingrance Saviors O$'ax Commercial General Liabilin.Co erapc..'oonerr ;:'form CC0001 or "elamts-made" frnm CG(M2:or FROM INSURANCEPHONE NO. Jul. P1 199R 11 :.i9AM P4 PEC-0-1995 1t4:57 FGut1 TO • .�,.77 : 1-.u., (3) If ac=affords cntterage which is at kart as broad as the p:mmary inwraaaee forms refaeaced m the pre mmg SWOR115(1)and(2)- 4. SEV ERABELJTY OF rMRM. The insurance afforded by this poliey empties separately to each insured who is seeko$eoverage or agaicSt whom a claim u made or a suit is brought,except with respect to the Company's(i=oi' liability. 3. PROVISIONS REGARZING 7EX INSUREDS DUTIES AMR ACCIDEN'T OR LOW Any fzQ=to oomply N-&zgm0mg ptrM1 isiow of the policy Shall tmt affect coverage paov(dad to to City and the Commumty Redevelopment Agemy,fu elected or appomsed otficem of ic:2 t employees or vokwun. 6. CANCF.IIAITON NO'IICL Mw iasmamoe affmdcd by this policy shag not be=Vended.voided,cmeebd redoced ]aa coverage or limits except alter thirty(30)days'prior- rM to aatuioe by cradfied mail atI --receipt requ$W has been given w the City. Such notice shall be addtened as shown m the herding of ibis mdotsetnent. C. RM _NT ANDcL rnr xFnoRrnv _vl�oegD 1e Iavidents and claims ate to ba reported to dW iosorer ar- ATTN 6E,-.37 _ (Bile) (Deparameat) TAra MF- (Company) __ --- -• -. _ -- ?7SS3 - � rn� I✓uE �OS� 4 # G- (Sheet Address) N (City) a (State) (Zip code) (TekPhonc) D SIGNATURE OF LVSURE$QRAUTMOtt{ZEDELPREAM-FAZIVEOF IF gNSURKE 1. 3jsw1 6&,+46 (prmvtgw aaame)�warrant that I bave trthonly to bmd the below hste0 insn W=company and by my signature hereon do so bind this oompagy- SIC1N OF A REPRESENTAYMs (Ori on rndarxlnaa to the Circ) ORGANIZATION rAle #OTITLE ADDRESS: 3 C wI'no 11�1K.4 ��z1�.4 _ Cr - TELEPHONE. A 32400 PASEO ADELANTO fuel MEMBERS OFTHE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 Il�7 JOHN O GREI CAMPBELL OHNN R HART (714)493-1171 �j muoouuo WVATt HART (714)493-1053(FAX) i+minm 1961 GIL JONES 1776 DAVID SWERDLIN • CITY MANAGER March 27, 1998 GEORGE SCARBOROUGH Mr. &Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, CA 92675 Re: Renewal of Automobile Liability Certificate of Insurance and General Liability bility Endorsement Form (,Overseer Services - Swanner Property) Dear Mr. & Mrs. Bathgate: The Automobile Liability Certificate of Insurance,regarding the above-referenced service, is due to expire on April 3, 1998. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. The General Liability Certificate of Insurance received by the City did not have the required General Liability Endorsement form.. 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 Automobile Certificate and the General Liability Endorsement form to the City, attention City Clerk's office, by April 15, 1998. If you have any questions, please contact me at(714) 443-6310. Thank you for your cooperation. Very truly yours, 4121 4i"1 S lI vt y ?)�' Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Silvia Cintron,Public Works DRUG USE Is A6 San Juan Capistrano: Preserving the Past to Enhance the Future NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST FARMERS INSURANCE EXCHANGE RECEIVED POLICY NUMBER DATE MAILED p 97 13997 86 37 87 TOYOTA 05n15w98 MAY 'J II 48 PREMIUM DUE 7 15 356 04-22 344 . 10 AGENT BEN $iH:OFSTAD PHONE 714 661 6692 rBgcause of nonpayment of Premium,you are hereby notlHetl that all cowrre a extendatl to you urger the shoes - described policy is cancelled eRectirw at 12.-00 NOON(1291 A.M.In CA.,OR,TX.,WA.,OK.,VA.,and Fire Only Policies in AR.,VA.,and ID.)on the date shown here but onN as respects the interests of the Mortga9ae Orbiter interests shown. COVERAGE STOPS AT 12:00 NOON(12:01 A.M.IN CA., OR., TX., INA., OK., VA., AND FIRE ONLY POLICIES IN AR.,VA.,AND ID.)ON MAY 30, 98 Named Morlcroe Insured: Or Other WILLIAM BATHGATE Interest CITY OF SAN JUAN PATRICIA BATHGATE CAPISTRANO EMPLOYER PO BOX 217 324 PASEO ADELANTO SN JN CAP CA 92693 SN JN CAP CA 92675 25-12038-9]12401 C/4000 NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST J�l FARMERS INSURANCE EXCHANGE RECEIVED POLICY NUMBER DATE MAILED 97 13997 86 38 69 FORD PU 05.15m98 MAY 19 II 46 I 1 PREMIUM DUE M J 1 97 15 356 04-22 281 . 80 AGENT BEMrS 0pFSTAD PHONE 714 661 6692 - Because of n ranyment of premium,you are hereby notdietl that all ewara extended to you under the abme descnbed Polby is cancelled effectlre at 12:00 NOON(12,01 A.M.in CA.,OR.,TX.,WA.,OK.,VA.,and Floe only Pellcbe In AR.,VA.,and M.)on the date shown here but onN as respects the lammele of the Modgagae -.or other interests shown. C COVERAGE STOPS AT 12:00 NOON(12:01 A.M.IN CA., AR.,VA.,AND ID.)OSA., AND FIRE ONLY POLICIES IN v 0'L ;1 MAY 30, 98 1 Mortgagee Named or Other Insured: Interest WILLIAM BATHGATE CITY OF SAN JUAN PATRICIA BATHGATE CAPISTRANO EMPLOYEE PO BOX 217 324 PASEO ADELANTO .SN JN CAP CA 92693 SN JN CAP CA 92675 25-12038-97 12401 C/4000 FROM INSURANCE • PHONE NO. Sep. 26 1997 04:34PM P2 %ODUCtR Hotdad IT1MITnHx A9�7 THIS CERTIFICATE IN ISSUED AS A MATTER OF WFORMATKIN NF 3663 CAMINO MIRA COSTA STE G ONLY AND COWERS NO BIGOTS UPON THE CERTIFICATE THS CFRTEK:ATE DOES NOT AMEND. EXTEND D OOR SAN CLEMENTE,CAS2e72 ALTERIRTME COVERAGE AFFORDED BY 7NE POLICIES BELOW. _ _COMPANIES AFFORDING COVERAGE _ I714)6614SS2 COWIPAW FARMERS INSURANCE EXCHANGE WOE: *us CODE- .A MauMEO COWAIW WILLIAM A AND PATRICIA SATHGATE B COMPANY P.(X BOX 217 C _^� SAN JUAN CAPISTRANO,CA SMS COWAW D •. THIS IS TO CPOLICIESFIFY THAT THE POLICIES OF*MU`4N` C LISTED BELOW HAVE SEEN ISSUEDTO THE FMSLRED NNIlO AOONE FOR THE POLICY PERIOD rypXMIN TED, NOTWITHSTANDING ANY REOUIRO IRM , TOW OR CONDTTXIN OF ANY CONTRACT OR OTHER DOCUMENT ENT WITM RESPECT TOWHICH TM CERTIFMJITE MAYBE ISUMD OR WAY PERTAN. THE WSUWINCC AFFOROSO B'Y THC POLICIES CIFMCPoBBD HEREMI IS SUBJECT TOALL TRE TERAS, EXCLUSIONS AND CONWK)NS OFSUCII POLICES- LWTS SHOWN MAY HAVE SEEN REDUCED OYPND MAW. _ T'YI'E Or MDORANCE POUOT IIII•WEl PouCYEP11111m nVE w LMTTS L LTA Pwwwm OEIERAL AG[,'REOATE f 1,SOO,S00 LWTun aoIHIERMLGLABLTIY !�� A!m MADE OCCUR PERSONAL i ADV.P6RIRY 1,OIS,000 ('ACH OCCURRENCE 7000 avnmis 1 CONTRACTORS PROT A �1 IIIIM-Na 16063/16 W12W 2112111111FNW DAMAT� M1,114)(AS1,114) S.. - - M�EIw lAAY OPP pwTRN f AUTOM E LABILITY OOMOIKLD SWGLE LMR f ANY AUTO ALL ONINED AUTOS 13097=7 E 32 4M7 loam BDDaY VLAIRY s 200000 A ❑ SCHEODUEO AUTOS PNAAA) '- ❑ PfRCO ADIOS BOOLY WARY f SIMON NONOMLO AUTOS PROPMMDANAOE S 100000 wY AUTO OILY-EA AO®EI'IT s ANY AUTO OTHER THAN AUTOON.Y- EAC!ACCKKNT f AGGREMTE f EXOMOLUORM EACH ocGURAENCE s AKaEI .FORM AGGREGAYE f ... s OIIIER THAN uMHRELLA FORM STATDORY UMRS wORMEIA OOMIBIMTIOH AMO BlIOYHIIC IMDLIRY EACH ACCNQTi f 111E PROPPoETOPo AOI. fA9EAGE_POLICY LMR s PSE OFFMRSARE: EICL OISEARE EAG1 EAIPLOYEb $ OTNR O6tI WnW OF OPo1ATOMRLOCAYKXIIW0 ICLFfRPeC1AL ITEM CITY OF SAM JUAN CAPISTRANO fHOIID ANY OF we ADWE DOi011sls0 POUOEi W CANCELLED BOOR TI1f nPNATNM DATE 1MEIEAP. TIN WOUM OOATPAHY DNL 90F110POt/D HAL COMMUNITY DEVELOPMENT AGENCY t6 DAYA HNITTED I1uTIGi TO TW ClRTNGAM HOLOEII MAHHO TO TRE LEPY, 22100 PASEO ADELANTO MR PALWIE To slAIL AICA MITICE sIM1LL OANMIE HO ON IGATLM OR UAMARY ar AIIY IHI IIFOH Im OOAlAMY, IS A@QEIIIOFF NW. SAN JUAN CAPISTRANO.CA.SM76 AUTNOMHlD M MIEEITATN[ FROM : INSURANCE PHONE NO. Sep. 26 1997 04:35PM P3 7:a<33.rjS f" OF SHN JUDY-1 Cr4P Qi' F03i0W_ SVP 25 '?" 15:4c LIABILITY BNDORS£MENT CITY OF SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adslaoao Sam Juan CYplarrwno.Ca(ifOrpY v2675 ATTN: A. POLICY INFORMATION gdpyi 1. InsuranccCompany ;PolicyNumbor OS3�H4 2. policyTerm(Erom) i (To) 7. Fiidotsetneet t'!ku'iveIlate� 3. Namedbtarrtd 4. Aridroseof'Namedlnamail 3 0 0 5. Limit of Liability Any One Occurrence/Aggmilate$ 1 epi COC,e / General Liability Algragate(Check one:) Applies"per kitation/prejeet" Is twice the occurrence limit 6. Deductible or Self-Insured Retention(Nil unless otherwise specified)- S 2.50 db I. Coverage is equivalent to: Comprehensive Clenerai Liability form GLOM(Ed 1173) �J Commercial General Liability"claims-made" form CG0002 6. Bodily Injury and Property Damage Coverage is: „Waiva heads "occurrence, If clsims-made-the retroactive date is B, POI,ISxAWSNP ffNTS This endorsoment is issued in consideration of the policy premium. Notwithstanding any inconsistent stafemen;in the policy to which this endorsertlent is artached or any other endorsement stacbed thereto, it is agreed as follows' 1. INSURED. The City and the Community R.edevebpment Agency,its eletxod or appointed offices,of5eisle,employes and volunteers aro inchided as inaureds with regard:o damages and defense of claims arising boom; (a) activities performed by or on behalf of the Named Insured,(b)projects and completed operations of the N mrd Insured,or(c) premises owned,leased or used by the Named insured. 2. CONTRI9MION NOT REQUIRED. As respeots:(a)work pcifomrd by the Named Insured for or on behalf of tie City,or(b)projects sold by the teamed Insured to the City;or(c)premises leased by the Named Insured from the City, the insurance afforded by this pol;cy shall be primary insurance as respects the City, its elected or appointed officers. officials,employees or vrAunteera;or stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. In either event,any otter insurance maintained by the City. Its elected or appointed officers,officials,employees or Yol'.mteers shall be in excess of this insurance and stall not contribute with it. 3. SCOPE OF COVERAGE. 'this policy,if primary,affords coverage at:east as bro€d as: (1) Insurance Services Office faint number 45YL0002(Fd. 1 i 73).Comprohcosivc General Liability Insurance fed insurance Services Office fbmt number GLO404 Broad Form Compmhcnsive General Liability endorsement; or. (2) Insurance Services Ofiee Commercial General Liability Coverage,`occurrence"form CG0001 or'claims- made" form CCIOW:or, FROM INSURANCE PHONE NO. Sep. 26 1997 04:36PM P4 714zg310S ry ❑F SAN JUAN CRF •5 PPS%�h SEP 25 '97 115:49 (3) If excoec,affords coverage which is at least as broad as the primary iustuzn a forts referenced in the preceding sections(I I and(Z). a. SEVERARTL1TV OF INTEREST. The inturance afforded by this policy applies separately to each miatred who is seeking coverage or against whom a claim is meds or a wit is brought,rxcapt with respect to the Company's limit of !lability. 5. PROVISIONS REGARDINC THE INSURER'S DUTIES AFTER ACCIDENT OR 1.065. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the City sea the Commis ity Redevelopment Agency, Its elected or appointed officers,officials_employee:or volsmaans. 6. CANCELLATION NOTICE. The imteance afforded by the policy shall not be suspendal voided,oaecelled reduced In coverage or limits except after thirty(30)days prior written notice by wttifwd mail return receipt requested has been given to iho City. Such notice shalt be addraased as shown in the heading of this endorsameht C. INCIIJINT AND-CLAIM REPOtt77NG P .SD RR Incidents and elatms are to be reported to the insurer at ATTN; 6ek-sr (Title) (Department) 't 4tGM�E1t� �✓kin-y�N�C� (Company) 3i2s:s C*"lrfu MI►I* eoAq s44 G^ (Soret Address) .58r. Qe»I n±k (GQz47 2 (CRY) (stats) (Zap code) (Tetephoer) D. SIGNATURE OF INSURER ORAL"fNORt13D REPRKSPNTATIVR OF THE INSURER !11 nt that I have audwrity to bind the below listedinsurance company and by my signmt¢e heram do so bind S RE OF AU 105nSENTATM (Origin etre on endorsmrent fumWwd to the City) ORGANIZATION: Trrl.F� ADDRESS 3553 (5:6"ek ho H�'M (06}� dir 13 ' 'MLSPHONE: 6W-jWQL . *** UNSUCCESSFUL MEMORY TRANSMISSION REPORT *** • TIME SEP 25 '97 0.53 TEL NUMBER 7144931053 NAME CITY OF SAN JUAN CAP NHR FILE DATE TIME DURATION PGS TO DEPT NBR MODE STATUS 917 25 SEP.25 15:52 00/00 0 3487773 M 50 *** THIS TRANSMISSION WAS UNSUCCESSFUL. RE—TRANSMIT BEGINNING WITH PAGE 01 *** facsimile TRANSMITTAL to: Hofstad Insurance fax A (714) 348-7773 re: Insurance requirement William &Pat Bathgate: 1) Under general liability please check the occurrence box; 2) Automobile liability - combined single limit amount to be $1 million and the expiration date looks like 10/3/87; 3) Requirement of General Liability endorsement form naming City as Additional Insured. City form attached date: September 25, 1997 pages: 4, including cover sheet. cc: Public Works From the desk of... Dawn M.SchandeH Deputy City Oer k FROM INSURANCE • PHONE NO. Sep. 26 1997 04:34PM P1 FACSIMILE COVER SHEET Including this page the following Fax has pages. COMPANY oee A OF -+ A7n0TPI0N FAX _ ( fa3—)o53 Frain HOFSTAD INSURANCE AGENCY 26371 CROWN VALLEY PARKWAY, SUITE 110 MISSION VIEJO, CA 92691 Phone (714) 348-7770 Fax (714) 348-7773 Message: LIFE FAX CURRENT RATES Farmers Flexible IIni-wersal Life 7 .1% Aamiities (Including IJtA'S) 6.6 - 7.0 THANKS FOR USING THE HOFSTAD INSURANCE AGENCY! FROM INSURAWE PHONE NO. Nov. 20 1996 01:16PM P2 49- FARMERS INSURANCE GROUP OF COMPANIES HnFSTAD I INSURANCE AGENCY BEN HOFSTAD To City of San Juan Capistrano $e William and Patricia Bathgate Policy#'s 139978637 on a 87 Toyota Pickup and 139978638 on a 69 Ford Truck were paid on 10-22-96 which prevented any cancellation Both polices have had continuous coverage with no lapses and are currently in force. They will not be up for renewal until 04-22-97. If you need any further information please call me @ 347-7770. Ben Hof ad of urance Agency AMERICA 0A DEPEND ON FARMERS 26371 Crown Valley Parkway, Suite 1. Mission Viejo. CA 92691 L3usrness: (714)348-7770 - Fax. (714)348-7773 FROM INSURR E 1. • PHONE NO. • Nov. 20 1996 01:16PM P1 FACSIMILE COVER SHEET Including this page the following,Fax has , pages. COMPANY ���7 =k% ATTENTION FAX From HOFSTAD INSURANCE AGENCY 26371 CROWN VALLEY PARKWAY, SUITE 110 MISSION VIEJO, CA 92691 Phone (714) 348-7770 Fax (714) 348-7773 Message: LIFE FAX CURRENT RATES Farmers Flexible Universal Life 7.1% Annuities (including 1,RAIS) 6.6 - 7.0 x THANKS FOR USING THE HOFSTAD INSURANCE AGENCY! tTT il:. t FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA NOTICE OF CANCELLATION OF MORTGAGEE OR OTHER INTEREST MORTGAGEE OR OTHER INTEREST: DATE MAILED: 10-31-1996 CITY OF SAN JUAN CAPISTRANO EMPLOYER AGENT: 97 15 356 32400 PASEO ADELANTO SN JN CAP CA 92675-3603 = CANCELLATION DATE: POLICY NUMBER : HOUSEHOLD NUMBER: 11-15-1996 97 13997-86-37 139978637 EFFECTIVE AT: - - VEHICLE YEAR 1987 TOYOTA 12:01 A.M. &DESCRIPTION a NAMED INSURED: WILLIAM BATHGATE You are hereby notified that all coverage extended to you under the above described policy is cancelled = effective at the date and time above. Your loan with this policyholder may have expired; however, this notice complies with the provision of our policy. FARMERS INSURANCE GROUP OF COMPANIES REGIONAL OFFICE P. 0. BOX 9016 CARLSBAD, CA 92018 nnor L A =. . r rn 250007 5-95 AOD07101 P. OOX 9016 CARL D, CA 92018 CITY OF SAN JUAN CAPISTRANO EMPLOYER 32900 PASEO ADELANTO SN JN CAP CA 92675-3603 IIIIIIIII�IIIIIIII��II I�IIIIIII�II�II I�IIIIIIIII�IIII��IIII,I I T1O 101 1 ;.R OTHER INTEREST H FARMERS INSURANCE EXCHANGE DATE MAILED 97 13'197 86 38 69 FORD PU 10.25-96 PREMIUM DUE—� `I7 15 356 10■03 343. 50 AGENT BFtJ S HOFSTAD PHONE 714 348=7770 li y' C v ti• t`SI h,n3by no6Ned that all coverage exwnded to yen under the above 12:tX1 NOON(12:01 A.M.in CA.,OR.,TX.,WA.,OK.,VA.,and Fire he shown here but only es respects the interests of tine Mortgagee IS96 %:O1 A.NL INCA_ O IY POLICIES IN 1, 3we Or 1,4 It LIAIi BA-1HGAI_E CITY OF SAN JUAN PAJRJCIA .BAI)iGATE CAPISTRANO EMPLOYER f't; P,D,( l,7 32400 PASEO ADELANTO Sri ,IN f,:AP CA 92693 SAN JUAN CAPD CA 92675.3 OS 'IC RECiAGEE OR OTHER INTEREST i! FARMERS INSURANCE EXCHANGE (-.. _, DATE MAILED 97 13997 86 37� 87 TOYOTA 10■25-96 PREMIUM DUE-- 97 15 356 10 03 360.90 AGENT BEN S HUFSTAD PHONE 714 348■7770 nii rr y,are hereby rKKified that all coverage extended lo you under Me above ,.I rto-7 re ul 12:00 NOON 02.01 A.M.In CA.,OR.,TX.,VIM.,OK.,VA,and Fine r. ;n na IO.1 n toe date slwwn here but only as respects the interests of the Mortgagee ::O NC:)ON(12:01 A.M.IN CA., t�y(1Q 1 yl FIRE ONLY POLICIES IN NOV. 09, 96 M rtgagee of Other WILLIAM BATHGATE niereet CITY OF SAN JUAN PATRICIA NATHGATE CAPISTRANO EMPLOYER PO Box cli'7 32400 PASEO ADELANTO SIJ ;"q (All Cn, 92693 SAN JUAN CAPO CA 92675*3603 RECEIVILU Mbyby` FARMERS INSURANCE EXr4M,jl�'%�GELES, CALIFORNIA E1136 NAMED INSURED: Nur ' `� 1st Edition WILLIAM BATHGATE cljY CI.LHh PATRICIA BATHGATEDEFAR PVOA PO BOX 217 ('l. JDAk i,Dj 15 356 97 13997-86-38 i N SN JN CAP CA AGENT Policy Number 92693-0217 Effective: 10-22-1996 PART l CERTIFICATE OF INSURANCE © APPLICABLE ❑ NOT APPLICABLE COVERAGE IS INDICATED BY AN"X" LIMITS OF LIABILITY- -X Bodily Injury Liability $ 250 ,000 each person $ 500 ,000 each occurrence Property Damage Liability 100 ,000 each occurrence Bodily Injury&Property Damage Liability ,000 each occurrence Personal Injury Protection-Property Protection Insurance(See Endorsement) Comprehensive,Actual Cash Value Less S 240 Deductible _ yJ Collision or Upset,Actual Cash Value Leas $ 500 Deductible $ retained limit POLICY NUMBER Umbrella Liability $ each occurrence $ aggregate YEAR AND TRADE NAME IDENTIFICATION NUMBER Description of Equipment 1969 FORD PU Jr25YRr26833 This certificate is subject to all of the terms,conditions and limitations set forth in the poficy(ies)and endorsements attached to A. It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previously issued certificates. PART II ADDITIONAL INSURED ENDORSEMENT ❑ APPLICABLE EKNOTAPPLICABLE ---I We provide the coverages indicated below by an "x', with respect to the above described equipment, to the person or organization named below as an additional insured. This coverage applies only(1)while the named insured is the owner, or has care, custody, or control of the above described equipment, and (2) when liability arises out of the acts and omissions of the named insured. This coverage does not apply(1)where liability arises out of negligence of the additional Insured,its agents,or employees, unless the agent or employee is the named insured, or (2) to any defect of material, design or workmanship in any equipment of which the additional insured is the owner,lessor, manufacturer,mortgagee,or beneficiary. Bodily Injury and Property Damage Liability Personal Injury Protection-Property Protection Insurance(See Endorsement) Comprehensive(including Fire and Theft) j Collision or Upset If any court shall interpret this endorsement to provide coverage other than what is stated above,then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibility law of the state,province,or territory where the named insured resides, as applicable to the equipment described above. If there is no such law, our limit of liability shall be $5,000 on account of bodily injury sustained by one person in any one occurrence and subject to this provision respecting each person, $10,000 on account of bodily injury sustained by two or more persons in any one occurrence. Our total liability for all damages because of all property damage sustained by one or more persons or organizations as the result of any one occurrence shall not exceed$5,000. The insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attached to it.This endorsement does not increase the limits of the policy. Upon cancellation or termination of this policy or policies from any cause we will mail 15 days notice in writing to the other interest shown below. CITY OF SAN JUAN CAPISTRANO EMPLOYEE COUNTERSIGNED 324 PASEO ADELANTO SN JN CAP CA 92675 in06 TEDrtION >fiP AUTHORIZED SIGNATURE E1136101 I', COMPANY NAME: DECLARATIONS FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALCFC.RNL4 AN INTER-INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY TRANSACTION TYPE: REINSTATEMENT The Effective Date is from TIME APPLIED FOR. The policy maybe renewed for an additional policy term of six months each time the Company offers to renew by sending a bill for the required renewal premium, and the insured pays said premium in advanceof the respective renewal date.The Policy is issued in reliance upon the statementsin the Declarations. INSURED'S NAME&ADDRESS: POLICY NO: 97 13997 -86-38 � WILLIAM BATHGATE POLICY EDITION. 03 PATRICIA BATHGATE EFFECTIVE DATE: 10-22-1996 PO BOX 217 EXPIRATION DATE04-22-1997 SN JN CAP CA EXPIRATION TIME: 12:01 A.M. Standard Time 92693-0217 ISSUING OFFICE: P. O. BOX 9016 AGENT: Ben S Hofstad CARLSBAD, CA 92018 AGENT NO. 9'1 i5 3 5 G AGENTPHONE (714) 348-7770 f DESCRIPTION OF VEHICLE Year Make Model Vehicle Identification Number Rating Pointe ___— MAJOR MINOR ACCIDENTS 1969 FORD FORD PU _ 1 0 0 1 COVERAGES *ENTRIES IN THOUSANDS OF DOLLARS. _ (SEE REVERSE SIDE FOR COVERAGE DESIGNATIONS) Uninsured Motorist Medical/ Comprehensive Collision Towing Soddy InjuryP.D. I3odgv In P.D. No Fault Daduct!ble Deductible Premium Non-Auto j .i . + • NOT COV 250 15001100 250 15001 NC XXX ! XXX 5, 000 240 500 — -- NCS ' NC Other•Prem. 1 Each i Each I 1 Each XXX XXX Lieb. i Medical Person Occurrence Person! Occurrence _ _ 10.10 PREMIUM BY COVERAGE 206.70_ 17_780.90 xxXXXxxxXX 31.30 ] 3.20 11.80 1 10.10 ENDORSEMENTNUMBERS MESSAGES/RATING INFORMATION E9007 LISTED ENDORSEMENTS ADDED ON EFFECTIVE DATE ABOVE. E1136 CAR SYMBOL(H) . COVERAGE FOR E9007 IS C-2 ANNUAL MILEAGE IS LESS THAN 15,001. DRIVING EXPERIENCE IS MORE THAN 8 YEARS. PLEASURE USE/UNDER 30 MI. WKLY. TO WORK, AGE 60-69 THE CLAIMS COST FACTOR IS 66. DISCOUNTS/RATING PLAN POLICY ACTIVITY(Submit amount due with enclosed invoice) -- MULTIPLE CAR $ 348. 50 Previous Balance DUE GOOD DRIVER Premium HOMEOWNER DISC Fees ANY-TOTAL-BALANCE OR 30/60 170.000R Payments or Credits MUSE APPLEDIT OIEDTO YOUR NEXT SWUNG. BALANCES 178.50 Total DUE OVER$7.00ARE DUE UPON RECEIPT. LIENHOLDER OR OTHER INTEREST: Countersignature Authorized Rep t-b" 565002 5-96 I-96 10-28-1996 050321 11 � e I RECEIVED Tft�.` FARMERS INSURANCE EXCHANGE, LOS A,tll 5, CALIFORNIA E1136 NAMED INSURED: 11oY �� 30D 1st Edition WILLIAM BATHGATE It PATRICIA BATHGATE "lTf - li- PO BOX 217 Ct r+r f i1 SN JN CAP CA 1UAk CApI'` lAGENT6� 97 13997-86-37 92693-0211 Policy Number Effective: 10-22-1997 PART I CERTIFICATE OF INSURANCE APPUCABLE C NOTAPPUCABLE COVERAGE IS INDICATED BY AN"X"� LIMITS OF LIABILITY X Bodily Injury Liability $ 250 ,000 each person $ 500 ,000 each occurrence Property Damage Liability _ _ 100 ,000 each oxunence Bodily Injury&Property Damage Liability _ _ $ ,000 each occurrence Personal Injury Protection-Property Protection Insurance(See Endorsement) X Comprehensive,Actual Cash Value Less _ Deductible X Collision or Upset,Actual Cash Value Less __$ 500 Deductible $ retained limit POLICY NUMBER Umbrella Liability $ each occurrence $ aggregate YEAR AND TRADE NAME __ _ IDENTIFICATION NUMBER Description of Equipment 1987 TOYOTA T 740 This certificate is subject to all of the terms,conditions and limitations set forth in the pdicy(tes) and endorsements attached to it. It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previously issued certificates. PART 11 ADDITIONAL INSURED ENDORSEMENT APPUCABLE 'X NOT APPUCABLE We provide the coverages indicated below by an 'x', with respect to the above described equipment, to the person or organization named below as an additional insured. This coverage applies only(1)while the named insured is the owner, or has care, custody, or control of the above described equipment, and (2) when liability arises out of the acts and omissions of the named insured. This coverage does not apply(1)where liability arises out of negligence of the additional insured,its agents,or employees, unless ft agent or employee is the named insured, or (2) 10 any defect of material, design or workmanship in any equipment of which the additional insured isthe owner,lessor,manufacturer, mortgagee,or beneficiary. Bodily injury and Property Damage Liability --- Personal In'u Proboiion- Protection Insurance(See Endorsement) Comprehensive(indudirrg Fire and Theft) __ Collision or Upset If any court shall interpret this endorsement to provide coverage other than what is stated above,then our limits of liability shall be the limits of bodily injury liability and property damage liability specified by any motor vehicle financial responsibility law of the state, province,or territory where the named insured resides, as applicable to the equipment described above. If there is no such law, our limit of liability shall be$5,000 on account of bodily injury sustained by one person in any one occurrence and subject to this provision respecting each person, $10,000 on account of bodily injury sustained by two or more persons in any one occurrence. Our total liability for all damages because of all property damage sustained by one or more persons or organizations as the result of any one occurrence shall not exceed$5,000. The insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attached to it.This endorsement does not increase the limits of the policy. Upon cancellation or termination of this policy or policies from any cause we will mall 15 days notice in writing to the other Interest shown below. CITY OF SAN JUAN CAPISTRANO EMPLOYER COUNTERSIGNED 324 PASEO ADELANTO I SN JN CAP CA 92675 9t-IM ISTEDITIpN 7-88 AUTHG LIED SIGNATURE r r FROM : INSURANCE_ • PHONE NO. Oct. 22 1996 03:47PM P2 CERMF II1ll+{TSlMi q v f '17 t V {yL$(,{ta'��i 11 y( (�7 '"^��• /r� Y: N�` oATe(wx100'rTl ! o., , '.,fp��'TI fVtu 2`v'IRIt1A,�h 1 ./ 101Z2196 PROOUCER Hofstad Insurance Agency THIS CERTIFICATE IS ISSUED ASf A MATTER OF INFORMATION 26371 Crown Valley pkwy.#110 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mission Viejo,Ca.92691 VKK 13ER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE X714134#_7779 c:UMPANv CODE: suB coDE: A FARMERS INSURANCE EXCHANGE INSURED WILLIAM AAND PATRICIA BATHGATE — .^.pMPANv - - - P_O_BOX 217 COMPANY _ SAW JUAN CAPISTRANO,CA 92675 C COMPANY D _ .TAa�I G�;�IIr:?*3.s!�"��✓IS�4'i,... -, -. S''�wYR. . JI ° � _r .. ,. ,,; �.+ _.: ! .., ., �' ...;;!, .,.G�Eit�'n."`3.� :M ,CI THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAYE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOWIffiMENT, 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 CLAMS. TION TYPE OF IN IVRMGE POLICY NUMBER DATE[ YI POLICYTPW WM LIMR9 GENERAL LIABILITY URtucc- . q COMPREHENSIVE FORM BODILY INJURY AGG f PREMISESAOPERAVONS I PROPERTY DAMAGE OCC UNDERGROUND PROPERTY DAMAGE AGO EAPL061ON$CALLAP6E HAZARD PROOUCISACOMPLE DOPER M&MCOMRINEDOCC__ _S 0 CONTRACTUAL _BIAPDCOMSINEDAGG q INDEPENDE.WCONTRACTORS I P R WAd1Y AGG S _ BROAD FORM PROPERTY DAMAGE PERSONAL INJURY AUTOMOBILE LIABIL(IY VQDILY INJURY f 26009D pwon ANY AUTO Pel A A ALL OWNED AUTO'(P,.M P..) 1399796371.39 1013190 413197 eooar lNJURr s 5p0pp0 ALL OWNED AUTOS (Other V,.Pllwte (Per xdd— ❑ HIRED AUTOS _ PROPERTY DAMAGE f 190999 NON—OWNED AUTOS GARAGE UADIUTY BODILY INJURY 6 PROPERTY DAMAGE S COMBINED "GIRSS LIABILITY TACH OCCURRENCE 5 _ UMBRELLA FORM AGGREGATE s OTHER THAN UMBRELLA FORM s INONKER$COMPEMMTgx MO STATUTORY LIMITS EMPLOYER$'LIADBrn' THE PROPRIETOR/ iNCLI EACH ACCIDEM q PARTNERSEXECUTUF I I DI6EASE-POLICYLIMIT f OFFICERS ARE �EXCL — ����LU-IEEE DLSE OTHER v c TV r.O CAJ " To 1.� c m DE$GRI"011 OF O►E14TNIx6/LaGA1TWxCATixICLGEIBPiGULL REMd - - o m _. ca Cr') .... ,, ... . . :6�'if,<A;y. n1�n��S4�]R`Y47� l�A )a�4a �; Y,�T., '� .}nir.;" d''tl9r :rl°a. :N�k�b� • "`i!'. .OA Ai9 Ai CITY OF SAN JUAN CAPISTRANO SHOULD ANY OF THE ABOVE OF3ORM® POLIDIBN RE OAMCELLEO BEFORE THE EXPIRATION DATE THEREOF, THE "Unix, GoxwA MGL EMDPAVOR ro MAN COMMUNITY DEVELOPMENT AGENCY 16 DAY$MITTEN NOTICE TO THE GERTN TE HOLOERNAMNDTOTNNINFT, 32400 PASEO ADELANTO AUT FAMURE TO ILS NOTICE SIIALLMIPOW MO OBLOATMIM M LW " OF ANY KAHN U TME COIPAW- R$ AOEMTA OR REPREAEMTATAAEN_ SAN JUAN CAPISTRANO,CA_92675 AUTHOgQEO q R ATNF J" MEMBEPS OF THE CITY COUNCIL COLLENE CAMPBELL WYTT LAIONE RT ',mmno+uio S CAROCY nnuuxm 1961 AROLYN NASH 1776 DAVID SWERDLIN CITY MANAGER GEORGESCARBOROUGH September 25, 1996 Mr. & Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, CA 92675 Re: Renewal of Automobile Liability Certificate of insurance (Overseer Services a.,anner Prol2ertvl Dear Mr. & Mrs. Bathgate: The Automobile Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on October 3, 1996. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. Please forward the updated certificate to the City, attention City Clerk's office, by October 13, 1996. If you have any questions, please contact me at (714) 443-6310. Thank you for your cooperation. Very truly yours, �A. 600vr� Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Silvia Cintron, Public Land & Facilities 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171 FROM : INSURANCE ` • PHONE NO. • Aug. 27 1996 11:26AM P2 - N ro 8/281V96W YY1 PRODUCAR HOh1aO Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 26371 Crown Valley pkwy.6110 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 26377 n own Ca.92691 HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Viep, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (774748-7770 _._. COMPANIES AFFORDING COVERAGE COMPANY TRUCK INSURANCE EXCHANGE cone 3UB 4006- A w "ED WILLIAM AMID PATRICIA BATHGATE COMPANY B P.O.BOX 217 COMPANY __ .... SAN JUAN CAPISTRANO.CA 92675 C COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 14SLRED NAA®ABOVE FOR THE FOULY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIRIEWNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY OF ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LAIITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAMS. LM TTPi OTwWRAMCE POlJ4Y aU1NN1 �� LaMis U MFAAL LIABILITY S 1,000.680 A ® COMPREHENSIVE FORM 16063948 9/i?186 811287 BODILY INJURY PREMIS SKAERAYIOM PROPER7VOA�eO ,000 1 UNDERGROUND PROPERTY AGG EJtPLOSIONa GOLLAPSE HAZARD PPTYO %M 'Doo "POCOUDNEDOCC 1.000.080 ❑ CONTRACTUAL COMBIMM ACGf 1.000.000 Ll INDEPENDFWCONTRACTORS ..?ERsonaL.m�uaYecc_ ,s1_000.000 BROAD FORMPROPERTYDAMAGE _nIPFRSONALNJURY AUTOMOBILE LIAILLm BODILY INJURY f ANY AUTO ALLCW IFOAU (PrNat*Wes) 90DLYINJURY f ALL OANED AUTOS (Oaiee tlun Pnwb PeeeerlVe' rarsidp ❑ INED ALRQS PROPERTY DAMAGE f NONANRJEp AIfiQS GARAGE LA& ITY BODILYHJURYa PROPERTY DAMAGE S COMBNED FIICFSa IJABaJTY EACH OCGDIaENCE f A UMBRELLA FORM AOOREpATE S ODER TAN UMBRELLA FORM S wORKERSOOMI-EKSATKNI AND STATUTORY LIMITS Rllffl iRa'LMHLm ORI EACH ACCIDENT THE PROPRI Ts INCL PARTNERS/EXECUTIVE DISEASE.POLICY LHR S OFFKfRS ARE b(CL OTHER OFSORIPTION d OPPIIATKIMNLOWTKIRaIVENICLEBIBPBCNL REMG CITY OF SAN JUAN CAPSTRANO SHOULD ART Of TIAs ABOVE 001ORMM POLK ES RE OARCFlifTT REPORE THE k"IAATION GATE TWEIIIOP, THE ISSMVIR GOIMPANY VLL aRpiAVOR TO MAIL 32400 PASEO ADFLANTO m OAYS wamER Nnn4E TO THF OEassITUITR IIOIDMI NAMED TOTIIE LfiPT. SAN JUAN CAPISTRANO,CA.82676 HJT FARAWL TO NAL SUCH NOTK:F sauL aMasE NO ORLMATKMI OR LIABILITY OF ARY KVO UP WE ODfPARY, Ila JIMTiRTa OR ItEPREBEMTAw/Fs. AUTHOII DR[PR -_..ATMA �.. FROM : INSURANCE • PHONE N0. • Aug. 27 1996 11:25RM PI RECEIVED Auc 21 12 41 PM '96 FACSIMILE PpVCLER SHEET 04?1„21MENT CITY Or SAN JUAN CAPi51RAN0 , Including this page the following Fax has pages_ COMPANY etA of ATTENTION * FAX From HOFSTAD INSURANCE AGENCY 26371 CROWN VALLEY PARKWAY, SUITE 110 MISSION VIEJO, CA 92691 Phone (714) 348-7770 Fax (714) 348-7773 Message: LIFE FAX CURRENT RATES Farmers Flexible Universal Life 7.1Y Annuities (Including IPA'S) 6.6 - 7.0 } THANKS FOR USING THE HOFSTAD INSURANCE AGENCY! IINICEN TH18CEp'TiF TE-16VUWASAVAITCROFUMFORMATIMONLYANO CONFIRS NO MOHTS UPON THE CERTIFFGATE"OLOER,T14S GERTIPICATE GOES NOT AMEND,ZVE"D OR ALTER THE COVERAGE AFFORDED BY THE 2/x37! GFLa.A I tj4lfe� tic) POLICIES BELOW. 1i ssicul Lhejo Gt J COMPANIES AFFORDING COVERAGE - UTM on— rn SIJL J 1E17Ep (71 rrI 174P93 OOMryVPf 0") (EVER S ' VGIiAOB it, w s i., Y ..8• iFS; �_h +,. T/AS STOCERIIMTHATTHE PC NYMOFHEMWT.CE N(* M M70H FH ANY IONIPACP THETKAM VKH ABOVEFOA 111EVOLICYMTHIS INDICAIEO.NORNiHSTANDINO ANY PEOWIEMEHT.TON(*CCYLnITWN OF ANY CONI PACT OR OTHER WGUMENT 1Yntt RESPECT TO WI11CH THIS CFRINICIAIE MAY BE 16A"OIt MAY PERtAIN,THE NIS ROW 4,TFMMD VY THE POLICIES DESCRIBED I01M S SUSIECT 110 ALL THE TERAS. EXCLUSIONS AND 0040IT)0RS OF SUCH POLIOIES.UNIT$SHOWN MAY WAVE BS-EN RELW-EO BY PAW CLAN& TYPE 01 IIgL1AAAl:EPOLICY M)me {FOUDYONLCTWt PWADYDt►IATIOX _—^•••-_lllRt! ,•,•`—_�_.-_ I 'DATE imwOCnY; 6Aft AdAOt1YYT} IEtSnM NACILTrY --- OENEMt AG[fXtTMIE f �1 �a+�0 f1mm,ACMIZENEPIOAA011 1505 3$ VEP a�tz�4g $lrL�46. Pa�ac;s_ooloiaii+asa:— i �'�Jp°p ktAims MADE mnum. PEROCIV.L 6 Nw.MA" 1 hceoO coo _ WRiEf196CONTMGIPSPIg1. 6TONOCp1RRENCEu 6GOCIQI cw 1b MEG.E%P6NlE N'v PM IMOXq ! �—�. AMTOIVOlflE DA6fA1 ; OOY.l14EOTa/gL6 ' q,Atq* I NIMH LL0RAIEOAVTry6 .. OAth[8 ..R REO A" lgply MArR+—' OYINEDAUTOq IPr,�°�IJMA T JXA/MOELMBLDY -- FROAiRIrMAVWp — em"LLL61UTV EfCHOCCUNElKE ! _ UMBREIIA FOTO/ AUW1Td1TE - !••� Nfiq TNAH IAJ6REllAfORM I t 'IiIDNNFT'6CONPUSAIIOR I GTUTOPYUK11 .. „ ...:�,:�.•".: AND FALSI AOCfOEtR 6 �__ - 69CA9s.PIX10vuMrt !-.. YMPIOKRi•WBNIY - _- - lOFAOE-EACX EMPLprEf ! OTHEA 1 ! IIMlIDRMOFEAAtIO1fM.00AT1oMaMNIttEWVCMI-1IEMf _ _ —_ _ `__ .r r!-KA ER•.r,:: :, �^. •,,s 'rC-A qO .Ir1 V/' -'X'w 1,*N `bhts-iPA"P' 9HCHRO AM Of THE ARMF DF6CRIOED PCVCIES BE CANCELLED BFFOfE THE I ♦ -( ` EXPINATION DATE 71IFNEOF.THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL . .._WYS WIIITTEN NOTICE TO THE CERTN'ICATF HOLDER NAMED TO TlIE .tet f - Litt,BUT SANLURE TO MAIL SUCH NOTICE SHALL JW06E NO OCLIOATtdi OR .gh '„/VL�'F-j [AiNs71� i7� (/( " 4N60.IM CF KIND UPON THE COMPANY.US AGENTS OR REPREBENTA7NES. _ f" 121P 3. AM L!O Pf1Eat ARVE Fm wo(IMP F L iDACORD CORPORATKO 1f00. Page t • FARMERS INSURANCE GROUP OF COMPANIES AMERICA CAN DEPEND ON FARMERS FACSIMILE COVER SHMT Including this page the tolIowing Fax has pages. + c COHPANY ATTENTION FAX # L4 `Z3 _ 105:3- From 053From HOFSTAD INSURANCE AGWCY 26371 CROWN VALLEY PARKWAY, SUITS 110 MISSION VIEJO, CA 92691 Phone (714))348-7770 Fax ((714)348-7773 LIFE FAX CURRENT RATES Farmers Flexible Universal Life 7 .I% Annuities (Including IRA'S) 6.6 - 7.0 rS FvR USING 7"r piOPSTAD IYSi'su14NGE AGENCY! FROM : INSURANCE • PHONE NO. Aug. 26 1996 04:30PM P3 7:4.=9-s103_ _..7r OF ifJ J�1•4I D�;F X97 P©2 R iG 26 "Jh G=•:46 UARnM ENDORSEMLW CITY OF SAN JUAN CAPL9'1'RANo COMW"TrY REDEV'SLOP..MKNT AGENCY 32N10?4Akhalb, S"Joan capbtraan,CaMmIls 92675 Ate. A. MUCYYNPORIIMA•t'aOli firxbtst®osN 1. h"aeeeCcrr4mv_ fAetot6 4. ;PolicyNumrer $o55y"46 2 Po(i y Te m(Ftrnn) 2 t. (To) P Qement Emmonve Daae 8ja I'm. 3. Ni -- d. afNamadt+nuretd Z�IgS 11 wrw�..e ,.afro... Sn��yart r/M+.e Limit cf Liability Any One(3eetrn:t Awgiita S Gausat Liability Agffegm(Cluck one) / Applies"ps locationopmect' Is twice the occt nvme limit 6. Ovd=tible a Self-Inured Rtrantion(Nil untea otherwise specified)' S .250.00 Coverap ie equivalent to: Comprebcwive General Usbllity tbcm CL0002(fid 1/77) ✓✓ Cotmtetcid Genera!LieGitity^chsims-made'tam CG0002 S Bodiy lnjtny and Prope zV llamage Coverage is: occunclac If cinims-mede.the mmoactice dete is B. POLICY AWMADMI This mdorsememf a imucd in consideration of the policy premitan Notwtthamndiug aay muonaiatmt statement In the policy to wbicta*is endersement is attached or any attar andrnsameal attached thucto.it is agncd as follows: 1. IN6i)I MD. The City and the Cotmmuni(y Redevelopment Amy,as dared or appointed afflom,officials.comloyeer and,vol]rtew are mpcl,.lded as koveds w6 regard to damages cod defame of clamts a2 mg&am,(a)a0mvince pe rfocIIbd by a on beh ilfofthe Named Inaned,(b)ormiccz and cormplated epaetiona of the Named Inured,or(c)premises owned, leaned or tend by tlee Named hatred 2 COMMMI I40N NOT 1B417IRS0. As reapecta:(a)work pwkxinad by tha Named Inured fm or on behalf of the City;m(b)ptejam sold by the Named lasered to the City:or(c)piamiso leased by the Named Inured 1Yom the City,the inaraw dbnkd by thio policy aW be primary imiwwxce as rmpeols the City,its elected cc appoimea of cv%,officials, cmployeae m valunteas:or stand in an unbroken,chain of coverage excess of the Named Inamrod's schefted trderlymg urtmm7 wia2ga. In eitlta6 event,any other ineurmer mdnta=4 by the City.as de-ud or appoimed oe/cers,afficials, . employees or cclmteen shall be m excess of tow imwance cod shay not comnbob with it 3. SCOPE OF COYIVRAGL This policy,if 7etntvsy,adatda eovwnz at kms as bnomd a_ (1) Insurance Services Office form number GL0002 (Ed 1/73). Canprehanaive Ocneral Lmbibty+nny9 and Evamice Swaree Office ioan number OL0404 Broad Form Compre6msivc Guard L awlitq endor.ement or, (2) hmmacce Sesvicea 0150a Comm=id General L. bility Cyv¢ragt,"ok::.nrrsce"fom CGOWI or'clwrl.-nowt` form C00002;or. FROM INSURANCE PHONE NO. : Aug. 26 1996 04:31PM P4 ^_y.:431oS. 01 LSF 5phi JUW, Cf+P *7 PU3 PW 26 '96 tQ:47 (3) IfeXOM/Fords cavefaga which u at lanai w broad as the Pv=Mry msuraDCe Cornu referenced m rhe prcccdi,C sections(1)and(2). 4. SEVElABILrn OF WTFALKS T. no vasttrarm affmded by din;prrucy Applies mparawly t°each msut d who is sockmg coverage cc agaiori whom a claim u nude Or a,mit is brought,except with respect to the Compacys I=w of Lability. 5 novsIONS RLGARptNG THE @ WWW'S DUTW AMR ACMZNE OR LOSS. Any f4 um to comply with reporting provisos+of We policy$sill not affect coverage provided to the City sod the Community Redevo:opmm nt Agency,&is elected Cr 2 isnied offk em,otiacisls,cst>Fioyocs or volumeem 6 CANCELLATION NOTICL The insurance afforded by this policy shall sot be su+peodad,voided.agsi,,led,trtduwd in coverage of lirptts coapt attar W M(3 01 days'prior written notice by caufiad mail n m meipt regmwcd has been gicm to the City. Stich mtiee 9139111 ba adi musil=shown is the hesdiag of this cnilw%mse rc C. MCM&M AND Ca lriawn its std oIaims are to be mparted to the matt"at AWN. A(oys rc (title) (Dep91ttm�} TA4Jrmt.�S .�S.�grS� GLL�- (,omp�y) -2(P-3-) ► (S,ered Addtam) f1►Ssntnn Utelo L4. ClZAIR1 (City) (8122c) (Zip Cade) (Telephone) p. SI(rlttA son irlettveR OgAL>T�+Onraia�■anorvrta's'a .e�•rLa IIVSLm�>Q I. IL-Wfcv.3 IA0TZ4 Aa7 (prfeNgpe o2me) watrat I have asboray to bind the below haW aimancr wmparry and by my sngtlah"Barron do oro bindtltis oompany. 3[dNA RCMESENTATIVE (Oti eadoracmma ftnished to the city) r� �r ORGA_-WATION: TME ADDRESS ,2tr3'ft 4f&Ocu41-1 QA 1f,_-?4j -k1f0 TELEMONE: N—x}8_791?0 • Page 2 FARMERS INSURANCE GROUP OF COMPANIES AMERICA CAN DEPEND ON FARMERS CERTIFICAT£ -OF LIABILITY INSURANCE STATE OF - CALIFORNIA Policy Number Year Kaye \ Ilodel Veh I.D. No. 139978635 69 FORD PU F25YRER6833 Effective Expiration Date 4/03/96 Date 10/03/96 FARMERS INSURANCE EXCHANGE, an authorized California Insurer, in compliance with the California Financial Responsibility Act, certifies that it has issued a policy in an amount not less than that required by the Callformla Financial Responsibility Lav for the described motor vehicle. Agent : 97-15-56 WILLIAM AND PATRICIA BATHGATE NOFSTAD INSURANCE AGENCY P.O. BOY 217 26371 CROWN VALLEY PINY 8110 SAN JUAN CAPISTRANO 92675 KISSION VEIJO CA 92691 TEL (714) 346-7770 FAX (714) 348-7773 LIABILITY LIMITS 250/500/100 ADDITIONAL INSURED: CITY OF SAN JUAN CAPISTRANO PASEO ADELANTO SAN JUAN ,CAPISTRANO, CA. 92675 4BENHAD 1 • � • Page 1 FARMERS INSURANCE GROUP OF COMPANIES AMERICA CAN OEPENO ON FARMERS FACSIMILE COVER SHEET Including this page the following Pax has ?. pages. COMPANY . �J5, 4iJ V)Fe �-- ATTENTION FAX a �tq3 - 1053 From HOFSTAD INSURANCE AGEMY 26371 CROWN VALLEY PARKWAY, SUITE 110 MISSION VIEJO, CA 92691 Phone (714)348-77700 Fax (71(4�)348-7773 Message : oFe-o _ �(1+� It; M(.s F LIFE FAR CURRENT RATES Farmers Flexible Universal Life 7 .18 Annuities ( Including IRA'S) 6.6 - 7 .0 8 THAWS FOR USING THE HOFSTAD INSURANCE AGENCY! .___........... . . Page 1 RECEIVED FARMERS INSURANCE GROUP OF COMPANIES Noy Z IO A4 ( � °95 AMLgICA CAN DEPLNC ON FARMERS o'` `, r FACSIMILE COVER SHEET Including this page the following Fax has 3' pages, )) CCA COMPANY ATTENTION_ �DAtyO FAX 1053 From HOFSTAD INSMANCE AGCY 26371 CROWN VALLEY PARKWAY, SUITE 110 MISSION VIE30, CA 92691 Phone (714)3148-7770 Fax (714)348-7773 Message:_ -Ao bl !t T.� Kpee,f-- -t– l� t�( jlrne� t.+y G' Wit- �I �F Peeve am-A,4t £lsr . LIFE FAX CURRENT RATES Farmers Flexible Universal Life 7.1% Annuities (Including IRA'S) 6.6 - 7.0 T=WS FOR USING THE HOFS AD INSURANCE AGENCY I Page.... 3, L, r the Exchaugo a Y deskinikled on the rcw rise We as i number& - - msrrOd by. LJ A daG1 srurwtoe coapary.I+erpn ergo as mn+oaRr- CLY eM Wage M"daarvodM4 VA E W Edam CIA 9AA TE !7 is sss sss139Q7 !6 37 Asad ._ 'e�•Y'N.nlw - EfleClbie PART 1 CERTIFICATE OF INSURANCE il APpticAlax E) APPtIfwVILE COVEAAQE Ia INDICATED ev AN'X' _ �"" Llan TY Bodily Nwv Lrabaay .^..—�. S x_Am each peon Jtt �(S QQQ 4W each 00mrorm x Pruparly OamABe Liahtlty ~J'. -388' DW each oeaummce _. Bodey aWrY a Pmpwly Damage Uabiary__ �$ PW each ocounmtce Paganat alury Proreclba•Properly Rolcclbn Ireuruncn is"ErdoraMgnl} CWKmhemr .Adite Cash V@LC Lost _ >�;�-- Q�^^ Deductible@'afSbn IX u0;EL A0kWI('i9]rl Val!LPr4 5 - -- >b 00 Deactaft relalwil orrwl ,_Umbreas Liabaay $ each octcunance i4xcvrurrrw3ca y agarewra YEAR AND TRADE NAME_ �.-^�.. IDENMCAT1001 NUMMIT CA L451 3 Eeut+marr 67 TMIA T AG sir this cerlilicale is aublad ho all of the lame,conditions and imitations set forth in are oo"icsi a4d erdomemonto of anhed to I.It is furashw as a matlor or aoprmaeon only and does mt change, rwil IV or ext" the policy In any way- A supersedes as raevlouaty i"Ued cvnlflcda5. PART 11 AWIT1ONAL INSURED ENDORSEMENT APKWAeLE QWN61 41@ provide the coverages Imhcated below by an Y, with respect to the above described eptipmenL to the person or orpanizaion named below as an additional? insured- this coverage apprws ady (1) while the named insured is the water, or has care, custody, or Wilyd of the above described equipment,and(2)when liability arises Out of the acts and ornissions of the named insured. This coverage does not apply (I) where L*Ity arises qd of rtegiigenCe 01 Ilre additional Insured, fts agents, m mplayl!".unless the agent or dntployate is the ria rttstaed, or (2)to any detect of mairnial, design 0r wodcmansMo in any oquipment 01 which the ad66onet hlsaeed is the o near,lessor,maMadurer,mortgagee,w beneficiary. B�CodA�nr nRd Preocpony R �t Mia—sna nceS nshe eadihet � ndmsemettt _ —�� h arty coUr1•shali hderprel this endoryemeni to provide cdveragc ulnar Ilan what Ls staled above, then purr lirrdts of 6app'ity shag 6e the tmtils di bod njtny habiOp and prrmerty damage iaMINYY speofietl t,y any me101 veticte finartciai responsprAity iaw 01 the stale, p��ince, er territory ro the named irLaxed resides, as appicabie m Ins egntpnrent described above. N gnere is rm such lacy, our unlit M tiaNity ILI shah he S5,IN10 rn account of hatldify injury srrslairred by roe person m any orre ocanrenca and subject to fhb provaum respoctlrg a�etr Persson.$1D,DOD 0n accotmt e1 oed(Y mj ny stylar�d by two a mrxe yarsORs m arty rare arx7Re ice Dur IOtal iabi fit to ad rlamape beck p operty damage sustaietetl try onn n more persons or mgarxzanons as the r9snh of oryr Orrc rlrra;rnretcs shwa 7tW er¢tred SS.DDD- Theinsurance allotdad by the Policy descrleed above is subje,cl to all terms of l p—Wy errd any endorse-m— s attached fo it yfi5 e&=- mem does riot increase. the ami s ut the policy, Upon cancellation or termination of this Policy or policies from any cause we will Maydays notice in wtlthrs In th of mtrn_st she wn below. y a Saw _ . SN P GAP �79 m les _ n _ o CAxrntersigned 01.11W 161 ECnaMdWIWc COMO gn.COO RAA n1UPreeOnralML `r` Ieel .acENrs v cr.r Page 2 hw/ed by, - _.. +.a,y ueay,lmlW an "0" ' verse side as nurnbeS� , ?. A¢tock itnteama ,(Yasin cow the PD"WW f• �- -pd mid 5010 • -, ' E-1736 NamaA I,rw,nrtl W j e TE � .. LI Edition � I �SfA3r2r B+krtr6ATe 97 1x ;56 i#9!1 i6 38 WJ, rx,atanr PART 1 CERTIFICATE OF INSURANCE Jt APWAM-E p Asp �E GOyERAGE l& O6Y AN~X WAITS OF.UAMITY sodity lroery l-iahiidY � S AM each Person X /Il — — _ �._.._ S �@ .000 esti occurrence 1'tgYerly Danerge LWtvky40111 A00 each owwoence Badly IniurY d Properly Damage Liability_ ___ S 'QW each OccunaRM 94n1:rgr rrnaY PID1eci'ion-PMpedy Pidlecapl Nrwranpg{Ssa ErAyaememi CutsptyamaM1e,Ackof Cage Yakw IAas .•--._-- § .�_^..• DedtMJitlle X Caaltian a llpsd,Aduar�cwt l,oae $ peduclihk mtahed reel Omtrene l)nhaay S each occurrence PRO aim R $ swreciate or LAST 3 Ict, 64 FORD til f 6;i OKOTS aab�ner+ SHOWN This cente::efe is a,b-y nt W na d aa, Wrens, dardllicais and rimtlaaonn sed lurlh in the porrcytiee)and erdorsntneRls t laclrad to R e lo huMered ,vs a nwttet d inh�rmM1cn aay and does not change, mndify or extend the POT(y in any ray. It euparxedes ae Dr WMIY kaed Comte" PART N ADDITIONAL INSURED ENDORSEMENT _©APMCAME EN ApR eLE e Vk provide the rwverages ilydicatod heWw by an "x', with respect la fhe above described o_qugmeni, to the person w orpanitation named be4aw as an additiunal Insured. This coverage applies only (1) white the named fnewed is the owner, a has care, custody, or conhol of One above described equipment,and(2)when 1'lability arises out d the acts and omissions at the named inswad, This Coverage does not apply (1) where liability arises out of negligence of the additlortal insured,its agaWs, or employees, unless the agent or employee is the named insured, at (2) to aty detect or material, design a workmanstup in any equipment of wldch the additional Inswed is the owner,Icssnr,manldachker, mortgagee,or beneficiary, Bads Inkny and t -!Y-Darn�c_Uahl�ty . PSsonaf Ir Protearotection�Property Rotectien ms lrarce_�W Endwsemen1_ Cnm :henave it cWding Hie and_Thsi� Calltsiun or upset Ii any coal shall Vnterpel oris eatorssnrerA tato p�rrvidu Erveragu toots flan vArat Is stinted above, Ihtn orw ani115 of AaGiiily siw% be the limas od bodily mjlxy hahlty and piopnrty damage kaMhfy SpecAiad Ey any motor petdcte tinanciat tesponaihitty law of de stale, pr��inc�, Oil" wflere the nomad ir�swed res des, as spilt reUk to Um etp>tpment dasa bed almve. tl the a is r o such 4awt our l and M Tabify sloes bo 55,000 al account of bodily injury sustains by mre pers m m am rine occw ante and subject 1e 1Fis prov Sion rerpegirlg each pass+.E tQ,ODO an accoutt of b xfily bi)ay st Sita nod by two or mine persm s m any tale occurre ce.Dur tM�Iial iHry Irn �I damiages hacausa 01 aN property damage slrs4ained Dy ale a mac pesons a aganoatarrs the resvtt of airy ate oceurence shall not encased $5,000. Tlr'visruanCCalforded byy the rdi�Y describcd abuve is suh)ecr to aN lernus of tort policy and arty Mllarsements ached to ft. This mxlwe - ment does not Increase 0w lim s of the pd'icy, 9POn esasdlatiOn OF termination of Ibis policy or policies (Torn any sense we Will mall--45—days notice in writing to the other interest shown below. pKOM SAN 1"AM"175 taplD CA 42575 NS c N Cwntersigned Y �, -:{ Ai-tcfr.lei EORKa+r-�WIveDGt!ap agNKV uvs� t._�..' hgltnp}riegP.9LMe AGEN 8 COPYrn cis c. 1 JIMANO MEMBERS OF THE CITU COUNCIL COLLENE CAMPBELL VVYDRUG YfE Ur GIL JO HART 1S imonvonnla OIL AROLYN NADH 1776 0 1961 LYN DAVID swEROLw • CITU MANAGER • GEORGE SCARBOROUGH September 29, 1995 Mr. & Mrs. William Bathgate 29643 Camino Capistrano San Juan Capistrano, CA 92675 Re: Renewal of Automobile Liability Certificate of Insurance (Overseer Service - Swanner Prooertvl Dear Mr. & Mrs. Bathgate: The Automobile Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on October 3, 1995. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. Please forward the updated certificate to the City, attention City Clerk's office, by October 13, 1995. If you have any questions, please contact me at(714) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Nancy Bamey, Administrative Services 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171 This form is The Exchange or Comp esionated on the reverse side as number issued by�, A stock insurance company,herein called the company. City and State E E-1136 Named Insured WILLIAM BATHGATE tst Edition PATRICIA SATHGATE ✓r :. 47 15 356 13997 86 37 / y i • (4 I l '' Agent Policy Number Effective 4-3-95 Y f PART 1 CERTIFICATE OF INSURANCE APPLICABLE El APPLICABLE COVERAGE IS INDICATED BY AN"X" LIMITS OF LIABILITY Bodily Injury Liabilityf$ ,000 each person $ 500 ,000 each occurrence X Property Damage Liability 100 ,000 each occurrence Bodily Injury 8 Property Damage Liability $ ,000 each occurrence Personal Injury Protection-Property Protection Insurance(See Endorsement) Comprehensive,Actual Cash Value Less $ 240 Deductible Collision or Upset,Actual Cash Value Less $ 5500 Deductible $ retained limit Umbrella Liability $ each occurrence POUCY NUMBER $ aggregate Description YEAR AND TRADE NAME IDENTIFICATION NUMBER of LAST 3 Equipment 87 TOYOTA T 740 DIGITS SHOWN This certificate is subject to all of the terms, conditions and limitations set forth in the policy(ies) and endorsements attached to it It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previously issued certificates. PART Il ADDITIONAL INSURED ENDORSEMENT ❑ APPLICABLE APPLICABLE M provide the coverages indicated below by an "x", with respect to the above described equipment, to the person or organization named below as an additional insured. This coverage applies only (1) while the named insured is the owner, or has care, custody, or control of the above described equipment, and(2) when liability arises out of the acts and omissions of the named insured. This coverage does not apply (1) where liability arises out of negligence of the additional insured, its agents, or employees, unless the agent or employee is the named insured, or (2) to any detect of material, design or workmanship in any equipment of which the additional insured is the owner, lessor, manufacturer,mortgagee, or beneficiary. Bodily Imury and Property Damage Liability Personal InLury Protection - Property Protection Insurance See Endorsement Comprehensive (including Fire and Theft) Collision or Upset If any court shall interpret this endorsement to provide coverage other than what is stated above, then our limits of liability shall be the limits of bodily injury liability and property damage liabddy specified by any motor vehicle financial responsibility law of the state, province, or territory where the named insured resides, as applicable to the equipment described above. If there is no such law, our limit of liability shall be $5,000 an account of bodily injury sustained by one person In any one occurrence and subject to this provision respecting each person, $10,000 on account of bodily injury sustained by two or more persons In any one occurrence. Our total liability for all damages because of all property damage sustained by one or more persons or organizations as the result of any one occurrence shall not exceed $5,000. The insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attached to it. This endorse- ment does not increase the limits of the policy. Upon cancellation or termination of this policy or policies from any cause we will mail days notice in writing to the otA interest shown below. 324YPASEOOF S �TCAPISTRANO EMPLOYER . SN JN CAP CA 92675 INS tsr EaTaN 7-aa zoo wicitzoo aniNreow osn Countersigned i- A hori ep2eenfative ggg tept FARMERS INSURANCE GROUP OF COMPANIES The following are inter-insurance exchanges sometimes referred to in the certificate, when issued by either of them, as the Company: 1. Farmers Insurance Exchange, 11. Fire Insurance Exchange, Los Angeles, California Los Angeles, California The following are stock companies referred to in the certificate, when issued by any of them, as the Company: 3. Mid-Century Insurance Company *4. Illinois Farmers Insurance Company Los Angeles, California Aurora, Illinois **5. Farmers Insurance Company, Inc. *6. Farmers Insurance Company of Idaho Shawnee Mission, Kansas Pocatello, Idaho *7. Farmers Insurance Company of Arizona *8. Farmers Insurance Company of Washington Phoenix, Arizona Vancouver, Washington *9, Farmers Insurance Company of Oregon Tigard, Oregon *19. Farmers Insurance of Columbus, Inc. Columbus, Ohio * Not licensed or operating in the states of Kansas and Colorado **Not licensed or operating in the state of Colorado Is, The Exchange or ComplWsianated on the reverse side as number____ issued1� � A stock insurance company,herein called the company. City and State E-1136 Named Insured WILLIAM BATHGATE tat Edition PATRICIA BATHGATE 97 15 356 13997 86 38 Agent J Pdwy Number Effective 4'395 PART 1 CERTIFICATE OF INSURANCE APPLICABLE APPLICABLE COVERAGE IS INDICATED BY AN`X" LIMITS OF LIABILITY Bodily Injury LiabilityJ$ ,000 each person X $ 520 ,000 each occurrence Property Damage Liability 1011) ,000 each occurrence Bodily Injury a Property Damage Liability $ ,000 each occurrence Personal Injury Protection-Property Protection Insurance(See Endorsement) Comprehensive,Actual Cash Value Less $ 240 Deductible X Colllskm or Upset,Actual Cash Value Less $ 500 Deductible $ retained limit Umbrella Liability $ each occurrence Poucy NUMBER $ aggregate DescriptionYEAR AND TRADE NAME IDENTIFICATION NUMBER W LAST 3 Equipment 69 FORD PU T 833 SHOWN This certificate is subject to all of the terms, conditions and limitations set forth in the policy(ies) and endorsements attached to it. It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all Previously issued certificates. PART 11 ADDITIONAL INSURED ENDORSEMENT APPLICABLE X NOT APPLICABLE We provide the coverages indicated below by an `x", with respect to the above described equipment, to the person or organization named below as an additional insured. This Coverage applies only (1) while the named insured is the owner, or has care, custody, or control of the above described equipment,and (2) when liability arises out of the acts and omissions of the named insured. This coverage does not apply (1) where liability arises out of negligence of the additional insured, its agents, or employees, unless the agent or employee is the named insured, or (2) to any defect of material, design or workmanship in any equipment of which the additional insured is the owner,lessor,manufacturer, mortgagee, or beneficiary. WIN Iniury and Property Damage Liability Personal Injury Protection - Property Protection Insurance See Endorsement Comprehensive (including Fire and Theft collision or Upset It any court shall interpret this endorsement to provide coverage, other than what is stated above, then our limits of liability shall be the limits of bodily injury (lability and property damage "abihty specified by any motor vehicle financial responsibility law of the state, province, or territory where the named insured resides, as apphcab a to the equipment descnbed above. If there is no such law, our limit of liability shall be $5,000 on account of bodily injury sustained by one person in any ane occurrence and subject to this provision respecting each person, $10,000 on account of bodily Injury sustained by two or more persons In any one occurrence. Our total liability for all damages because of all property damage sustained by one or more persons or organizations as the result of any one occurrence shall not exceed $5,000. The insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attach o it. This endorse- ment does not increase the limits of the policy. i Upon cancellation or termination of this policy or policies from any cause we z rfi s will mail 15 days notice in r. • -w�' � T writing to the other interest shown below. SF SAN � �ISTRANO EWLOYEEPAEO NT SAN ,JUAN CAPISTRANO CA 92675 c�f NS Countersigned 91-11WV3TEDITIONT-eewr200D/1200.NTEpinu SA tl representative &95 FARMERS INSURANCE GROUP OF COMPANIES The following are inter-insurance exchanges sometimes referred to in the certificate, when issued by either of them, as the Company: 1. Farmers Insurance Exchange, 11. Fire Insurance Exchange, Los Angeles, California Los Angeles, California The following are stock companies referred to in the certificate, when issued by any of them, as the Company: 3. Mid-Century Insurance Company *4. Illinois Farmers Insurance Company Los Angeles, California Aurora, Illinois **5. Farmers Insurance Company, Inc. *6. Farmers Insurance Company of Idaho Shawnee Mission, Kansas Pocatello, Idaho *7. Farmers Insurance Company of Arizona *8. Farmers Insurance Company of Washington Phoenix, Arizona Vancouver, Washington *9. Farmers Insurance Company of Oregon Tigard, Oregon -19. Farmers Insurance of Columbus, Inc. Columbus, Ohio Not licensed or operating in the states of Kansas and Colorado **Not licensed or operating in the state of Colorado P,itse 2 eX!IT. M,gn r"IS lnnwui until lite pmkcy applied(Of and culfoolly In UAW 111C is rrIj:,flted irsti-rm, 1pl' 'wanic,,ftl,CA to lite terniti,C ""inions and 111111ilpris Ill fepul appkrd a NnmLer nFECITIFE DATE WILLIAM AND PATRICIA HATHGATE 08-12-94 4'12:01 7 1. ; � . — . ,-- 1! ____ ___ III "W" ., I A'I kthN,ii I 04t I MIT i Wn kit I :TT!f I ArlRrlrr," Y1C11ewM UMn MPW1967 TD eta PU ID* JT4RN7OD6HOl33774D 02-12-95 _A112:D1 .50/5 _6/0�_,_ 5,00 240 To" 500 towing and rental car -3-3 9 3 OPremium F I A�11 _FARMERS INSURANCE EXCHANGE ------- 1311"91 14R)LOM CERTIFICATE, HOLDER 13OX 217 Palt-jillp CITY OF SAN JUAN CAPISTRANO rrdniwN...Vol 32400 PASEO ADELANTO SAN JUAN CAPISTRANO SAN JUAN CAPISTRANO, CA .2 01;TV GlAyt Mal AGENT Ion Immzin, M,Ild in bi-4111d III D all born i fho Elitt0we Pitt,p(PlAtili issuaoim of a poky to the Named lngLwred wIlo in 111i'll,'m xitl%ll.'Ind C Itt III III I,it I,,luntnd nntN va poNcy aprLrd for anduiamnilyin utiolly thmss"ITO in ncvmdam(h I k,i:, "A VIC toil"!lfir... 1. WILLIAM AND PATRICIA BATHGATE—.. x*1 1969 FORD PU IV# F25YRER6833 02-12-95 ISM, vrosod MemFOWN+ ECF, Um li Ar4Nl fioim 5,DO 5 oo SWIM 0/5 /Ib Ix lot. Flit. tovin"pdrental Cdr --- ---- ----- FARMERS INSURANCE EXCHANGE 0 139978638 CERTIFICATE HOLDER insured's Addnt%s_P.O,._.9OX__217 ?"'y"He CITY OF SAN JUAN CAPISTRANO : ""'1 32400 PASRO ADELANTO SAN JUAN, CAPIS-TRANO, CA 92693 SAN JUAN CAPISTRANO, 92693 .-- . SENiA41Yy.- ATE E"NIP 77 0 4?*1 is _�W(, STATE COST AGENT -2de CERTIFICATE OF INSURANCEAPAT6011 CSR DJ 10/04/94 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE H.W.JORDAN & ASSOCIATES INC. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P.O•BOX 139 POLICIES BELOW. LONG BEACH CA 90801 - ------------------------------------------------------------------ PHoNE310/597-6463 COMPANIES AFFORDING COVERAGE ---------------------------------------------------------- ---------------------------------------------------------------------- INSURED COMPANY LETTER A INSURANCE CO.OF NORTH AMERICA ______________________________________________________________________ COMPANY LETTER B William A. Bathgate -------------------------------------------------------------------- Patricia A. Bathgate COMPANY LETTER C BathgateRanch ---------------------------------------------------------------------- 29643 Camino Captistrano COMPANY LETTER D San Juan Capistrano CA 92675 ---------------------------------------------------------------------- COMPANY LETTER E > COVERAGES <:_______________________:__....._.:__ :__..__••__•__:.__...__.._...:.....__. __ ._...__ THIS IS TO CERTIFY THAT 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 MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE DAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED BERRIN IS SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. _________________________________________________________________________________________________________________________________ CO TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTA DATE DATE --- ------------------------------- --------------------------- --------------- -------------- ---------------------------------- GENERAL LIABILITYBODILY INJURY OCC. A [[}����� COMPREHENSIVE FORM FEZD 11497344 B-Farmers 11/26/94 11/26/95 BODILY INJURY AGG. [x] PREMISES/OPERATIONS Comprehensive Personal ------------------- -------------- [ ] UNDERGROUND EXPLOSION Liability Coverages PROP. DAMAGE OCC. & COLLAPSE HAZARD PROP. DAMAGE AGG. [ ] PRODUCTS/COMPLETED OPER. ------------------- -------------- [ ] CONTRACTUAL BI & PD COMB. OCC. 1,000,00 [ ] INDEPENDENT CONTRACTORS BI & PD COMB. AGG. 1,000,00 Iv'] BROAD FORM PROPERTY DAMAGE ___________________ ______________ (X] PERSONAL INJURY PERS. INJURY AGG. 1,000,00 ______________ ___________________________ _______________ ______________ _____________------ ______________ AUTOMOBILE LIAB BODILY INJURY [ ] ARY AUTO (PER PERSON) ------------------- -------------- [ ] ALL OWNED AUTOS (PRIV PASS) BODILY INJURY (PER ACCIDENT) [ ] ALL OWNED AUTOS (OTHER THAN ------------------- -------------- PRIV PASS) PROPERTY [ ] HIRED AUTOS DAMAGE ------------------- -------------- [ ] NON-OWNED AUTOS BODILY INJURY & [ ] GARAGE LIABILITY PROPERTY DAMAGE [ ] COMBINED --- ------------------------------- --------------------------- --------------- -------------- ------------------- -------------- EXCESS LIABILITY EACH OCCURRENCE 2,000,00 A [XI UMBRELLA FORM XPLG15593507-Excl.Med Pay 11/26/94 11/26/95 - - - [ ] OTHER THAN UMBRELLA FORM & Phys.Damage to Property AGGREGATE ___ _______________________________ ___________________________ _______________ ______________ __ ________________ ______________ ISTATUTORY LIMITS WORKERS' COMP EACH ACCIDENT AND DISEASE-POL. LIMIT. EMPLOYERS' LIAB DISEASE-EACH EMP. < --- - - - ------------- -- --- --------------------------- ------------- ------- --------------- OTHER M --------------------------------------------------------------------------------------------------------- -- FP DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Liability Coverage also includes- Damage to property of others @ $06' ea',! occurrence, Med Pay to others @ $1,000 ea.person/$25,000 ea. Accf entU Cancellation Clause 30 days company election - 10 days non payment > CERTIPICATE HOLDER CANCELLATION <_..:__.___:..__.___..___..._.---_....:..i:=...__..__... 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 City of .San Juan Capltstrano = LEFT, UT FAILURE TO MAIL 9UCH NOTICE SHALL IMPOSE NO OBLIGATION OR 32400 Paseo Adelanto = LI TY.OF ANY XI ND N THE COMPANY,ITS AVERTS OR REPRESENTATIVES. San Juan Capitstrano CA 92675 =--- -- -- -------- ----------------------------- ACORD 25 (7/90) RI HARD W JO N JUN 07 94 15:0"4 GIP f �1� 67%99 nOVP9 ,... Tiff CEMY Of INFO, .TM6 CDi71I�ONLY AMD W"o2:.W. JORAND RSSp(SATEB COEB; EJKlEs1llkHALT99T cow AFFOl�Eo;pN'AM PO L P:.0. Sox 1 } I.pN�T BEACH{ QA. O MARAMH S;A fiOR01�lG COVE A6E A AULLIM 4ROOT AICD A , OP:LATgs Tk MOOED. �� EYP'P80r I cauwl . N DIAb1CI_ INREI�fIT_ r PFIL"AM ADI . PATRICIA SAT$GAT F1 ccuPA v4 P:.O. 5OX 217 PAN ,TU,4N C ISTRANO, CA. wu 92675 D .: % l;$1014 GVN TIONS Of SUCH POI.MENT INSURANCE EO Y T"e Pou 1. TFN815 TD GF1iI1PY THE PMyFE( FAICENT,LICMII'I.�<+1'IOWM N0.Y 'r.w,EFm T.'•:f• _.i ,_� .y I A, . , •. __ __ _ED TO PW*9UAE0 NAM ABOVE FOP TNF POLICY PENHID AAL'I Pp UtMItN UUI. NT WITH/1EEPEGT YbriNWtFTMt3 C6NviFICATE MAY 9P tFU OB uAv PENT 4 LIES UE$Cws®nER11 BUDIEC7 YO ALL TNE'rEAU$. .. .. ._ SEE vmvBY PAID CLAN.16. . ..... 1 �... ........ .. I f m•. : 'TTsaePl PQLW 11NNBER Ki&YlywmeM'.1i t BLLlie}Mr,M Y+i }�oex -./A�I A Y4vLR1!6 WNI1T"- j. i HE;4 tf4iBldrT0.' . is . •x G9IINE.RCIAF µ,pyly 4 rr10EW,c oaNlvOP i ,ZA OQ�YO:QD cwr}wae omrA.: G1,64930672¢l94 4l R2/g5 rewuxr�s.sALry s+A/�r _:♦ 1,DD A00 "_ orNl3ra a •�1� uM B.Nmr.: r escal o�c i 1�OD c UO ,i ; . } mcnA�ngst,ypraro rM .y YNN�il1• '•:ODQ "Y AUM ' AUMM9NIF'WlP.NY � j 't'AYI 81N64E $'GLi+eMAEdwroP l- T.B.D:. /,3 9C i' I Lnurr is ! maLrlPuunr ' 12/3/04 u�Pwav . .� �` 2s01�9o. . ;WIQ ADW{)w`F ' I ' _AONC4lNfp�AUT09' I' aNYwe LmewTr ! tttl � marE�x P.v,,nec t s 10 Q r D{!D O ..... $,;uumtF?IA ryoAH XPLG15693507 '.il/ 6J4'3: ;3-j./2{/94u,Iewle, '.2,OD0 OD'0 AMfNY mo I _ .1 EAO�I• wPr,Tr s FAPIME '1M I Y CJ6EAS PaUC:'/l IN t_ 1 .... - l� i !D4x+V . ..noncar Es.,,s QTtw .S usPua!gia'ar � +wlwma.nmarcoy..nrr� I . ,. • 25932 CAeaFNo „,AHISTRANO, SAN JOAN CAP7$1' O; CA.; 92;675 CANC$LtIATION LAUSH 30 DAY COM2ANY BLP.�TI N' .0 4 rioN-eAxrNm CE[t7PXBXCATZ H Ll SitA1L- 8N; NAXZD AS 02 idj{AL I SfTdtED PHp FORM jCG2@101T$5 CITY OP SAN ! AN CAP15TRANO. a l aF MF ABOVE MSCRMW PgLICIEs Be c�.eeELUED N genie S.TiSQJum ,DAPS T&ANU f_,fxl4TJSt.1YY F%P 642 Ti101@C1', TME %SBUW0 OQMPAMf YALE EIiOEAYI:!F{.YCJ uAA _.. .11AYN'WIiTTLa NOBICSTO THE OERTIFIOATI MULDrtt IMMIU-jV.l Kr REA$v87,Op�fEN7'I.AGl;N'CY , ,` , 5Al1 au" CFYp-I'. TRAK9, CA. 92675, +-EEF, su std1.VRE T(1 MALL BiJ44i NmB�IBxatL BrIPO4E Ito 08W,ATV90 Ost . LAMA awit. ,u 711E LONwANr ITS AGCN'FS PA:rRE9ENT!}TS(E$. , JUN 07 '94 1504 GIF P.3 14 : T11 EMonsm to �ItAe�ca s r v.r1 ys a rr'c xutLr. .I , DIT1UNAL,INWRIE : t MlfyEIM LIEPSIE.-R OR. G�N?titAC : 1t5� fFaRM 13) 1 � • ll�,e�ldd'e,I rtptr�JtgdtJks 4liaiiezta Irriw{cGitt ta�rr;1 �+•{rrR � �_: , I _ COO MOICIALGL• E M LIAUN.!IyUovEj 1l00410d t'a as az tltllatJzzAlwk: �' CZ{Y 01 531N JUAAS Qh$IHTRANpD�AI. SAN 3 C"ISJ.'RMU COMKOWITY as IICI�MSNT ACRNCYI d SA 1 J C"ISTRAM>, :CA. 92675f 1� (tftto.grtkX 111Marsalxw,.,i,Arnnialkw�tas<prNritla'' Pk Ia1apofto"asomillwalim4WMI;4a*t*clvMUNI$ i .a3;n�P,11CiN .16 fldF eektopm ..11.) 1m{kJ. AM' S1Nlt lJ t5acl4m tl31s arll�rr ted M kn lre we aj.;lksprNdrll�e'rwrmr Tr argNdzqWt strown.14.Urc jF�IeJtAe.6 M.1y wIN.re5hecl In#i.�hiply arlsh�e¢tl `yaLlr aarl�lot Nall MrstktJ by cx tds XM4 I � 1 F I I I - 1 r III I ' I it ' I ' •i ' ° I � i i _ i,: i . C13.21F11!11 c�t+y.iNi x.t.raolx,►Se fmAlflra,lr��.19114 - 1:{ MEMBERS OF THE CITY COUNCIL GARYL E CAMPBELL GHAUSDORFER IL JON ES CA JON CAROLVN NASH a rmum 1961 JEFF VASOUEZ 1776 CIN MANAGER GEORGE SCARBOROUGH April 12, 1994 Mr. William A. Bathgate P.O. Box 217 San Juan Capistrano, California 92693 Re: Renewal of General Liability and Aumobile Liability of Insurance Services - Swyer Propea)Proneal Dear Mr. Bathgate: The General Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on April 22, 1994 and the Automobile Liability Certificate of Insurance is due to expire on May 16, 1994. In accordance with your agreement,the insurance certificates need 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 the above expiration dates. If you have any questions, please contact me at(714) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Nancy Barney, Administrative Assistant 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 0 (714) 499-1171 +ERTIFICATE OF INSURANCE � 02/28/94 This certificate is issue s a matter of informatio ly and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies listed below. PRODUCER C Letter A INA H.W. JORDAN AND ASSOCIATES O P.O. BOX 139 M Letter B WILLIAM BROWN AND ASSOICATES LONG BEACH,CA. P SCOTTSDALE A Letter C UNITED PACIFIC INSURED N I Letter D William & Patricia Bathgate E P.O. Box 217 S Letter E S.J. Capistrano, CA 92693 This is to certify that 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. -----------------------------------COVERAGES------------------------------------ Cc Type of Policy # Policy Policy Limits Ltr Insurance Effective Expiration ---- GENERAL LIABILITY --------------------------------------------------------- A ( ) Commercial GL GLS493867 04/22/93 04/22/94 Gen Aggreg $1000000 ( ) ( ) Claims Made Prd-C/Op Ag$1000000 (X) Occurrence Pers/Adv In$1000000 ( ) Owners & Contr Each Occur $1000000 ( ) Fire Damag $50000 ( ) Medical Ex $5000 ---- AUTOMOBILE LIABILITY ------------------------------------------------------ ( ) Any Auto CSL $ ( ) All Owned B. I ./Pers $ C (X) Scheduled AUS29541802 11/16/93 05/16/94 B.I./Accid $ ( ) Hired P. D. $ ( ) Non-Owned ( ) Garage Liab ---- EXCESS LIABILITY ---------------------------------------------- - B (X) Umbrella Form XPLG15593507 11/26/93 11/26/94 Each OccurAggregate ( ) O.T. Umbrella 2, 000, 000 $2 ,000, 000 ---- WORKERS COMPENSATION ------------------------------------------------------ W.C. STATUTORY Employers Liab. Each Accid $ Dis/Policy $ Dis/Employ $ ---- OTHER --------------------------------------------------------------------- -------------------------------------------------------------------------------- DESCRIPTION OF Operations/Locations/Vehicles/Special Items 29932 CAMINO CAPISTRANO, SAN JUAN CAPISTRANO, CA. 92675 CANCELLATION CLAUSE 30 DAY COMPANY ELECTION 10 DAY NON-PAYMENT CERTIFICATE HOLDER SHALL BE NAMED AS ADDITIONAL INSURED 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 below but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. NAME and ADDRESS of CERTIFICATE HOLDER CITY OF SAN JUAN CAPISTRANO i SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY --`---1 020 SAN JUAN CAPISTRANO, CA. 92675 uthor a Representative •^ERTIFICATE OF INSURANCE MAR p 7 1994 02/28/94 This certificate is issueTas a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies listed below. PRODUC-SR C Letter A INA H.W. JORDAN AND ASSOCIATES 0 P.O. BOX 139 M Letter B WILLIAM BROWN AND ASSOICATES LONG BEACH,CA. P SCOTTSDALE A Letter C UNITED PACIFIC INSURED N William & Patricia Bathgate E I Letter D P.Q. Box 217 S Letter E (r . S.J. Capistrano, CA 92693 cr This is to certify that 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. ---------------------------------------COVERAGES--__-...--._--.--_.__._.____ -_______._•-._-____-- Co Type of Policy # Policy Policy Limits Ltr Insurance Effective Expiration ---- GENERAL LIABILITY --------------------------------------------------------- A ( ) Commercial GL GLS493867 04/22/93 04/22/94 Gen Aggreg $1000000 ( ) ( ) Claims Made Prd-C/Op Ag$1000000 (X)Occurrence Pers/Adv In$1000000 ( ) Owners & Contr Each Occur $1000000 ( ) Fire Damag $50000 ( ) Medical Ex $5000 ---- AUTOMOBILE LIABILITY ------------------------------------------------------ ( ) Any Auto CSL $ ( ) All Owned B. I./Pers $ C (X) Scheduled AU829541802 11/16/93 05/16/94 B. I./Accid $ ( ) Hired P.D. $ ( ) Non-Owned ( ) Garage Liab ---- EXCESS LIABILITY ---------------------------------------------------------- B (X) Umbrella Form XPLG15593507 11/26/93 11/26/94 Each Occur Aggregate ( ) O.T. Umbrella 2, 000,000 $2,000,000 ---- WORKERS COMPENSATION -----------•------------------------------------------- W.C. STATUTORY Employers Liab. Each Accid $ Dis/Policy $ Dis/Employ $ ---- OTHER --------------------------------------------------------------------- -------------------------------------------------------------------------------- DESCRIPTION OF Operations/Locations/Vehicles/Special Items 29932 CAMINO CAPISTRANO, SAN JUAN CAPISTRANO, CA. 92675 CANCELLATION CLAUSE 30 DAY COMPANY ELECTION 10 DAY NON-PAYMENT CERTIFICATE HOLDER SHALL BE NAMED AS ADDITIONAL INSURED 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 below but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. NAME and ADDRESS of CERTIFICATE HOLDER CITY OF SAN JUAN CAPISTRANO SAN JUAN CAPISTRANO COMMUNITY REDEVELOPMENT AGENCY 020 SAN JUAN CAPISTRANO, CA. 92675 Autnopzea Representative AU 8295418 02 AGENTS COPY SACR mw PERSONAL AUTO POLICY Reliance UNITED PACIFIC INS. CO. RENEWAL DECLARATION Unlfed Pacific Insurance Company Philadelphla, PA PREMIUM WILL BE PAID BY THE INSURED PAGE I OF 2 POLICY NUMBER POLICY PERIOD AGENCY NUMBER 16, AU 8295418 02 1993 0593396 00 FROM: Nov TO: MAY j6, 1994 NAME OF INSURED AND ADDRESS AGENCY NAME AND ADDRESS 10/17/93 BATHGATE, WILLIAM A. WALL GENERAL INSURANCE AGENCY 34000 VIA DE AGUA PO BOX 217 SAN JUAN CAPISTRANO, CA SAN JUAN CAPISTRANO, CA, 92693 92675 ACCOUNT #920400578500-AB PHONE: 714-661-2201 VEHICLES COVERED VEH ST BAND YR MAKE-MODEL SERIAL NUMBER SYM CLASS ST AM CHG DATE 001 CA 4512 69 FORD PU F25YRE26833 06 892400 11/16/93 002 CA 4512 87 TOYT XTRACAB LON JT4RN70D6H003I740 10 809500 11/16/93 INSURANCE IS PROVIDED WHERE A PREMIUM IS SHOWN FOR THE COVERAGE FROM THE EFFECTIVE DATE TO THE EXPIRATION DATE AT 12:01 A.M. STANDARD TIME LL COVERAGE LIMITS OF LIABILITY PREMIUMS VENN 1 2 PART A BODILY INJURY-PROPERTY DAMAGE $500,000 EACH ACCIDENT 256.00 256.00 PROPERTY DAMAGE $ 10,000 EACH ACCIDENT 42.00 42.00 PART B MEDICAL PAYMENTS $5,000 EACH PERSON 21 .00 21 .00 PART C UNINSURED MOTORIST COVERAGE BODILY INJURY $500,000 EACH ACCIDENT 65-00 65-00 UNINSURED MOTORIST PROPERTY DAMAGE LIMIT $3,500 6.00 PART D DAMAGE TO YOUR AUTO am OTHER THAN COLLISION LOSS ACV MINUS $250 DED. 27 -00 111121111 COLLISION LOSS ACV MINUS $500 DED. 78-00 sz—Z TOTAL BY VEH# 390-00 489.00 TOTAL TERM PREMIUM $879-00 DRIVER ID DRIVER NAME LICENSE NUMBER BIRTH DATE 01 WILLIAM A BATHGATE Y0977189 01/04/25 02 PATRICIA A BATHGATE F0074109 03117132 o 21 IF.N T V ­ .�..... .......... AU 8295418 02 AGLNIS COPY SACH PERSONAL AUTO POLICY ®Reliance UNITED PACIFIC INS. CO. RENEWAL DECLARATION United PRCIIIC Insurance comany Philadelphia, PA PREMIUM WILL BE PAID BY THE INSURED PAGE 2 OF 2 POLICY NUMBER POLICY PERIOD AGENCY NUMBER AU 8295418 02 FROM: NOV 16, 1993 TO: MAY 16, 1994 0593396 00 NAME OF INSURED AND ADDRESS AGENCY NAME AND ADDRESS 10/17/93 BATHGATE, WILLIAM A. WALL GENERAL INSURANCE AGENCY 34000 VIA BE AQUA PO BOX 217 SAN JUAN CAPISTRANO, CA SAN JUAN CAPISTRANO, CA. 92693 92675 APPLICABLE FORMS FORM # DATE VEH# FORM # DATE VEH# FORM # DATE VEH# FORM # DATE VEH# wiP6913 01/79 ALL AUT2273 08/85 ALL AUT2284 06/79 ALL AUT2570 08/85 001 AUT2570 08/85 002 BEAR POLICYHOLDER, THANK YOU FOR YOUR BUSINESS. IF YOU HAVE ANY QUESTIONS REGARDING YOUR POLICY, PLEASE CONTACT YOUR AGENT. .......... ....... 1776 I BOA um 1161 It FACSIMILE TRANSMISSION RAtM FAX Nurnber 714/493-1053 <:UMPANYs 'T t S . .G: a f A f14: X_ ..!:•. ., b fr FROM! -t � eL.r:c': . 'C.4.r.c.. .., I-WPARTMENT3 DAIEt _._._._ %':1/c�i ._.. NumnuR ot; PA(it_S: (including thi% form) CONTENTS OF fRAMSMITTAL •4'�"?.v.'<.,t.w G<. -° /-•. o./_.+ n;. ; 7.% r - (.OMMf:Nl'S; it t Y NOTICL Mont laf.4imllr t7)at'him,-. pro,tucr` CoI71e5 On then Ti f q,� r. Prior- liYHoB prUtiu-6 1' .•lighll onstnble and will iptvrioi me significantly in a .,,ray ;bort p^rio'1 of titn It the ar:r:ompnllying (to(tim-1 It •:CYltain5 :illth0(17„%)fitOnr JT nth,tIrllpor't )rlt inf)rrlmi) )lt, •;on rhooll hp >.anrt• that lhi: iifcrma:ion might be IUSt to +,t,'ri,,tation in the fttllte. t{'n ;vill IOvw_ d 'h1` originzl dgcumcnis t0 you by m,)il for your fin^, — We it•(onnnenrf you photOCOpy (using a plain paper ropirr) thn followin riot-Irn,•nts and plal:e Ow, photocopi's in your files, not flu! f.11cisi17111, ]D 4Ol7 nn of t\ n0rr +1) t•., ^.Arl IIIA It C + nr^- 'MA`//` It In 111.1 .101. ♦ r1I + 1 ant ,1"I r r - 1 / ,,} ". �iit�...✓.�C<_ ; G�/ f:i.t..�.f-r.LP r.i.r.l�4_.: -_ny,.c�.{r :?..I,.,•1 ,: _. i J i7 c (J (l JIN '51 v' V C r Yf y7^ � • LJAMLITY ENDOtZSFMENf . CITY or SAN JUAN C;AFISMANO COMMUNITY REDEVELOPMENT AGENCY 32400 Paseo Adelanto San .JcnCapistrtsm, f:aliforrrfa 9)Pf+77 ATl'N: \. POLICY„INI'ORMATION En<lorac im+t I I. Insurance .o"11pallyy Number 2• policy' Term (From) !3atn 3. Named Insured h. Address of Varfte�4Tnsure� . .--- 1. ( knit ,)( Liability Any OneJccurrcrxeTcSp,gr”$ateFi ..__ ._. _ ._ ---.__.. . ,.!--. General Liability Aggregate (check Diet) Applies "per location/project" lc. twi^_e the or:rurrenre limit r,. Deductible or Self-Insurr.d Retention (Nil unless other• ke ;pe<:ifind`: �- 7. Coverage is equivalent tot t.oniprehenslve Central Liability firm (il-0001 (f-d 1113) _ ofninercial General Liability "clairns-+r,3da" form C(r OtlQ1. 3. Bodily Injur ) aryl Property Damage! C:oveTags ist '.claims-made' '+oc:cur re nce" If Cisims-made. the retroactive cfatir is B. POLICY AMENDMENTS This ondortentanr is issued in consid+xatinn of the policy premium. Nnt .vithstarrlirig any staternent in the policy to which this endorsement is attacIw.d or any ether elrtnr;rrn.nt a±+. t- thereto, it is agreed as follow" 1, INSURf?D. The City and the Community Redevelopment Agrly-y, its nl<cte--f nr ac ;+- offJceri, officials, employets and volunt P-ery aro inchlded Ai iriv.010A, xith rPvrd to JIA'M..t''" and d+tense of claims arising frornt (a) activitles performed by ar on behalf of t'- c Inxured, (h) prcxhJr_t-t and completed operations of tho NArned Insured, or (r) per uls ; .,:• , leased of used by tbo Named lnstared. s_ orrinav+/Ttnn1 ober nonrttOpn A., r-tnsrtst (A1 work ne!r'fornyed by the NAtn—:i for or nn behalf of the Cftyi c)r (b) praJucts sotd 13y th:t Plarntd Insu,*:(5 tr> too c_ tt'; )t prrmisr< leased bvthe Named Insured from trip City, ttr, Insurance atfnrded by t'ii^ r )1; ih,01 hr prirnAry insttrary:e as rexper_ts the City, its eitct*-1 or appointed ntflc-RrR, •,fr; employees or volunteers; or stand In an unbrckan rhAn of c;nvorngr nxcc ; of the Mari, lnsuroffs snccduled underlying primary coverage. In eithttr evont, any other ir:u, nri - rnaintainad by the City, its elftted or apppointed nfflcars, offiriats, cmlAry�rs `ar ,•:i�,,. sh -If je in exc�rss of this Insuranro serf shaJI not rarttrih+rte +pith it. ( JVCR) 7. St;QRE or r.U/FRA�.E. This policy, if primary, affords c:overago 3t !i? j,,! (U Insur3rv:+ irrviren Ullire lram nutnhrr I . QQr)Z 0:,;I. ..„• 1'. . • Liability Insurance and Insurance irrvice.i 0(fire form nunth^r c,i. <ornp;^h^,nsivc C,rnKai `,iAbility endors9tpent; or l Ilr; nnur ;rr vi. ns >ifi, r i',mnullutl r�ru tl I n"ilii , ,, 1{ Ilrnil ill I'll-" I ( !) !1 iffill '1'. '.V-I:lge a,hoII It If .I •, .t•. fn ril Ii i !, n ::.u . : . forrns re.ferenc •:,1 in the preceding sections ( 1) .u<l 4. SEVEPAIBITATY or INTPp.F.Sr. The inalr3rre afrnrrl'-d by thin, heli,:.. alrn(i•e: :^.'C+Ir lr each insuted vho Is ;eoking cove.t'age or against whom AtaA itrl l5 "I 1 'r Ii'. except with r2cpeCt to th? Company's limit of liability. 3. PROVIS(ONS REGARD114G THF. INSURF.015 UUTIES APTT'rR At:GiDf.NT OR failure to cofnply vith reporting provisions of the policy shall not Of--t to the City rttA thf 7,omrnunity Redevelopment AgostN,y, itt »{*ct*%1 , . :.t31;;,j 1(r.l "I' '; , of ficiak, employees or volunteers. A. CANCEht.A'TIQN No1I<a?. The insurance ;afforded iay this pnliri-r shall of ':,F ,;r.• •'. voided, �!alKelled, reduced In coverage or in limits except after thirty r?ni days' i,rl?r :,, i: ;•: notice by certified mail return receipt requestfd hnit hcen given to shall l:,e. 30die.ssed as shown in the heading of thin en+,inrsrin'!lit. C- RfCLDELHT Atdla CLAlh RGFc RTICaC. [`I 0CIEDURL Incidents and d3iavt are to he reported to the insurer au A Milt greet AddreisS'� -- m-. ---- of e O. SIGNATURE UP INSURER OR AU'rHOW4D FtR:EZNTA-nYE Of TEft INSURER ►, (print/type narne), warrant that i ha.v+t euthW-ty to hiryl the insurance companyAr'KJ bymy slgnature hereon do so bind thli compaIny, fTCiFjX�IJ Cl��lF1 ] �J 1� _ �Y (nrigirltl signature required on er,.Aersement furni.�hnd in th+ Clty) (-W*W I ZAr ir'N: T I TLE: N't'PF_SS: _.._--------- rY�F.t•11TE.: -C__�_. .. - ( MRR 10 '94 1226 GIR P.2/2 • I I i (MAR 01994 cm iFRAL INSURANCE A6 C� 44000 V N M AGUA-Wq JVAw<AiISTRAwq CJS 1 UP M .. li i March j 0, 1994 O±ticc� ot the City clerk City a San Juan Capistrano JI I 32400 ase* Adelanto San Jut Capistrano, CA 92675 I .- Re: Liability Endorsement - Wi,p,'i &. Patri.c,ia uthgate The City of San Juan Ca latrans la! vile cijY of San Juan Ca iat ano -Comms it Re evelo men A - ;are liate a4. Addi:ti nal Insured under Genera; !L ab ISty;paSicy #GL5491807. . i khORda. C9nei[a '- WALL GJNERAL I1950RA2iCY 'dtCsBPCY i. j 1 � j I i l i 1 ` i 1 MEMBERS OF THE CITY COUNCIL A COLLENE CAMPBELL /Jl GARY L.HAUSDORFER GIL JONES If Ly mf11Ie1�III CAROLYN NASH Est"Is'" 1961 JEFF VASQUEZ 1776 • • CITY MANAGER / GEORGE SCARBOROUGH December 30, 1993 Mr. & Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, CA 92693 Re: Renewal of Automobile Liability and Submittal of General Liability Endorsement Form (Overseer Services - Swanner Property) Dear Mr. & Mrs. Bathgate: The Automobile Certificate of Insurance, regarding the above- referenced service, expired on November 16, 1993 . In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. The agreement also requires a general liability endorsement form naming the City of San Juan Capistrano as an additional insured. I have included one of the City approved endorsement forms to submit to your insurance company; however, your insurance company may provide their own endorsement form. Please forward the updated certificate and the endorsement form to the City, attention City Clerk's office, by January 17, 1994. If you have any questions, please contact me at (714) 493-1171 extension 243. Thank you for your cooperation. VVeenry, 'truly yours, Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Nancy Barney, Administrative Assistant 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 0 (714) 4931171 • CERTIFICATE OF INSURANCE 09/01/93 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 by the policies listed below. PRODUCER C Letter A I.N.A O cn H.W. JORDAN AND ASSOCIATES M Letter B WILLIAM BROWN AND 4SSOCIATES P.O. BOX 139 � . - P = N LONG BEACH CA ` ��• " A Letter C `JD INSURED N p. m i' - I Letter D William & Patricia Bathgate E My `m P.O. Box 217 S Letter E S.J. Capistrano, CA 92693 This in to certify that policies of insurance listed below have beensued to the insured named above for the policy period indicated. Notwithstan ing 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. -----------------------------------COVERAGES------------------------------------ Co Type of Policy # Policy Policy Limits Ltr Insurance Effective Expiration ---- GENERAL LIABILITY ---------------------------------------------------------- B (X Commercial GL GLZ493867 04/22/93 04/22/94 Gen Aggreg $1000 ( ( ) Claims Made Prd-C/Op Ag$1000 (X)Occurrence Pers/Adv In$1000 ( ) owners & Contr Each Occur $1000 ( ) Fire Damag $50 ( ) Medical Ex $5 ---- AUTOMOBILE LIABILITY ------------------------------------------------------ ( ) Any Auto CSL $ ( ) All owned H.I./Pers $ (X) Scheduled AU829541801 05/16/93 11/16/93 BB.II./Accid $ Hired ( ) Non-owned ( ) Garage Liab - EXCESS LIABILITY ---------------------------------------------------------- A (X) Umbrella Form XPLG14534659 11/26/92 11/26/93 Each Occur Aggregate ( ) O.T. Umbrella 2 ,000,000 $2,000,000 ---- WORKERS COMPENSATION --------------------------------- ------------ W.C. STATUTORY Employers Liab. Each Accid $ Dis/Policy $ Dia/Employ $ ---- OTHER --------------------------------------------------------------------- -------------------------------------------------------------------------------- DESCRIPTION OF operations/Locations/Vehicles/Special Items 29932 CAMINO CAPISTRANO, SAN JUAN CAPISTRANO, CA. 92675 CANCELLATION CLAUSE: 30 DAY COMPANY ELECTION 10 DAY NON-PAYMENT COPY OF AUTO POLICY ATTACHED 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 below but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. NAME and ADDRESS of CERTIFICATE HOLDER CITY OF SAN JUAN CAPISTRANO 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 -` 020 u oriz esen ve AU 8295418 Ol AGENTS COPY IRVINE PERSONAL AUTO POLICY ® Reliance UNITED PACIFIC IHS. CO. RENEWAL DECLARATION Untied PsolOo lnsursnos Company PREMIUM WILL BE PAID BY THE INSURED y Phlledelphle, PARECEIVED APR 2 6 1993 PAGE 1 OF 2 a 8 ppLICY NUA119i pOli>:Y pKamAq$NG`Y N4iME1lq $ °? AU 8295418 01 FROM: MAY 16, 1993 TO. NOV 16, 1993 0593396 00 Nr<ME Cif �NSUREp ANd AdDRSS AGENCY NAJI AND J111D�tE55 ;< b4I1gI,53 BATHGATE, WILLIAM A. WALL GENERALA NSURANCE AGENCY 34000 VIA DE AGUA PO BOX 217 SAN JUAN CAPISTRANO, CA SAN JUAN CAPISTRANO, CA. 92693 92675 N ACCOUNT #920400578500-AB PHONE: 714-661-2201 VEHICLES COVERED VEH ST BAND YR MAKE-MODEL SERIAL NUMBER SYM CLASS ST AM CHG DATE 001 CA 4512 69 FORD PU F25YRE26833 06 892400 05/16/93 002 CA 4512 87 TOYT XTRACAB LON JT4RN7OD6H0031740 10 809500 05/16/93 INSURANCE IS PROVIDED WHERE A PREMIUM IS SHOWN FOR THE COVERAGE FROM THE EFFECTIVE DATE TO THE EXPIRATION DATE AT 12:01 A.M. STANDARD TIME COVERAGE LIMITS OF LIABILITY PREMIUMS VEH# 1 2 PART A BODILY INJURY-PROPERTY DAMAGE $500,000 EACH ACCIDENT 256.00 256.00 PROPERTY DAMAGE $10,000 EACH ACCIDENT 42.00 42.00 PART B s MEDICAL PAYMENTS $5,000 EACH PERSON 21 .00 21 .00 PART C ® UNINSURED MOTORIST COVERAGE ® BODILY INJURY $500,000 EACH ACCIDENT 65.00 65.00 UNINSURED MOTORIST PROPERTY DAMAGE LIMIT $3.500 6.00 ® PART D ® DAMAGE TO YOUR AUTO OTHER THAN COLLISION LOSS ACV MINUS $250 DED. 27.00 COLLISION LOSS ACV MINUS $500 DED. 78.00 ® TOTAL BY VEH# 390.00 489.00 TOTAL TERM PREMIUM $879.00 DRIVER ID DRIVER NAME LICENSE NUMBER BIRTH DATE 01 WILLIAM A BATHGATE Y0977189 01/04/25 02 PATRICIA A BATHGATE F0074109 03/17/32 ENTEREDMAY 1 8 1993 i� 7� i�•�a moi., � _ r.is� j MAR I 1 199J GENERAL INSURANCE AGE$CY ,4000 4 j AKM•F'AN V-"CAMMMCF,CA')W% (A F W- Nn I 1 i►alt:i `aia�aae-171.8 UM, Cc oC PA=tgl TO 1 � I • I !lffttttelttliffltteleeltse!!Rf!lfff!!••!A! rt•ltetttte!lttet j ss i f t /Jia. n F 3 x �✓� I • r t • t • t • • • e t ::t t t • • • t • r • r • r. r r • The information contained Tindiviftal fecsiU10 in confidebtial and intended solely for the use of tl or antfty naFMd above. It the reader of the message is intended recipient, yon are hsxsby notified that any dissss, distributionR Copying os usautboriaed use of this 000uns strictly prohibited. If you have received this facsimile inplease notifyVthe sender immediately by tplapno". and rIaesisile to the sender at the above address via the UnitePostal Service. 'shank you. 313 �vv-6L lrnilllon /-1dA���on� lv�su�edi �ti.,dovse�m��11' Cffit?IPIC112B OR 02/01/93 Tb&* cartilioata issued as a setter. of inlaszsatSau only fend confers no rights the olsxtit holder. Thia cantiP cats does not amend, extend or alter t ' coverage afforded by the policies Listed-b"OV. C Iwt r A : SDA N:W.JORDIili I116DRAIiCB X . Later B 8,0, 7i0Y 119 P LOM WCACY, CA. 90501 A I&Ater C I]IAORRD N I : Letter D Isiliiam i Patricia batbgate E i P:O, Sax 217 9 r 8 -- IB.A. Capistrano, CA 98693 TWO in to cartiiy that policies of inisargpci list": below have bwm issued to wured Amsed above for tbs policy. ipd i Dicmted. Nptvithgtandisg spy r t, tars or condition of any meet or:other document with respect tniob this certificate may lvs ismuad o;, may pertain, thwinsurance afforded by ehe polio Lee deeori]bow hsreIn is egbyeFct to all the teras, exclaniona and conditions o! snob policies. Limita ahowp sap have been reduced by paid claiaa. -..�-__r_NN--_r-M__N-N_ NNNMVIOfI:fY NNMsaMyNw I Policy i B�-T;"estlayiva �isation z.isiu i A� (X commercial GL OFL GG altih19A ' +3q/92 03/30/93 ea 81,004,000 Dm ( ) ( )ClaiMade I Prd�Ag41,000,000 jX)Occurraoca wI Pers/idv In31,000,000 i ( OfRleDes i Caaitr Each 000th $1,000,000 (( ) Fire Daae q $0,000 Medicals Ix 5 •.•+y-- AUTONDNF.L= ZIABILITY -_—•--___-�___�_r-� .._ __.�._«_ ( ) AnY Auto i CSL �$ ( ) Eli Oma A.I./Pers b (( ) Sabaduled B.I./Apeid $ f .( ) Hired p,D. S ( )Q�/G�a��xags ib �p MICM LIABILITY JX) Umbrella Fcrm ]PL6145346891 /26/92 :11,/26/93 $sob occurAggxaoate O.T. Umbrella 2,000,000 $2,000,000 --�- MMS C01@SNg�i,Tl�( -____�__��__ ---__ —�- _ >iWOyers Limb. I TAlfT' mi $ Dis/Yoliiay 8 Dis/Nayloy S .N MOCMMDN OF operations/Locati=o/vohicXao/8pw al iteme CAHCXWATION CLWSH 30 DAY CGI hnA ELPMION it DAY DM FAYOK I $Si ATTACMW FM AUM LIABILITY PANCEL aTTCN: should any of the ,eba�ra described policies be cane llwd before the expiration date thereof, the isanixg aoapanI Will endeavor to mail 30 days written notice to the Cantu Cate bolder named below but failure to sail mach ngtic} shaYl' impose no obligation or liability of any kind upon tba cony, its agents orirepresentatives. . R111R and ADDP M of CAR'Y'ID"TC4.TE H07A�. � CITY OP "N JDAN CAPIdMUM i 32400 PASNO ADiL11R'O j 9EN JUM C"ISTRADID, CE. 92675 022 FAO 493-sog3 a"�eA afiva i i i MaR 1 10!29 G1,- avlN , PERSOM A 0 PK I� UN17ED:PAC FIC iWS. 0.' NEW DEGLAR TION. NM1MUV Y��C�y way,yAl, PREMIUM Mt 'L_ BE PIlO BY`THE INS1RtE0 PAGE I OF 2 1 Au 8195418 00 L3LOBt NOV 16. 1992 TO. MAY, 16, 1993 0593396 00 - I BATHGATE. VILL)AM A. CENRAL: INSURAKE AGENCY ., P 0201'6010' PO BOA 217 MDSSION:VIEJO, ;A " SAN JUAN CAPISTRANO. CA. j ' 92693 98690 + I ACCOUNT /920400578500^A6 I FMIOMEs 714-41-2201 i VENICLES COVERtD E I VEH ST BAND YR MARE-ADDEL SFRIA� WUMOCR SYR CLASS ST!AM CHIS DATE } . 001 CA Wilt 69 FORD PU 125YRF26633 06 . 992400 11/16/93 002 CA 451I BY TOY7 ATRACAB LON Ji4RN006M ylj40 10 409500 11/16/92 INSURANCE IS PROVIDED WHERE A PREMIUM ISPSN04M P01j THE COVERASE FROM THE i EFFECTIVE DATE TO THE EXPIRATION DATE AT 53101 A.M. STANDARD Tine .. n COVERAGE .LIRITS Of LIA4 Ll TY PREMi UIi . VENT I 1 2 PANT A + ROOILY INJURY-PROPERTY BAMAGE 5500.000 �ACN ACCIDENT 256.110 256:00 PROPERTY DAMIISE S10.00D EpCN ACCWNT 42." 42.00 aA PART B } . MEDICAL PAYMINTS $$.900 EAFN' PERSCM ! 21." 21.00 PMT C OIINSUR►Jl MOTORIST COVERAGE ! i BODILY INJURY $ 500.000 EA em ACCIQENT' 65.?o 65:00 i UNINSURED MOTORIST PROPERTY DAMAGE LIMIT: $3,PC6.Q0 PART ft I DAMAGE TO YOUR AUTO OTHER THAN COLLISION LOSS ACV MIND :S¢¢0 DED: 27:00 COLLISLON LOSS ACV RINUSsl $50.0 DEO: 78;00 I OTAL LIY VENN. 790.00 489;00 E� 70TAL TEAM IRERIUM $819.00 DRIVER IR DRIVER NAME L�CEYSE NLSIBER: 41RTN DATE � . 91 WILLIAM A BATHOATE Yp977.189 i 01/04/1 02 PATRICIA A BATHGATE i F 4109 . 103/17/31 I i MEMBERS 000L E CITY COUNCIL J CARYL. AUSDORCAMPBELL GIL JON HAUSDORFER muuounl CA JONES ® ' JEFF VANNASR 151776 1961 JEFF VASOUEZ 1776 CITY MANAGER GEORGE SCARBOROUGH September 10, 1993 Mr. and Mrs. William Bathgate P. O. Box 217 San Juan Capistrano, CA 92693 Re: Agreement for Overseer Services - Swanner Property Dear Bill and Pat: This week it was brought to my attention that you did not receive an executed copy of the Agreement For Overseer Services. A fully-executed copy of the Agreement is enclosed for your files. Please accept my apologies for this oversight. Our City Clerk's Office has not received original copies (received faxed copies) of the insurance required under Item No. 7 of the Agreement. Item No. 7 also requires that an endorsement is to be provided establishing that the City has been legally added as an additional insured to the insurance policies required by the Agreement. The City's Liability Endorsement form is enclosed for your use. Pat spoke to my secretary, Diane, earlier this week and stated she would bring in these documents early next week. If you have any questions regarding insurance, please contact Dawn Schanderl, in our City Clerk's Office. Thank you both for your patience and cooperation in this matter. Sincerely, 4e rou ita r GS: Enclosures 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 0 (714) 498.1171 STRANO pun a �: 12ss2 32400 PASE(&ELANTO • No.! SAN JUAN CAPIS NO, CA 92675 - THIS LL INVOICES,MUSPA PPEAKING SLIPS. (714) 493-1171 PACKAGES AND CORRESPONDENCE SMpTO: Above Unless shown Otherwise MOW V'"dOf Willies 5athaate P.O. Boz 217 San Juan Capistrano, CA. 92693 `f DATE ORDERED DATE REQUIRED CONRRMBie TO: 00 NOT OUPk CAM VENDOR TELEPIWIE VENDOR NO. YE$ NO 8/ 1219 I 3 ACCOUNT NO. DEPARTMENT PURCHASING CONTACT F.O.B.POINT 32-62134-4500 Scanner Nancy Barney uNn JMCt: JLYGUIff i Overseer services - Scanner Property July 1, 1993 thru June 30, 1994 (per attached ajreesent) . S700/20 $8,400. 00 i I 1y V . 1 F S L � I .. PLEASE SIGN AND RETURN ACKNOWLEDGEMENT COPY SALES TAX NOTE ANY CHANGES IN SPECIFICATIONS OR DELIVERY SCHEDULES TERMS AND CONDITIONS SHIPPINGIOEIJVERY I) IF DELIVERY CANNOT BE MADE ON DATE SPECIFIED ADVISE PURCHASING DIV.AT ONCE. 2) MAIL INVOICES IN DUPLICATE IMMEDIATELY AFTER DELIVERY TO CITY OF SJC,SJC,CALIF. I 3) INVOICES MUST BE ITEMIZED,STATING PRICE AND AMOUNT OF EACH ITEM. 4) ENCLOSE PACKING SLIP WITH EVERY SHIPMENT. TOTAL ORDER S 8 4 O O O O 5) TRANSPORTATION CHARGES MUST BE PREPAID IF QUOTED FO.B.SHIPPING POINT,ATTACH ORIGINAL RECEIPTED FREIGHT BILL TO INVOICE. 8) SALES TAX WILL BE PAID BUT MUST BE SHOWN SEPARATELY.THE CITY IS EXEMPT FROM FED-EXCISE TAX. 7) CITY OF SJC DESIRES TO PAY ALL BILLS PROMPTLY.HOWEVER CLAIMS CANNOT BE PAID UNLESS OR J/ UNTIL THE VENDOR COMPLIES IN FULL WITH ALL INSTRUCTIONS HEREON. �— f 8) NO DELIVERIES WILL BE ACCEPTED WITHOUT PURCHASE ORDER NUMBER AND/OR PROPERLYAPPROVED. 9) ALL MATERIAL FURNISHED IN THIS PURCHASE ORDER WALL BE SUBJECT TO TEST AND INSPECTION. PJRgI AGENiIOENTY ACCOUNTING COPY P(1RC)IAS j; REQUISITION NAMES AND ADDRESSES OF VENDORS CONTACTED A W,14.1A1), 3A7H Cffrc_ / ?0 —RCA ;216CSV-/SST a/ 3 e/ Jus+u CApiS Pf}W &o9-92-6 4 3 1 and Acct• Dept/Div # Cost Center Detail B dol Futwks Available p, � C Delivery Address Quantity/ p Unit Description Unit Prior Total B C i' Unit Price Total Unit Price Total C✓F s see v c FS - � oo rlo � 8�•c� _ y / f993 fh ew SUNS 30, (4a4 �z f�77",9CfffD 6.e�s a,F,�rT� �-ROtl SlEVFRS G)mpuler Description(30 spaces) Sub total �85fCn,00 GVfKS£.EK 52V - 6,elsiNn/e1� ��P. Sales T= Shipping TOTAL I �$yoO.CO Lmrrii- 2,!-Y DAIM i nn xr imm) Dnllr APPR WE UAII? AGREEMENT FOR OVERSEER SERVICES CITY OF SAN JUAN CAPISTRANO SWANNER PROPERTY This Agreement is made as of the first day of July, 1993, between the City of San Juan Capistrano ("City") and William A. Bathgate ("Bathgate") . RECITATIONS OF FACT A. On or about May 28, 1992, the City acquired certain property described in Exhibit A ("Swanner Property") for open space and agricultural purposes. B. Bathgate has farmed adjacent land and has first-hand knowledge of the land, the crops and facilities comprising the Swanner Property. C. Bathgate has, as a matter of fact, managed and overseen the Swanner Property since its acquisition by the City. D. City desires to have Bathgate continue as manager and overseer of the Swanner Property. NOW, THEREFOREO IN CONSIDERATION OF THE PREMISES, City hereby hires Contractor, as an Independent Contractor, to manage the Swanner Property on the following terms and conditions: 1. Term. The term of this agreement shall commence on July 1, 1993, and shall continue until terminated by either party by written notice delivered to the other no later than ninety (90) days prior to the intended termination date. 2. Scope of Work. Contractor shall, subject to criteria promulgated by the Director of Public Land and Facilities: a. Oversee and direct the work of Ignacio Lujano. b. Oversee the care and maintenance of the Swanner Property, including the irrigation, spraying, cultivation and harvesting of the orange grove located therein. C. Oversee the maintenance and operation of Egan Wells No. 1 and No. 2 . ; coordinate access to the wells and collection of charges from others entitled to their use. d. Oversee the weed abatement program. e. Provide periodic reports on the state of Swanner Property, including problems or other matters of concern. 1 3. Contractor's Responsibilities Beyond Scope of Work. a. Any other work or labor required in the performance of the tasks enumerated in i 2 shall be provided by the City by separate agreement with that employee or contractor. b. Any work or responsibility required of Contractor by the City, beyond that set forth in i 2 , shall also be set forth in a separate written agreement signed by both parties. C. The cost of materials, repairs and replacement of tools, equipment, machinery and vehicles shall be borne by the City and paid upon presentment of invoice(s) . 4. Responsibility of City. The City shall, through its Director of Public Land and Facilities, provide: a. A written statement of the duties and responsi- bilities of Ignacio Lujano. b. written directions, criteria or specifications, if any, relating to Contractor's Scope of Work. 5. Relation of Parties. The relationship between City and Contractor shall be that of an Independent Contractor; Contractor shall, accordingly, have the right and authority, independent of the City, to: a. Establish his own work schedule. b. Establish, at his sole cost and expense, such office and office equipment and supplies as he may deem necessary for the fulfillment of his contract with the City. 2 6. Compensation. a. Contractor has been paid the sum of $9,800 for services performed from May, 1992, through June, 1993 . b. Contractor shall be paid the sum of $700. 00 each month commencing on July 1, 1993, and continuing for the duration of this Agreement. C. Compensation for any work in addition to that set forth in i 2 shall be by separate agreement. 7. Liability Insurance. Contractor shall, at his sole cost and expense, maintain a policy of general liability insurance insuring his acts and activities (including motor vehicles) under this Agreement in an amount of not less than $1, 000,000.00 Combined Single Limit. A certificate of such insurance, showing the City as an additional insured, shall be delivered to the Director of Public 2 Land and Facilities within fifteen (15) days after execution of - this Agreement by the City. S. Certification of Non-Existence of Conflict of Interest. Contractor certifies, to the best of his knowledge, that: a. No City/Agency employee or office of any public agency connected or involved with this Agreement has any pecuniary interest in his business. b. No person associated with him has any interest that would conflict in any manner or degree with the per- formance of this Agreement. C. He has no interest and shall not acquire any interest, directly or indirectly, which would conflict in any manner or degree with his faithful performance of this Agreement. d. He is familiar with the provisions of SS 87100 et seq of the California Government Code, and that he does not know of any facts related to his performance of this Agree- ment which would constitute a violation thereof. 4. Binding Effect. The entire agreement between the City and Bathgate for the management and overseeing of the Swanner Property is contained in this document. Any changes or amendments must be in writing signed by both parties. The terms contained shall, moreover, inure to the benefit of and be binding upon the successors and assigns of City and Bathgate. IN WITNESS WHEREOF, the City and Bathgate have signed this Agreement as of the date first above written. Cit o San an Capistrano 77 William A. Bathga 3 1 MEMBERS OF THE CITY COUNCIL COLLENE CAMPBELL JOHN HART R mtowalatD GIL JO HART 0nwfefo 1961 NES DAVID M.S 1776 DAVID M.SWEgDLIN July 22, 1997 •'� CITY MANAGER • GEORGE SCARBOROUGH Mr. & Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, CA 92693 Re: Renewal of General Liability and Automobile Liability Certificates of Insurance Overseer Services - Swanner Property) Dear Mr. & Mrs. Bathgate: The General Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on August 12, 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. Also, I do not have on file a recent Automobile Certificate of Insurance. Please forward the updated certificates and the endorsement form to the City, attention City Clerk's office, by August 22, 1997. If you have any questions,please contact me at (714) 443-6310. Thank you for your cooperation. Ve`ryI truly yours, Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson,City Clerk Silvia Cintron, Public Works 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO. CALIFORNIA 92675 • (714) 493-1171 e� MEMBERS OF THE CITY COUNCIL CO LENE CAMPBELL NNATT HMT mmlreenH OILJONES tduuln, 1961 CAROUN NASH 1776 DAVID SWEROUN • • CITY MANAGER � GEORGE SCARBOROUGH August 2, 1996 Mr. & Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, CA 92693 Re: Renewal of General LiabiLily Cerfificate of insurance (Overseer Services Swanner Property) Dear Mr. & Mrs. Bathgate: The General Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on August 12, 1996. 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 certificate and the endorsement form to the City, attention City Clerk's office, by August 22, 1996. If you have any questions, please contact me at (714)443-6310. Thank you for your cooperation. Very truly yours, ka,umA ' ojla/� Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Silvia Cintron, Public Land &Facilities 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171 MEMBERS OF THE CITY COUNCIL L21 COLLENE CAMPBELL HART i m0a101auGLUTNES o CAROLYN ASH ' Issann.0 1961 WE DA — 1776 DAVVIDID SWERDLIN CT'MANAOER GEORGE SCARBOROUGH March 25, 1996 Mr. &Mrs. William Bathgate 29643 Camino Capistrano San Juan Capistrano, CA 92675 Re: Ikenewal of Automobile Liability Certificate of Incurance (Overseer Services wanner Property) Dear Mr. &Mrs. Bathgate: The Automobile Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on April 3, 1996. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. Please forward the updated certificate to the City, attention City Clerk's office, by April 12, 1996. If you have any questions, please contact me at (714) 443-6310. Thank you for your cooperation. Very truly yours, u"o)) ., )/ta'X Gtom., Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Silvia Cintron, Secretary Public Land & Facilities 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO. CALIFORNIA 92675 0 (714) 493-1171 To u�n Lj -1 2 AM Date4 -!Z TiEne PM WHILE [WERE OUT M_LL/�i t /j f� �/ 92&= of n (/ Phone�) 3(: V r /'s� 6 Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALLAGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message tee itze hIF 065r�t /lf Aelt- Operator 2orn�oLa. R� W s'A QIp h k c #71100 J facsimile TRANSMITTAL to: Holstad Insurance Agency fax #: (714) 348-7773 re: enera is > ity erti icate of Insurance - William Bathgate. On the interim certificate received I need an effective date of 11/26/95. Please insert address of certificate holder, 32400 Paseo Adelanto. I spoke with our risk manager and if we are unable to obtain the additional insured endorsement form for several weeks then lease send a copy of the policy. I must have one or the other so these people may get paz am so faxing a copy of the endorsement form sent with the renewal letter to Mr. &-Mrs. Bathgate on 11/14/95. Please send fax transmissions to the attention of the City Clerk's office. It took several days for us to received the interim certificate as a transmittal letter was not received. date: December 20, 1995 pages: 3, including cover sheet. S")' 1 vleed o_e-rrec;f-ed From the desk of.. Dawn M. Schanderl Deputy City Clerk �j ' '� h C� c cts I he ECJ lJors �I City of San Juan Capistrano e G5 T 32400 Paseo Adelanto �ou +p,y,ed-}-w I ce - Tha n N � G t.l • S+111 San Juan Capistrano, CA 92675 11R2C1 eer-H- seat-L- Or Ph0PE`F*1y (714)443-6310 --ha.nJCS +ajaglas no response. Fax:(714)493-1053 Page 1 1`I _ . _ . - MARGIN _. TA`B T',B -- .__ XNISURANCE F14E WGURANCE FARMERS INSURANCE RID�CENIURY EXCHANGE EXCHANOE ❑EIICHANSE ❑INSURANCE CO. INTERIM CERTIFICATE AS TO EVIDENCE OF PROPERTY INSURANCE THIS 0 NOT AN INSURANCE POLICY, THIS IS ONLY A VERIFICATION OF INSURANCE, 17 DOES NOT IN ANY WAY AMEND,EXTEND OR ALTER THE COVERAGE PROVIDED BY THE POLK IEZ LISTED BELOW. [� 1rmd "d 112.y ,4+ Pe-l�r - - +STFrr Addma • 'A' Z-t-j J SAnt'Sun+-I G.e�•.,,s-i+aa-�c� � �i7-15-354 ItaS34ylo I Ayanr Pufty Mo. This is to certify that this policy for the above named insured ie In force as follows: This Interim Gertificale As To Evidence of insurance shop expire sixty days from 12 1511S M., l of 18 5, unless cancelled prior to such date by written notice to the mortgagee. Location of property covered if other than above: Cl Building rrage&Perils ❑ Business Pers.P .coy&Perils ANT.OF INS. AMT.OF RMS. LlF e.E ❑ Flm,E? ❑ v4m VMN ❑ OPMFMU Padla_ .. Q Wiorar Pe Us Q AN Hiek Q AN Risk Q RePlacen.enl Cost Q RaplN PnrC K TOTAL ANNUAL G%P POLICY PReWuI1 $ G•-'�� r"DEOUCTIULE j Forms and Endorsements Applicable at Inception X1t =DFU NS ��"!t1 1S f�L cx �I oc*'O ' 4..¢�•C.i� . • m�nRe 201 Mod909ea - MOM a Address , • 2rd IACn No. lot A4ei46 HAM Addtas �. . cTaDiaA`P1 /'}IO�� Avy'K? //'�� G �.^ S2A - L Al, Lf•'rJtz4WX'T 0 !`^' -12(,7? IM igen M. 11 Cauntmslgnm T— ALRYgRREe IWPI�#1TASNE GATE se-Ezr x-s W1MC/IEOp Icaunr+UroOH REYER9E&DEI INSURER'S COPY r.p 19V1 121 ISf9S L�M LSy(vra. ® X110 P h O r� U" WLIVY� aI MEMBERS OF THE CT'COUNCIL COUFNE CAMPBELL WYATT IMMUSE1 GILJONES pI 1961 SwASH 77E CAVONA H/ November 14, 1995 •A • CITY MANAGER GEORGE SCARBOROUGH W. & Mrs. William Bathgate 29643 Camino Capistrano San Juan Capistrano, CA 92675 Re: Renewal of General Liability Certificate of Insurance (Overseer Services- Swanner Pronerwl Dear W. and Mrs. Bathgate: The General Liability Certificate of Insurance,regarding the above-referenced service, is due to expire on November 26, 1995. 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 the City approvedendorsement form to submit to your insurance company,however, your insurance company may provide their own endorsement form. I have not received an updated copy of your Automobile Liability Certificate of Insurance which expired on October 3, 1995. Compensation per agreement can not be received until this requirement has been updated. Please forward the general liability certificate and endorsement form to the City, attention City Clerk's office, by November 26, 1995. If you have any questions, please contact me at (714) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Nancy Barney, Administrative Assistant 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493.1171 FAHMUR s 1N-URM--CE L'aROJP OF-CCjNe!PAN1LJ' AMFRIrA rAN ^FPFNr ON FAf7 rRS FACSIMILE COVER SHEET Inclmliag this page Lhe folloving pax has pages. COMPANY ATTENTION `A;bh , -T,1 FAX ss. _ L4I3 -- Ind-'-4 F orn HOFSTAD INSURANCE AGENCY 26371 CROWN VALLEY PARKWA"f, SUI'T`E 110 MT SIOV 'VIEOU, CA 326191 Phoi:e (714)34V'-77x70 Fax (((714)348-7713 41 3 4 LIFE FAX CURRENT RATES VAAr1Mexz Flexible Universal Lite 7.1% Reinuities (Includi.rg IRA'8) 6.6 - 7 .0 T FOR USING "Aim hvFST'AD INSURA:si.E AG r.+^1! MY OF SAN J'i AN CAM'CttANO, Ct]T4�REDMLO,MNTAGUdiT " A � Aa&rlsxrtu ' 4ftmlatan4 ,CsaKovnta p2b'f4 A POLICY t_NFORMAUUN Bi grtnwa# 1- IaysnmuaceCtm�any rkc-atecas. 4'rio L ;Policy tSa9S3fq& a, Yoli.^y'i'arm.{Nmmj 8 (z. 4S (1®) s ez '7� C4veAate IZ sDl9."�'••'�-___-_ 3. N4MdbAk%:d "lltan_ -A w as+�,"4- nth ear - A. A&Inm vWmW Wund 9. L.itntr 0t`L ablllty AM 0111 tw.tytModAppregate GuamalLiobayAggroffefe(Checicone:) APPllcs`per JocaliotllprujeeR" ✓ Te Mi—fha:Vcsmfense limit 8. I3ta$tss�tible or 5elf•TRsmrd A►10Ltaou(Nit axohss u�enYLse specttie:d): T ._. . _��C> 7. Co't'at�{atiat agtrivaleaof IXr: _,'...�_'...... CQ=preLemlve(3eu44 Liabpl(y torilr QLQM(lid 1/73) Commrteifd Gepq;p(Liabt7ity"clamtwmede"fotau cS�x.�.,��___—_ V. T. Mil,'e'lyajtnr azul Prvperty D,.tua�c t;vvarage Is: If v&W.v-=#At,the vehassltve date is l3. PtS7rjCYAMri:T4'a�iyas-,fT+t Ibis erDdarnxneut is isvw^ak iry auxas7ultratfoa of IIIc Foamy"yrewiaim. Nvlwitttslmdmg any ittoottaiekm staletnent int6e po&cy to which this raaluc,I-au_-ur iw AUULed of um_v;.daet•udVaagn J atl+akWd dnrota,it b gpmd ag follewa: 1. M'LIW, 7116 Cm.-and the LGMM wily 4ts developx,reutAgan y,its ekcted or appeittted of oem officials,emptoyoes nand vabautc,•ts ate luciddcd as ux aon3s with rugmd 10 daWq" mid dct=n of elaWra m'Wmg fbom; (a} ecthuias performed by or pry bchaff of the 3 AMW Lys vmL(b)Pt'4JOIAS and eamplakd opvatiom of the Notried ks47d.or(c) pm-miles i"med,lr.....,a ear vwd by the Named lash a :'. t:">tSh"[A38S€ll N NVI i;lEQlSMD. Aa mV ua:(a)wftk performed by the Maned huuted for ex on behalf of the City;aux(b)projects sold by the Named huumd to the City;of(cT Pmauiaea ieasad by the Named lnmod from the City, the laauramoc&Mrdor by this pink.&Lint ba:primary ulsalPilN:c as twpaa.ta top Cltr,it:t nicvtmd or appoivad mt41Ce75, efCtsaala,vmploy fts ur volmmteasrs;or stand in mt tmbrokea 4,111 Of cot-erage excess efthe Named Lrutued's scheduled ml derBbT primary roveragc. *a dans etecatt,urg Olin karanw tmauataimed by the G cry-.its elected of appaimw off=L ofIIolnL^.empleysoa or i'oltmla,rs 3h&u be in-asci,of this luvw mco saad shall us•a u„utalbutc+i9b iL 3. SCOPE OF COVERAGE. Mis policy,d pri"v.affords,pcefage at least as brood as: ((� lours M44 Secs les L'lIeo ibrrb number UL0002(Ld, l li 3),Caxupxehe -e Genera!Lzubility Insurance and IriRwmce Sc"vieas fJll"ice farm ntambrf OL0404 llroe 14 Perm Comptchcrosivc Cremeral Liebt`ti y wdormmml; or, (21Insenae5,-MomOffimCemmemt2lQmftalLtaF.In-Cr�rrava.';x;am,drag fcr*xtcGttOctur "c;aictas-a:alc- fanm CCT(=2;n, WMfkaaeaMn ._ i9j4 ILL: %r 0I'I 7'�� . •• I'.v(., . (3i ll't�'ecss.aPtarda warp'mi;>r xsthicdx is se lcayt rk`oxasad as the pttuarr nxs�riane:e;iorau reiervnaxi m x9c jttcvatmg seaiitma(1)and( ). .t. SEVF.RABI LTTl,'OF TNTEREST. The k ,.a., a afforded by tlxia polios appfisv aep wmtety to mb btsured wbe is seeking ccn•arage ar a2ainat wbow a claim is malt or a rRtit i brought,mcpt with respect to the CotrVoy's Well of liability. 5. FROV[1UNS RLGARULWG TILE MURED'S Did M AFTER ACCYLkUM Olt LOS.'- Any fwhm to 00mp4 �xYthzxgtar4ng ptarieioa vCdw poti:y"not affea corcragc provided la the City aad the Commwxm'Rtderelopmem Agency,its el-red of ltppaluled oJlioers,Qme'als.empkxy ccs or volua L"�- G. CANCELfAMM KOTM The h,...mpe afforded by this policy shall not be suspended,wided,coo med.redeeod in co"emp or iitltits except atter thirty(30)daps'prior written uotiom by sonified mail remm to"ralueaced hm been gives to tho City, Such noticeshall be addressed as shown im be beading of dds endorsimemt. G, C CID .iVF T AND C AIM REPORTING ZB . loci,:xt%and claim,=to be mporW to the km=ar ATTN- -- (Title) (impartment) c4c3 7 f t�#1 cel+ tJ Afl C11 ?)4—� 1 IIO (Strae/d Address) (tidy} (Stawo) {Zip node) 7-170 (Taimphone) - D. sUJWAT Tt� r�rosuRt.i+ S�$ C►91� xs. yIJSGPi"+�tATiYt Ott ltill� i1j�►:x 1, i'aa�, sama warrant that t hove aMdfntr to t!itb tba boles•lisc►4 instuarce campagv tend by ray stgaahtre-hereon dv sv bind dxQ oampeny- S[tily_� -yr At7 '"" t�EtvrTtE'ss A7I'vB ( on endorsement fumished to the City I 0RCrAN1ZAT 0N. ' Af,�geoem kDDr.F.5F,: :2C73-71 (r00AICa UAIA- !;yl-1 -lam _-- ��.---, TELEPHONE:�r`f 3tf?T-7770 • FARMERS JNvUFIANGL GR00P C+ C' �iFANJES AMU11 rA CA CFTC4Jn ON r LRS F IMIL CDVEiEY SKEET lneiudin ihi page the fo2lowinq Fax has �• q pages.COMPANY ATTrXT TON PAX TL Pa um HWSTAD TNSURANCE AGE= 263'!1 CROWV VALLEY PARKWAY, SUITJS 110 MISSIOV VInJO, CA 92691 Phone (714)/348-7770 Fax ('114)348-77q3 YSessxgw:: '�+.•� � f�f t.4.,� �J6.E'.-D rJ^��1o+tf LIM FAX CURPERT RATES Farmers Flexible Universal Lite 7 ' V& Anwn it ltm ,-,c (Including IRA`S) 6.6 - 7.0 MAWS MR USING is Wr'-"a"liAt'i+ JTh"SJRt414TCE A tMCi 1 LUMM V MOF SAN JUAN CAMTR&NO COMWT�M REMUDMEN r AGWLT 32"PAK&Addwgu -lVAU CnPWr*W,CHWOrAll, 92675 A. P0LICXMYQRIWAMN ... ... ..... ........ 1. lr=auce cumpauy lj;DS3?,Y(_ CEM(From) rem..-AuukenwAM Effiectift Doe—, 9. 7,im5t of y 4Ay C)zlq,-UourrmWAjgM&t 0 6 j e'lcx:' tlraisral NAMIby oAf ATTHel.; T%t"i—er Mcuxmcc L mit Sty-14mrrerd&jcutwu kmwam Covftft*is ejuv"ep: Lorapulkerrsivo Giro"LlfibMy tOW QLQW2(Ed VIJ) CommaoW GeucrJ Liab"y"rWh"vide"I;xm CGWZ ............. . . ... ..... rl. &Aky LWUAX mid PivpKaiy D4u4e Cvvage is: P40witbsi"Mg my i4cousistew somat in Aha POHGy to which this UlLauw,ILb-&F=d asigllqww C. P(SMD, TkLAN and Lha C0awmiryPwdwcjojiwexdAppy,its decind or appmw offism,affidiatsemployees "d volua%cIx Lie,ivaudwd as=wv"- with y Savd lo dawagvb wad depose of i;jalw atft noew (4) wthitim perletmed by or on behalf Qf aie Named Lwurvd,(4)prujocuaii4cumpldcd operations of ahs Named Insured.or(c) pr4ricwi owoW,lkaqtzd or mcd by tht Named ZD=t4 CONUMMON Wr FXQIMED. As rMeou:(a)vvxk perfamwd by ilic,Named Warned for or on behalf of the CITY;or W pruivot sold by the N&iued Su mad to the City,or(i*prowisc*leased b.the Named bonevil Ikom.tits City, thr,lwurmaffordvA 17.1 aiia pvlk�s al Q bt pxl®. "i+ p6vithe City,kulw"or appoiumd QMMM offlc6t%cuVIbj*eK,ur vvhmta=or stand in an whiakon cham of omwage exp of the Named hw=4!S sohadukeL x1rderbilb?P&jl;kt CKMvnge, Tn either cwm my offm inswautcAnakUmed by the City,its ckctod ut appointed offims. 6frlo;45,Mpky,�4 UK vvllmlwxa %haM I)V,;"exwIg of this 1a lw anuq and AZ aux voillute"4 it- SCOM OF COVERAGE. This policy,if priuwq,allerds covmv.v at least as broad as: (u Totwmw Scn-iccs 09ko fww Wb= Ut�OWZ(Ed, 177 3),Luu*zvovnsrve Geaeral LiabiW finwave and Twwxnat,Srvv6m Ofrlqe fpnti uvmbu OL0404 Broad Fum Comprthcauive(katial Liabikty endorsement: A, (2) IrLgurnnceSftv,s0f5_ or"claim;-made'. form C414002;or facsimileTRANSMITTAL (DD•3o to: Hofstad Insurance Agency fax #: (714) 348-7773 re: Bathgate Automobile Insurance Certificate date: June 16, 1995 pages: 1, including cover sheet. Per the agreement with Mr. 6L Mrs. Bathgate the City of San Juan Capistrano requires a certificate of insurance naming the City as certificate holder. We will always need a certificate, a printout of the screen is not sufficient. Please send a permanent certificate so we do not have to go through this every 2 months. Thank you for your help. cc: Nancy Barney, Public Land Sz Facilities From the desk of... Dawn M. Schanderl Deputy City Clerk City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (714)443-6310 1 Fax:(714)493-1053 Page 1 FARMERS INSURANCE GROUP OF COMPANIES RECEIVED _ AvWPJCA CAN tXPENO ON FAMMS Jux 16 11 07 �I1Y Cl.€RK ➢FPARIMEKC FACSIMILE COVER SHEET � � sar+ !UAN Including this Rage the following Paz has Z pages. COMPANY L-t-J , Or_54-t 'c/q-t ATSENTIOW 1HV1►\ PAX t Lie? 1bS3 From HOFSTAD INSUEJWM ACFFCY 26371 CROWN VALLEY PARKWAY, SUITE 110 MISSION VIEJO, CA 92691 Phone (714)348-7770rr Pax (`714)345-7773 Message: !�� 4*1, Or �tl+�oleo- �� 61-act s R)44 i LIFE FAX CURRM RATES Farmers Flexible Universal Life 7.14 Annuities (Including IRA'S) 6.6 - 7 .09 THANKS FOR USING TM HOFSTAD UUMANCE AM CY! Page FARMERS INSURANCE GROUP OF COMPANIES AMERICA CAN DEPEND ON FARMERS AI)9 0( 0611111411915 I I I F, P:'I 1;1 f.h 111-116 1 1.-� pf' I"0Y ;117 1..m ,.jo 4ItqP cA Q 2 6 1101:141 It 1[' p f r f 6 1 11 1 FJ '10Y011d I Q ci w o? r out) f'01 1-1 ll N pT r. 11c)) i t qii' J-If I 4J-,)1- 3. (V2 t F It. 6A : 7 1 1j" 50K 19 1;o I V, OJ 1 bo,II 97 1�5 :7'�6 A Ili (700 Z'1060 1ti 7 R ntoobt3060 F 1.0 Y (,I 2S()1500"I00 2!J0/S()0/ (00 U H-QV '2501`toWWAIV 5m 10 5ri f:;00[1 24 0 V 500P lt 0:-1 C I,:, 0 0?/] 917 0 19 m "Y 0 1 1 i CA' 1 9 04 '03,/';'.i 00 2 04/0'W"!, r-1f, NflC I C VWSTI(.: NO 140 1 St., m 2 '40 04/P-I 0 <?FS lIS .1-14 GO .11 111.4t,1 n. .'9 ;.(q . 10"01'3"7s ::I() WI I!",.(( CD I PIA!'41r.1,111 fl'12:::.F W I'l CITY .I A1 MEMBERS OCOLENECAM BELL 1 COLLENE CAMPBELL GN11011>{f 1 GIL JO HART mmnorm CAROWN K mnmrn 1961 eARDLVN NASN 1776 DAVID SWERDLIN • • CITY MANAGER GEORGE SCARBOROUGH May 12, 1995 Mr. & Mrs. William Bathgate 29643 Camino Capistrano San Juan Capistrano, CA 92675 Re. Automobile Liability certificate of Insurance (Overseer Services - Swanner Property) Dear Mr. &Mrs. Bathgate: Thank you for the Automobile Liability Insurance Binder, which was received by the City of San Juan Capistrano on May 5, 1995. The binder is only good until June 3, 1995. Please have your agent provide the City with an updated certificate by June 3, 1995. If you have any questions, please contact me at(714)443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk —� cc: Cheryl Johnson, City Clerk Nancy Barney, Administrative Assistant 32400 PASEO ADELANTO. SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493-1171 • �, ate„ • a MEMBERS OF THE CITY COUNCIL VVV F,� A COLLENE CAMPBELL 9 Cpl GARY L.HAUSDORFER 91I1b 9 / GIL JONES AMNUM CAROLYN NASH unlutul 1961 JEFF VASOUEZ 1776 CITY MANAGER GEORGESCARBOROUGH March 30, 1995 Mr. & Mrs. William Bathgate 29643 Camino Capistrano San Juan Capistrano, CA 92675 Re: Renewal of Automobile Liability Certificate of Insurance (Overseer Services - Swanner Property) Dear Mr. & Mrs. Bathgate: The insurance binder the City received, regarding your Automobile Liability Insurance, is due to expire on April 12, 1995. In accordance with your agreement, the insurance needs to be renewed for an additional period of one year. Please forward an updated certificate to the City, attention City Clerk's office, by April 12, 1995. If you have any questions, please contact me at (714) 443-6310. Thank you for your cooperation. Very truly yours, Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Nancy Barney, Administrative Assistant 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO. CALIFORNIA 92673 0 (714) 499.1171 Jy .»» I IIT,In$O....It 0 haC Hoon T,I I�I And w hn11Nd to 0 days loll.till'Ebrrffve Elale end. 1$RUanCC 018 pOM1Cy rV r11U IYA�OCV Ilai]'wtlV VRW'11� F in lllnlrri.;,Kan..^.as,and brogo mit is bound unf it f l.np14cy aP+plurz far and currenllyl ylt+e 15sulnq Company i9 CBnreRed fn secondaries 1•TV1ld(.�' wlQl its terms Itiaillsuriare is subject lolhe lnmis,condibom:and ltmhations of the pot .)applied for and currently In useby Who C.Dn+pany. . l j R Please III this for.aF a bender, + 'n'alSVRCO - --•. -- --- Lawn NenlWr — ERECTIVE VA IILLIA_M_ AND PATRICIA BA_THCATE _ I 4- mrWSIIHED AI nly IVt NIf:f F Will MAm- AND L2 It DW-I I IND TALL Sn1Ef r ADDRESS rlenlMNl time 969 FORD PU_ ID# F25YRIR6833 _ oraAa 10-03-95 A' 12-01 xk7k 'AllD.I - P 0. U M Mrd Comp 1 F' ,*._t 1 CAC 'cAllMlan I 1 Fbs Owenine LJ I:pMTh I.I HAmeoNner [J Eee Tnar. ppRV rl Turn IIIF5.00 f 240 pnd 500 Died f f s soma rqnw n ^"rrS I Printed. towing and rental car it Mobile Sen 9 if ._ .. --- _� - - _.. unn RamLMn pAl{eY NNmNer "T FARMERS INSURANCE EXCHANGE .00 139978638 nitULngPt CERTIFICATE HOLDER ... ...._ Insureds Address-11?.-0 - 21-7-- - - r'nvnbfc CITY OF SAN JUAN CAPISTRANO — SAN SAN JUAN q&PISTRANOr 9-k 92693 ....._-- nrDr 32400 PASSO ADELANTO SAN JUAN CAPISTRANO, 92693 ffoo -- ' 9CNT11TIVE -- � ATE 1nxl. •Em1ln.inlr.n�am+aFwnnxn.� �fb'=P77u `. __._ 4l_ ��.. -��-6--- r.nh .SM. a1VxVI M - PII .€..__ .61ATE DIST. AGENT Tne Insurance has bene applied for rind is hound for 60 days ham Ilea Eifocty a Dale pending issuance of a policy to the Named Insured:except I"Minns,Kmisac.nod 01egon wham t is boded unfit thU policy afl>ued for Ind rwrendy In Use by the issuing Company is canceled in acnordance I MANCE with its forms.This insumncn is subject fotbe(Arms,conditions am]limitations m The policylics)apptied for and currently in use by the Company. 11tH pteNso accopt.his loon as a binder. meet EFFEenye DATE LLIAM AND PATRICIA BATHGATE '12:01 � _ _ _ _ 04-03-95 P.M. u'lltly lllSURrn IVFHI(TF' IFAll MANY 1110 11)m llwf.11NR TO[C NIlIFF 1400xC55 11"Md Abri _ 1987 To ota PU ID# JT4RN7OD6H0037740 nI= 10-03-95 *112:01 P.M. !l nor f 0.1. p D V M t Wd CninA Fvc{ 1 I OAC COPe.pn I J nN!DNlIIIM f C.. .M. UxnmlYNnlr I J ELE iNen p pADNy lJ arrl"An inn S ! S Oed f ON f { 1 Pl Special 50/5 0/1-0 ` 5,00 f 240 500 ?Qnn _— - — 'L--_- , - rt N .. Pro.edm "^O45 towi ------ . EmmlVm Franey xtlMNer _, FARMERS_INSURANCE EXCHANGE { 339.30 139.978637 141101-13K.11 CERTIFICATE HOLDER_ - - -- P.O. BOX 217~ . . . . .. hasuled•s Adtlrsas_._ .i payable CITY OF SAN JUAN CAPISTRANO "O'milment 32400 PASEO ADELANTO SAN JUAN CAPISTRANO r"Vor of SAN JUAN CAPISTRANO, CA EPIIFSENTAfdE --_.--d TTE- 'Yr •Enhln IA[None.nd.VI dgln.: �.,�)iS q7 IS 36p _._. STATE 019T. AOEii( G� a� Page I FARMERS INSURANCE GROUP OF COMPANIES_ RECEIVED AMERICA CAN OEPENI7 ON FARMERS Mm 5 2 45 Py 95 FACSIMILE COVER SHEET ev Including this page the following Fax has pages, COMPANY ATTENTION FAX ! LAgs 1053 From HOFSTAD INSURANCE AGENCY 26371 CROWN VALLEY PARKWAY , SUITE 110 MISSION VIEJO, CA 92691 Phone (714)348-7770 Fax (714)348-7773 Message: LIFE FAX CURRM RATES Farmets Flexible Universal Life 7.1% Annuities ( Including IRA'S) 6.6 - 7.0% THANKS FOR USING THE HOFSTAD INSURANCE AGENCY! MEMBERS OFTHE NECAM BELL GARYCOULL. CAMPBELL GARYYN HAUSOORFER CA JONES CAROLVN NASH munum 1961 JEFF VASQUEZ 1776 • • CITY MANAGER GEORGE SCARBOROUGH November 28, 1994 Mr. & Mrs. William Bathgate P.O. Box 217 San Juan Capistrano, California 92675 Re: Renewal of Automobile Liability Certificate of Insurance (Overseer Services_ Swanner Pronertv) Dear Mr& Mrs. Bathgate: The Automobile Liability Certificate of Insurance, regarding the above-referenced service, is due to expire on December 3, 1994. In accordance with your agreement, the insurance certificate needs to be renewed for an additional period of one year. Please forward the updated certificate to the City, attention City Clerk's office, by December 12, 1994. If you have any questions, please contact me at (714) 443-6310. Thank you for your cooperation. Very truly yours, 43 Dawn M. Schanderl Deputy City Clerk Enclosure cc: Cheryl Johnson, City Clerk Nancy Barney, Administrative Assistant 32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 0 (714) 493-1171 FARMERS INSURANCE GROUP OF COMPANIES AMERICA CAN DEPEND ON FARMERS �- ,- Is I ! /�4'..�l2-r�Z�.-/Rs. Cktk Ca. A`7rn r . r„ co L FARMERS INSURANCE GROUP OF COMPANIES AMERICA CAN DEPEND ON FARMERS Ft.j . :. .. . .. �.. . . it _. , ... -i� it :.�.i.,!.. .. i,i•'I-:. . .. i.�. .`JL : ... iii::�:• OKAZAKI LAW OFFICES JAMES S. OKAZAKI 32222 CAMINO CAPISTRANO. SUITE A FAX BRIAN K. OKA7AKI SAN JUAN CAPISTRANO, CALIFORNIA 92675 (ola) 240-3761 TELEPHONE (713) 831-5222 June 18, 1993 Honorable Gil Jones City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, California 92675 Re: Bill Bathgate Contract Dear Mr. Mayor: On June 15, 1993, we sent a letter to Ron Sievers responding to a proposed contract for overseeing the "North Open Space Properties". Copies of our letter and his response are enclosed for your information. As you can see, the City continues to assert that a "public works" contract is appropriate to engage Bill Bathgate's services. We respectfully continue to disagree and emphasize that virtually all of the compensation would be needed just to fulfill the insurance requirements. There are, moreover, material misstatements of fact in Mr. Siever's letter which will be addressed by separate letter. We thank you for all of the courtesies shown to Bill and Pat. Very truly yours, es S. Okazaki JSO: yo Enclosures X� to f S JON 2 11993 tee, m , OKAZAKI LAW OFFICES JAMES S. OKAZAKI 32222 CAMINO CAPISTRANO, SUITE A FA% BRIAN K. OKAZAKI SAN JUAN CAPISTRANO. CALIFORNIA 92675 7141 240-3191 TELEPHONE (114) 931-5222 June 15, 1993 Mr. Ron Sievers Director of Public Lands and Facilities City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, California 92675 Re: Bill Bathgate Contract Dear Mr. Sievers: We have reviewed your draft of a proposed Overseer's Agreement and have offered the following comments to Mr. and Mrs. Bathgate: 1. The basic format applies to a typical public works contract; most of the terms and conditions are, therefore, not appropriate for a personal services contract. 2 . Bill Bathgate should be paid a monthly retainer fee for assuming the responsibility of overseeing the north open space properties. Any additional work, labor, materials, equipment or supplies should be billed to the City when they have been incurred. 3 . The Christmas tree operations have no bearing on this agreement. Because of his life-long involvement with the Swanner- Williams-Bathgate farming operations, Bill Bathgate is probably the only person capable of fulfilling the management responsibilities which would devolve upon an overseer for the City's North Open Space Properties. Historically he has been paid $700. 00 a month to perform similar functions for Charles Williams. We propose a simple personal services contract defining his duties and providing for a retainer fee of $700.00, retroactive to May 1, 1992. Thank you for your consideration. Very truly yours, �amesOkazaki JSO: yo CC: Bill Bathgate