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00-0606_GATEWAY COMMUNITY CHUCH_Improvement and Reimbursement Agreement0 RECORDED AT THE REQUEST OF AND RETURN TO: City of San Juan Capistrano City Clerk's Department 32400 Paseo Adelanto San Juan Capistrano, CA 92675 C Recorded in Official Records, County of Orange Gary Granville, Clerk -Recorder Illllllllllllll11210111011011101311311171107111021113111PM 0613100 109 73 Al2 7 0.00 0.00 0.00 0.00 18.00 0.00 0.00 0.00 1' IMPROVEMENT AND REIMBURSEMENT AGREEMENT 1 FOR WATER FACILITIES - GATEWAY COMMUNITY CHURCH OF THE NAZARENE THIS REIMBURSEMENT AGREEMENT is made by and between CAPISRANO VALLEY WATER DISTRICT, hereinafter referred to as "District", and Gateway Community Church of the Nazarene, herein referred to as "Developer". WITNESSETH Whereas, Developer agrees to design and construct, at its sole cost and expense of an estimated amount of $276,110, the construction of the water facilities in Rancho Viejo Road hereinafter referred to as °Water improvements"; and, Whereas, because the aforementioned water improvements benefit other surrounding areas, the Developer is therefore entitled to reimbursement for a portion of those cost of improvement; and, Whereas, In accordance with the cost share calculation described in (Exhibit "X), the Developer agrees to be reimbursed by the District a total of $96,533.35 for the upsizing cost to construct a 16 -inch domestic water main pipeline and a 12 -inch non-domestic water main pipeline including all appurtenances in Rancho Viejo Road; and, Whereas, Developer desires to enter into this agreement to provide means for allowing the construction of the water improvements as well as a mechanism for crediting the Developer for the reimbursable costs incurred in constructing such improvement; and, Whereas, District requires that the water improvements be constructed conjointly with the development of Gateway Community Church of the Nazarene; and, NOW, THEREFORE, in consideration of the premises hereinafter set forth, District agrees to reimburse Developer an aforesaid sum of $96,533.35 under the following terms and conditions: Section 1. Reimbursement to Develop2r: The reimbursement from the District, for the Water Improvement project, totaling $96,533.35 will be paid to the Developer when said improvements are deemed complete and • 0 Improvement and Reimbursement Agreement Gateway Community Church of the Nazarene Page 2 acceptable to the satifaction of the City Engineer. Section 2. Design Plans Developer designed plans shall be submitted to the City Engineer for his review and approval prior to construction. Developer shall submit faithful performance and labor/material bonds in the amount of the approved Engineer's Cost Estimate for the Water Improvements work prior to commencement of work. Said bonds shall be on a standard District form and issued by an Agency approved by the City. Section 3. LiabiliWindemnification/Insurance. Developer holds City/District and its elected and appointed officials harmless from any claims or liabilities that may arise during the Developer's construction of improvements, including warranty period, described in this Agreement. City/District holds Developer and its officers harmless from any claims or liabilities that may arise out of any improvements constructed by City/District or any operations and maintenance of the improvements by City. If a judicial action is required to resolve a dispute arising under this agreement or to otherwise enforce any provision of this agreement, then the prevailing party shall be entitled to reimbursement for reasonable attorney's fees and cost from the other party. Developer agrees to maintain liability insurance in the following amounts: I. Comprehensive General Liability. Developer or his agent shall maintain in full force and effect comprehensive general liability coverage, including premises operations, products/completed operations, broad form property damage and blanket contractual liability in the following minimum amounts: $1,000,000 property damage $1,000,000 injury to one person/any one occurrence/not limited to contractual period; $1,000,000 injury to more than one persontany one occurrence/not limited to contractual period. II. Worker's Compensation. If Developer employs employees or subcontractors to perform services under this Agreement, Developer shall obtain and maintain, during the construction and warranty period of these improvements, Worker's Compensation Employer's Liability Insurance in the statutory amount as required by State law. • 0 Improvement and Reimbursement Agreement Gateway Community Church of the Nazarene Page 3 These above stated policies shall not terminate nor shall they be canceled nor the coverage reduced until after 30 days' written notice is given to the City/District. Developer shall provide an endorsement to City/District establishing that City/District has been legally added as an additional insured to the liability policy required under this Agreement. Section 4. Force Majeure. None of the parties hereto shall be deemed to be in default if performance of the obligations required by this Agreement is delayed or becomes impossible because of any act of God, earthquake, fire, strike, sickness, accident, civil commotion, epidemic, act of government, its agencies or officers, or any legitimate cause beyond the control of the parties. Section 5. Notices. All notices, requests, demands, consents and other communications under this Agreement shall be in writing, including telex and facsimile transmission and shall be deemed to have been duly given on the date of service if served personally by telex or facsimile transmission or 48 hours after mailing if mailed by first class mail, registered, or certified, postage prepaid, return receipt requested, and properly addressed as follows: TO: GATEWAY COMMUNITY CHURCH OF THE NAZARENE Attention: Jim Tracy 28570 Marguerite Pkwy., Suite 221 Mission Viejo, CA 92692 TO: CITY OF SAN JUAN CAPISTRANO Attention: City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 Section 6. Agreement Runs with the Land. This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective representatives, assigns and successors in interest. Section 7. Entire Agreement This Agreement contains the entire agreement between the parties hereto and supersedes any prior or concurrent written or oral agreement between said parties concerning the subject matter contained herein. There are no representations, agreements, arrangements or undertakings, oral or written, between or among the parties hereto relating to the subject matter contained in this Agreement which have not been fully expressed herein. 0 Improvement and Reimbursement Agreement Gateway Community Church of the Nazarene Page 4 (Attach Notary Acknowledgment) q! = - APPROVE15 AS TO FORM DISTRICT COUNSEL i GATEWAY COMMUNITY CHURCH OF THE NAZARENE By: -53 TRACY, ASTOR ESIDENT DATE CAPISTRANO VALLEY WATER DISTRICT By: +MTHART, CHAIRMAN DATE Attest: �L CLERK OF DqE ARD 0 0 Improvement and Reimbursement Agreement Gateway Community Church of the Nazarene Page 5 EXHIBIT A PUBLIC IMPROVEMENTS TO BE CONSTRUCTED BY DEVELOPER SUBJECT TO REIMBURSEMENT FROM DISTRICT Construction of 1585 linear feet of 16 -inch domestic water main pipeline, 1470 linear feet of 12 - inch non-domestic water main pipeline, and appurtenances in Rancho Viejo Road. SUMMARY OF REIMBURSABLE COST IMPROVEMENTS SUBJECT TO REIMBURSEMENT ESTIMATED AMOUNT Upsize Proposed 12 -inch Domestic Water Main Pipeline to 16 -inch $68,212.25 Upsize Proposed 8 -inch Non -Domestic Water Main _ Pipe4ine to 12 -Inch $28,321,10 Subtotal $96;533.35 TOTAL $96,533.35 The surety bonds shall be posted with the City prior to issuance of EncroachmenUConstruction Permit for said improvements. 0 0 State of CAI IFORNIA County of ORANGE On 4R(&wAy .2mD before me, PHILIP J. HUGHES, NOTARY PUSLIC (DATE) (NAMEMTLE OF OFFICER -L.. -JANE DOE, NOTARY PUBLIC') personally appeared ❑ personally known to me -OR- B-' PHILIP J. HUGHES COMM. # 1163799 30 2Notary Pubk Callfamia < , oaAxGEY )Ny C0a NQ OnEsp.U. IY1601 (SEAL) ATTENTION NOTARY proved to me on the basis of satisfactory evidence to be the person(is) whose name(Vf Is/are subscribed to the within instrument and acknowledged to me that he/slaeflthey executed the same in his/herftheir authorized capacity(=' and that by his/ge4.6f.1—ir signaturefe) on the instrument the person(!), or the entity upon behalf of which the personwi acted, executed the instrument. my hand and official seal The information requested below and in the column to the right is OPTIONAL. Recording of this document is not required by law and is also optional. It could, however, prevent fraudulent attachment of this certificate to any unauthorized document. THIS CERTIFICATE Title or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number of Pages Date of Document DESCRIBED AT RIGHT: Signer(s) Other Than Named Above WOLCOTTS FORM 83240 Rev. 3-94 IPnro class 8-2A) 01994 WOLCOTTS FORMS, INC. ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITYIREPRESENTATIONRWO FINGERPRINTS RIGHT THUMBPRINT (Optional) CAPACITY CLAIMED BY SIONERISI ❑INDIVIDUALIST OCORPORATE OFFICERISI OPARTNER(S) ❑LIMITED ❑GENERAL ❑ATTORNEY IN FACT OTRUSTEE(S) OGUARDIANICONSERVATOR OOTHER: SIGNER IS REPRESENTING: (Name of Penumis) or Entityliee) RIGHT THUMBPRINT (Optional) CAPACITY CLAIMED BY SIONERIS) ❑INDIVIDUAL(S) ❑CORPORATE OFFICER(S) (TITLES) OPARTNERIST ❑LIMITED ❑GENERAL ❑ATTORNEY IN FACT OTRUSTEE(S) O GUARD IAN/CONSERVATOR OOTHER: SIGNER IS REPRESENTING: (Name of Person(.) or Entity0es) 7 III67775 IIII6� 3I2I40 II 8 • 0 PUBLIC AGENCY FORM OF ACKNOWLEDGEMENT State of California County of Orange ) ss. City of San Juan Capistrano ) (Gov't Code 40814 & Civil Code 118 1) On June 6. 2000 , before me, Cheryl Johnson . City Clerk, personally appeared - - - Collene Campbell - - - , personally known to me to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. Capacity Claimed by Signer Municipal Corporate Officer Mayor Title Signer is Representing City of San Juan Capistrano WITNESS my hand and official seal. OPTIONAL Description of Attached Document Improvement and Reimbursement Aereement for Water Facilities - Gateway Communtiy Church of the Nazarene Title or Type of Document Number of Pages June 6, 2000 Date of Document Jim Tracy, Pastor Signer(s) Other Than Named Above 6 0 Page 1 of 1 Christy Swanson From: Maria Morris Sent: Monday, November 05, 2007 3:31 PM To: Christy Swanson Subject: Gateway Church Hi Christy, Please close agreement per Craig Harris. Thank you!! Maria Morris Deputy City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 (949) 443-6309 (949)493 -1D53 -Fax 11/6/2007 ACORD. CERTIFICA OF LIABILITY INSU CE DATEIMS04/IS/200S PRODUCER C626)795 -9S95 FAX (626)793-7864 Mutual Insurance Agency CA License # 0574081 30 N. Marengo Ave Pasadena, CA 91101 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 BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Capistrano Gateway Community Church of the Nazi 27129 Calle Arroyo #1803 San Juan Capistrano, CA 92675 INSURERA: GuideOne Specialty Mutual Ins -INSURER B'. INSURER C: NSURER D: NSURER E: 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. MSR WO'i TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE DATE 1MM/DOMI POLICY EXPIRATION DATE 1MM/QQ/YYL LIMITS GENERAL LIABILITY 9622 -600 -AD 06/30/2005 06/30/2006 EACH OCCURRENCE $ 3,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1,000,000 CLAIMS MADE OCCUR MEDEXP(Anyonepenion) $ 10,000. A PERSONAL b ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMP/OP AGO $ 3,000,00 POLICY PRO- LOC ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANVAUTO (Ea amident) S BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS IPer person) $ HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per wddent) S PROPERTY DAMAGE $ (Peramdenq GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGO S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ 5 S DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE- EA EMPLOYEE $ OFFICER)MEMBER EXCLUDED? 11 es, deecnbe Under SPECIAL PROVISIONS Wow E.L. DISEASE -POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDE BY ENDORSEMENT i SPECIAL PROVISIONS ertificate Holder The City of San Juan Capistrano and the Capistrano Valley Water District re named as Additional Insured as respects insureds operation - Form CC2011 0196 is attached. City of San Juan Capistrano City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY UPON THE INSURER. ITS AGENTS OR ACORD 25 (2001108) ©ACORD CORPOF*ION 1988 0 i ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS 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 the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. Gopyrigel, Insurance Services Office, Inc.. 1994 CG 20 11 01 96 Page 1 W I ACOR CERTIFICA 5/0T. 006/2 PRODUCER (626)79S -9S95 FAX (626) 793-7864 Mutual Insurance Agency CA License # 0574081 30 N. Marengo Ave Pasadena, CA 91101 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 BELOW. INSURERS AFFORDING COVERAGE NAIL # INSURED Crpisti4ano Gateway Church of the Nazarene P. 0. Box 4788 Mission Viejo, CA 92695 INSURERA: GuldeOne Specialty Mutual Ins INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR 13R kDD-L hmTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE IMIWIDD� &IC ( EXPIRATION PDATE OMITS GENERAL LIABILITY 9622 -600 -AD 06/30/2003 06/30/2004 EACH OCCURRENCE $ 11000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1.000.0 CLAIMS MADE � OCCUR MED EXP (Any one person) S 10,000 A PERSONAL & ADV INJURY $ 1.000.000 GENERAL AGGREGATE S 3,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $ 3,000,00-0 POLICY ZCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) E HIRED AUTOS BODILY INJURY S LION -OWNED AUTOS (Per accident) PROPERTY DAMAGE E (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH. EMPLOYERS' LIABILITY E.L. EACH ACCIDENT E ANY PROPRIETORIPARTNERIEXECUTIVE E.L DISEA EA EMPLOYE S OFFICER/MEMBER EXCLUDED? I( deSadae under SPECIAL PROVISIONS Below E.L. DISEA�-POLICY OTHER L DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDE BY ENDORSEMENT/ PECIALPROVISIONS �) m ertificate Holder the City of San Juan Capistrano and t�e Capistrano Valley Wat4 ct re named as Additional Insureds as respects insured's Operation. <n Yi 1`m x IV o w City of San Juan Capistrano City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) OACORD CORPORATION 1988 • ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS INSURED (Section ll) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. Copyright, Insurance Services Office, Inc., 1994 CG 20 11 01 96 Page 1 of I nt By: MUTUAL INSURANCE; 6267937B64; Dec -30-02 3:48PM; Page 2/2 &C -ORD.. CERTIFICATE OF LIABILITY INSURANCE °12/05/µ0i 02 001fRRT 926)795-9S9S FAX (626) 793-7864 Itual Insurance Agency 4 License • 0574081 0 N. Marengo Ave asadena, CA 91101 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER3 NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC M unD Capistrano Gateway Church of the Nazarene P. 0. Box 4788 Mission Viejo, CA 92692 INBURERA', GuideOne Mutual Ins Co INURER9. INSURERc IN9URE8 INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A00VE FOR THE POLICY PERIOD INDICATED. NOTWiTHSTANDIN 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 )S SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR IJ& OD' him ME OF INSURANCE POLICY NUMBER POLICY EFf K IOLICY EXnRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL UAOILITY DAFIBMAGET N B cIF CLAIMS MADE F] OCCUR MED EXP (My mE preO,l) B PERSONAL L ADV INJURY 9 GENERAL AGGREGATE S GENL AGGREGATE LpWoII.T. APPLIES PER: PRODUCTS - OOMPNP AGG f POLICY LOC 288 AUTOMOMLE LIAEILT' ANYAUTO COMBINED 61NGLE LIMIT (eAYtteenq 5 BODILY INJURY S (Per perEonl ALL OWNED AUTOS SCHEDULED AU 106 BODILY INJURY (Per accld"i], HIRED AUTO$ NON -OWNED AUTOS PROPERTY DAMAGE S (Per 6a 1) GARAGE LIAEILRY AUTO ONLY• EA ACCIUENT S OTHER IRAN M ACC E ANY AUTO AUIOONLYAGO E EXCESSIIIMORELLA LIABILITY EACH°CCURRENCE f OCCUR F-1 CLAIMS MADE AGGREGATE 6 F S DEDUCTIBLE S RETENTION S WORKER!COMPENE11TIONAND WC0120S3526 10/27/2002 10/27/2003 We A u. oTH- A EMPLOYERYUABILITY ANYPROPRIETONPARTHER,E CVTIVE OFFICERNIEMBER E,(CLUIIFDT EL.EACHACCIDENT E 1,000,00 E.L. DISEASE - EA EMPLOYSI S 1,00-0,00-0- WuS S ECIALPROVISIONS SPECIAL Pder WIMP E.L. DISEASE - POLICY LIMrt S 1,0q0,000 OWeR ECL PROVONS °EECRJFTION OF 01 NB I LOCATIONS IVEHICLES r EXCLUSIONS ADDED BY ENOORSEAIE TI FAIM ertTficate HOT( r the City of San Juan Capistrano and tto Capistrano Valley Water District re named as Additional Insured as respects insured's operation. City of San Juan Capistrano and Capistrano Valley Water District City Clerk 32400 Paseo Adelanto San Tuan Capistrano. CA 92675 ACORD 25 (2081108) SNOULO ANY OF THE ASOVE OEEC WEED POLICIES BE CANCELLED BEFORE TNF lJVII141I0N BATE THRIAZ f, THE UUIUINO INSURER WILL ENDHAVOR TO MNL 60 SAYE NRI TEN NOOCE TO THE CERnFICATE NOLDFJI NAMED TO THE LER, WT FAILURE TO MNL iUCH NOTICE SMALL (IMPOSE NO OBLKAKON OR LIAMLItt OF ANY MIND UPON THE INSURER, ITS AGENTS OR gErRFJiENTATNEa. WAV V KU Lr V Kr V KA I IUM I WOO Sent By: MUTUAL INSURANCE; r 6267937864; Dec -30-02 3:48PM; Page 1/2 • Mutual Insurance Agency CA License M 0574081 30 N. Marengo Ave Pasadena, CA 91101 Phone: (626) 795-9595 Fax: (626)793-7864 Mutual Insurance Agency FAX MEMO To: City of San Juan Capistrano Attention: Craig Harris Fax No. (949) 493-3955 No. of Pages: 2 From: Mary Nazarian RE Customer: Capistrano Gateway Church of the Nazarene Policy No.: 9622 -600 -AD Subject: Corrected Certificate of Insurance Date: December -26,2002 IF ANY OF THESE PAGES ARE NOT LEGIBLE OR YOU DO NOT RECEIVE ALL OF THE PAGES, PLEASE CALL US IMMEDIATELY AT (626)795-9595. Dear Craig, Attached please find the corrected Certificate of Insurance as requested. Should you have any other questions, please give our office a call. Thank you, Mary Naiad Attachment 0 Dawn Schanderl To: Craig Harris Subject: Gateway P Oh, by the way I had already taken them off the non compliance list. So I'll wait and maybe they can fax you the correct certificate. 0 0 Dawn Schanderl To: Craig Harris Subject: Gateway Church Thanks for bringing over the certificate. One problem - certificate holder is in the name of the City and needs as per my letter be in the name of the CVWD. Needs to be reissued. Thanks 1 QCORA CERTIFICATE LIABILITY INSURAN iz/os/z o PRODUCER (626) 795-9595 FAX (626)W-7864 Mutual - Insurance Agency CA License # 0574081 30 N. Marengo Ave Pasadena, CA 91101 THIS CERTIFICATE IS ISS S 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 BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Capistrano Gateway Church of the Nazarene P. 0. Box 4788 Mission Viejo, CA 92692 INSURER GuideOne Mutual Ins Co INSURER B - INSURER INSURER D INSURER E. 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 CONTRACTOR 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 DD'L TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE POLICY EXPIRATIONINSR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY NT TO REED DAMAGE $ CLAIMS MADE ❑ OCCUR MED EXP (Any one person) $ PERSONAL B. ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ POLICY F7 JETaT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Pereccident) GARAGE LIABILITY ALTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 17 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC012053528 10/27/20021110/27/2003 U- T ER TORVLIMTH EMPLOYERS' LIABILIT' E L EACH ACCIDENT $ 1,000,00 A ANY PROPRIETOP PARTNERIEXECUTIVE E DISEASE - EA EMPLOYEE $ 1,000,000 OFFICERIMEMSER EXCLUDED? f yes, describe under SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT $ 110 000,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ertificate Holder the City of San Juan Capistrano and the Capistrano Valley Water District re named as Additional Insured as respects insured's operation. City of San Juan Capistrano City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTOMAIL 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AUTHORIZED REPRESENTATIVE Howard Wooton/MVJ ACORD 25 (2001/08) OACORD CORPORATION 1988 0 9 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) ITUAL INSURANCE AGENCY • 30 NORTH MARENGO AVE PASADENA, CA 91101 CA LIC # 0574081 (800) 362-7320 FAX: (626) 793-7864 FAX COVER Date: 12/5/02 Time: 08:43:06 AM Company: Capistrano Gateway Church of the To: Craig Harris Fax Number: +1(949)493-1053 From: Maggie Jansezian Subject: Capistrano Gateway Churcho fthe Nazarene Pages: 3 Including Cover Page Note: Per your request, attached please find a copy of the Certificate of Insurance. Should you have any questions, please contact our office. Thank You If any pages are missing and /or not legible, please contact our office as soon as possible. Please note that this fax contains personal and confidential information for the recipient. i 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 (949)493-1171 (949) 493-1053 (FAX) Iv w 1v. sanjnancapistrano. org October 25, 2002 Json ✓(��,�,'`�. IRII„Ilill • If111uuB I 1961 1776 Gateway Church 28570 Marguerite Parkway, Suite 221 Mission Viejo, California 92677 MEMBERS OF THE CITY COUNCI4 DIANE L. BATHGATE COLIENE CAMPBELL JOHN S. GEUT MATT HART DAVID M. BWERDUN CITY MANAGER GEORGESCARSOROUGH RE: Compliance with Insurance Requirements - Improvement and Reimbursement Agreement for Water Facility with the Capistrano Valley Water District The following insurance document is due to expire: VWorkers Compensation Certificate 10/27/2002 (Capistrano Valley Water District named as certificate holder) 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 November 1, 2002. If you have any questions, please contact me at (949) 443-6310. Sincerely, Dawn M. Schanderl Deputy City Clerk cc: Craig Harris Kathleen Springer r San Juan Capistrano: Preserving the Past to Enhance the Future ACORD�, CERTIFIC OF LIABILITY INSUOWCE DAT 1 oZ PRODUCER -(626) 79S-9595 FAX (626) 793-7864 Mbtual Insurance Agency CA License # 0574081 30 N. Marengo Ave Pasadena, CA 01101 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 BELOW. INSURERS AFFORDING COVERAGE INSURED Cap�Tstrano Gateway Church of the Nazarene P. 0. Box 4788 Mission Viejo, CA 92695 INSURER A: GuideOne Specialty Mutual Ins INSURER B: INSURER C: INSURER D: INSURER E: 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. INSR TR TYPE OF INSURANCE POLICY NUMBER DA M T LIMITS GENERAL LIABILITY 622 -600 -AD 06/30/2002 06/30/2003 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 1,000,000 CLAIMS MADE M OCCUR MED EXP (Any one person) $ 10,000 PERSONAL S ADV INJURY $ 1,000,00 A GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,00 17 PRO LOC POLICY0 JECT El AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea ae dent) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per ac dent) PROPERTY DAMAGE S (Per amidenU GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND I TORY LATU IMITSI ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY E.L. DISEASE - EA EMPLOYEE $ E.L. DIS E -POLICY LIMIT $ OTHER > p L A m DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ertificate Holder is named as additional insured as respects the facility locat"-at: 1 f71 9552 Rancho Viejo Road San Juan Capistrano, Ca. 92675 from 7-1-02 to 6-30-03. L,.J -- __ i Tl LA) P13 _J UCK I PILI I C nvLwmm I I ADDITIONAL City of San Juan Capistrano and Capistrano Valley Water District Dawn Schanderl 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORMED REPRESENTATIVE . I I . ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES Capistrano Gateway Church of the Nazarene Policy No. 4622-600,AD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Par; Leased to You): 2. Name of Person or Organization (Additional Insured): City of San Juan Capistrano and 3. Additional Premium: the Capistrano Valley Water District (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS 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 the ownership. maintenance or use of that part of the premises leased to you and shown in the Sched•ile and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. cocv,�gnl. In:�„"«se.�I�e�em�e.I Ige< CG 20 11 01 96 Page I of I I) MWdh N tiiranrvc[. A<a �..rva_v 30 NORTH MARENGo AVENUE • PASADENA, CA 91 10 1-1 902 August 30, 2002 City of San Juan Capistrano Dawn Schanderl 32400 Paseo Adelanto San Juan Capitstrano, Ca. 92675 Re: Insured Capistrano Gateway Church of the Nazarene Policy Description Package #9622 -600 -AD Insurance Company GuideOne Specialty Mutual Ins Policy Term 06/30/2002 to 06/30/2003 Dear Dawn hi reference to the above insured, please find enclosed the following: Binder of Insurance pending issuance of new policy Evidence of Property Insurance FTJ Certificate of Insurance and Additional Insured endorsement. New Policy covering Renewal Policy covering Endorsement showing If you should have any questions, please feel free to call our office. 626.795.9595 • 323.684.2630 800.362.7320 TOLL -FREES 626.793.7864 FAX WWW.MUTUAI.INSAGCY.COM CA LICENSE No. 0574081: 0 Dawn Schanderl To: Kathleen Springer; Craig Harris Subject: Capistrano Gateway Chruch of the Nazarene - Reimbursement Agreement for Water Facilities Good Morning fellow co-workers! I still have not received the general liability endorsement naming the City and CVWD as additional insureds. Expired 6/30/2002. 7-10-2002 - received fax certificate of insurance from Maggie jansezian of Mutural Insurance Agency - I immediately sent her fax requesting endorsement form I sent out a second request July 10, 2002. Craig made calls to Pastor Brad. I spoke with Pastor Brad twice and each time he was going to contract insurance co to request endorsment. I sent out a third request to the church on August 12, 2002 - no reply. Need help. Thanks • 32400 PASEO ADELANTO SAN .JUAN CAPISTRANO, CA 92675 (949) 493-1171 (949) 493-1053 (FAX) ivivlv.sanjuancapisirano. org June 14. 2002 Capistrano Gateway Church of the Nazarene P.O. Box 4788 Mission Viejo, California 91301 � All IIN11111111 • IRMusm 1961 1776 MEMBERS OF THE CITY COUNCIL O E L BATHGATE COUENE CAMPBELL JOHN S. GELFF WA`17 HART DAVID M. SWERWN CITY MANAGER GEORGESCARSOROUGH RE: Compliance with Insurance Requirements - Reimbursement Agreement for Water Facilities The following insurance documents are due to expire: General Liability Certificate 6/30/2002' General Liability Endorsement naming the City of San Juan Capistrano as Q( _� well as the Capistrano Valley Water District 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 the above expiration dates. If you have any questions, please contact me at (949) 443-6310. Sincerely, ' Dawn M. Schanderl Deputy City Clerk cc: Craig Harris, Assistant Engineer Kathleen Springer, Administrative Assistant San Juan Capistrano: Preserving the Past to Enhance the Future 0 0 Dawn Schanderl From: Craig Harris Sent: Friday, August 09, 2002 2:25 PM To: Dawn Schanderl Subject: RE: Gateway Church Pastor Bradley Shingler Ph. 949.234.1294 INIFM11P -----Original Message ----- From: Dawn Schanderl Sent: Friday, August 09, 2002 2:04 PM To: Craig Harris Subject: Gateway Church Please email me a contract name and phone number for insurance - thanks Date: 07/16/02. Time: 09:43 AM To: Craig Harris @ +1 (949( 493-3955 Page: 002-003 ACORD"„tERTIFICAW OF LIABILITY INSUWCE DATE(MMMOM) 07/10/2002 PRODUCER (626)795-9595 FAX (626)793-7864 ' Mutual Insurance Agency CA License # 0574081 30 N. Marengo Ave Pasadena, CA 91101 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 BELOW. INSURERS AFFORDING COVERAGE wsuREO Capistrano Gateway Church of the Nazarene P. 0. BOX 4788 Mission Viejo, CA 92695 INSURER GuideOne Specialty Mutual Ins INSURERS INSURER C'. INSURER D'. INSURER E' 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER GATE MM/ODM' DATE MM/DOW LIMITS GENERAL LIABILITY 622 -600 -AD 06/30/2002 06/30/2003 EACH OCCURRENCE S 1,000,00 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (My one fire) S 1,000,000 CLAMS MADE [X] OCCUR MED EXP Any one person) $ 10, 00 A PERSONAL &ADV INJURY $ 11000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMI T APPLI ES PER PRODUCTS-COMP/OP AGO S 3,000,00 POLICY PRCi OLOC IE - AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT [Ea accitlem) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ fPer person) BODILY INJURY S IPer acatlenl) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S (Per aaiden0 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 OTTER THAN EA ACC S ANY AUTO AUTO ONLY: AGO S EXCESS LIABILITY EACH OCCURRENCE S OCCUR O CLAIMS MADE AGGREGATE S S $ DEDUCTIBLE E RETENTION $ WORKERS COMPENSATION AND TORYUMITS I I ER EMPLOYERS'LIABILITY E L EACH ACCIDENT E E.L. DISEASE - EA EMPLOYEE E EL DISEASE-POLICYLIMIT S OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS ertificate Holder is named as additional insured as respects the facility located at: 9552 Rancho Viejo Road San Juan Capistrano, Ca. 92675 from 7-1-02 to 6-30-03. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City of San Juan Capistrano and 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Capistrano Valley Water District Dawn Schanderl BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 32400 Paseo Adel anto OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. San Juan Capistrano, CA 92675 AUTHORIZED REPRESENTATIVE Y/ ) t f �;� l� rY,.� °�� D�� v,.j , �. ,,,� J �� _� ':��,1��{� �, _ t� %i' � ?i '�a ; l i � _._ r l l v h% �' 1. '� ,1� �_ ,'� �� l'� \+` i %^�� \ w Date: 07/16/02 Time: 09:43 AM To: Craig Harris @ +1 (949) 493-3955 Page: 003-003 r` � • IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7197) 0 Date: 7/10/02 MUTUAL INSURANCE AGENCY 30 NORTH MARENGO AVE PASADENA, CA 91101 CA LIC # 0574081 (800) 362-7320 FAX: (626) 793-7864 FAX COVER Time: 09:30:23 AM Company: City of San Juan Capistrano Fell Dawn Schanderl Fax Number: +1 (949) 493-1053 Fpx�. —10: Maggie Jansezian Subject: Capistrano Gateway Church of the Nazarene Pages: Including Cover Page Note: Attached please find a copy of the Certificate of Liability Insurance. Should you have any questions, please contact our office. Thank You X/ L� &&j ads If any pages are missing and /or not legible, please contact our office as soon as possible. Please note that this fax contains personal and confidential information for the recipient. 0 32400 PASEO ADLLANTO SAN JUAN CAPISTRANO, CA 92675 (949) 493-1171 (949) 493-1053 (FAX) www.sanjuancapistrano.org MEMBERS OF THE CITY COUNCIL DIANE L. BATHGATE COLLENE CAMPBELL JOHN S. GELFF MATT HART DAVID M. SWERDLIN CITY MANAGER GEORGE SCARBOROUGH June 14, 2002 SECOND REQUEST � � IOIOZ Capistrano Gateway Church of the Nazarene P.O. Box 4788 Mission Viejo, California 91301 RE: Qompliance with Insurance Requirements - Reimbursement Agreement for Water Facilities The following insurance documents are due to expire: Y General Liability Certificate 6/30/2002 General Liability Endorsement naming the City of San Juan Capistrano as well as the Capistrano Valley Water District 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 the above expiratipn dates. If you have any questions, please contact me at (949) 443-6310. Sincerely, awn Deputy City Clerk cc: Craig Harris, Assistant Engineer Kathleen Springer, Administrative Assistant onuu use 1s San Juan Capistrano: Preserving the Past to Enhance the Future Date: 07/10/02 Ti..: 09:30 AM TO: Dawn Schanaerl L+ +1 (949) 493-1053 Page: uu2iiinr FACORD.a CERTIFICAM, OF LIABILITY INSUFMNCE DATE(MMIODMI 07/10/2002 ....,____., lwaw"i �r v'vd rrn _...... _.._.. Mutual . Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CA License # 0574081 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 30 N. Marengo Ave Pasadena, CA 91101 INSURERS AFFORDING COVERAGE INSURED Capistrano Gateway Church of the Nazarene INSURERA GuideOne Specialty Mutual Ins _ P. 0. Box 4788 INSURERB Mission Viejo, CA 92695 NSUR=_PC INSURER D ASJRER E COVERAQFS 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. LTRINSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDM' DATE EX LIMITS GENERAL LIABILITY 622 -600 -AD 06/30/2002 06/30/2003 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 1,000,000 CLAIMS MADE IFV7OCCUR MED ESP (Any one person) $ 10,000 A PERSONAL &ADV INJURY $ 1,00-0,00-0 GENERAL AGGREGATE $ 3,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMP/OPAGG $ 3,000,00 PRO - JECT OC POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident BODIL�INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILYINJURV $ HI RED ALTOS NON-OWNEDAUTOS(Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTOONLY- EAACCIDENT $ OTHER THAN EAACC $ . ANY AUTO $ AUTO ONLY AGG EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAMS MADE AGGREGATE $ 8 $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY EL EACH ACCIDENT $ EL DISEASE - EAEMPLOYEE $ EL DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSA.00ATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS L.ertificate Holder is named as additional insured as respects the facility located at: 9552 Rancho Viejo Road San Juan Capistrano, Ca. 92675 from 7-1-02 to 6-30-03. liCn I nrnl 1c nwo.lCn I INUVHRInML...Vnev nVauntn Le i i cei nvry City of San Juan Capistrano and Capistrano Valley Water District Dawn Schanderl 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Sent/6y: MUTUAL INSURANCE; 6267937864; Jan -2-02 4:21PM; Page 1/1 ACORD CERTIFICAT F LIABILITY INSURA DATEIMMAD 0102/0212002 PRODUCER (626)79S-9S9S FAX (626)793-7864 Mutual. Insurance Agency CA License M OS760E1 THISCERTIFICATE 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 BELOW. 30 N. Marengo Ave Pasadena, CA 91101 INSURERS AFFORDING COVERAGE INSURED Capistrano Gateway Church of the NaZarene INSURER A: Guideone Mutual Ins Co P. 0. Box 4788 NsuRER e: Mission Viejo, CA 92692 IauRERG: INSURER R NS~ w EACH OCCURRENCE i 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, Ida TYPE OF INSURANCEPOLICY Mumma LIMITS GENERAL LIABILITY EACH OCCURRENCE i COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(AAy Env Am) i CLAIMS MADE OCCUR MEBERP(Myonvpovn) f PERSONAL 41. ADV INJURY S OBNBRAL AOGREGATA S GEN'L AGGREGATE LIMIT APPLIES PER: FAOOUCTS-COMFIOFA S POLICYF-I PAM A7 r7 LOC AUTOMONLE UABILM ANYAUTO COMBINED SINGLE LIMIT (EI BFM411nU i BODEYINJUAY i P') ALLOWNEDAUTOG N�... ULe AURAS 6DONY INAIRY i (PW 0=41060 MIRED AUTOS N 1,1 WINED AUTOS _ PROPERTY DAMAGE v GARAGE LIABILITY AUTOONLY-EAACCIOENT I OTHER THAN "AM i ANY ALTO AUTOONLY: AIG I EXCESS UAmUTY EACH OCCURRENCE i OCCUR FICLAIMS MADE AGGREGATE T i i OEWCTIBLE % RETENTION B WORMERS COMPENBf.TION ANO OCOIZOS3S2A 10/27/2001 10/27/2002 T rt A EMPLOYERS' LIABILITY _ E.L. EACH ACCIDENT L 1,000,00 El. DISEASE - EA EMPLOYU F 1,DOO,00 E.L. DISEASE -PXL VALIT I S 1,000,000 OTHER Gncm N OF W SIL TIONBNEHICL wEECLUSIONG A D B1' ENBOMEeMENT FACIAL PROMSIONB ertlricate Holler the City oV San 3uan LaplBtrano an� the Capistrano Valley Mater District Ore named as Additional insureds as respects Insured's operation. City of San Tuan Capistrano City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANY OF THE ABOVE MWIUBED POLICIES BE CANCELLED BEFORE THE W"TION DATE THEREOF, THE MANG COMPANY FALL ENDEAVOR TO MAIL 60 DAM WRITTEN NOTICE TO THE CERTInCATE HOLDER NAMEO TO THE LEFT, BUT FAILURE TO MAIL BLAH NOTICE SMALL OR LIABILITY Sent By;_�6�SI-TUAL INSURANCE; 46 6267937064; Jan -2-02 3:50PM; Page 112 • Mutual lnsu cc Agency CA License M 0574081 30 N. Marengo Ave Pasadena, CA 91101 Phone: (626)795.9595 Fax: (626)793.7864 Mutual Insurance Agency FAX MEMO To: City of San Juan Capistrano Attention: Craig Harrison Fax No. 949-493-3955 No. of Pages: 2 From: Maggie Jansezian RT Customer: Capistrano Gateway Church of the Nazarene Policy No.: WC01205352A Subject: Cettificate of Liability Insurance Date: 1/2/2002 1F ANY OF THESE PAGRS ARE NOT LEGIBLE OR YOU DO NOT RECEIVE ALL OF THE PAGES, PLEASE CALL US IMMEDIATELY AT (626)795-9595. Dear Craig; Confirming our phone conversation, attached please find an updated Certificate. Should you have any questions, please contact our office. Thank You • 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 (949) 493-1171 (949) 493-1053 (FAX) www.sanjuancapistrano.org December 6, 2001 Gateway Community Church Of the Nazarene P.O. Box 4788 Mission Viejo, California 92692 IIIMIIIAIII ISIA116111 � 1961 1776 MEMBERS OF THE CITY COUNCIL DIANE L BATHGATE JOHN S. GEI FF COLLENE CAMPBELL MATT HART DAVID M. SWERDLIN CITY MANAGER GEORGE SCARBOROUGH SECOND REQUEST 14 RE: Compliance with Insurance Requirements - Improvement & Reimbursement Agreement for Water Facilities - Gateway Community Church of the Nazarene The following insurance document is due to expire: IWorkers Compensation Certificate 12/18/01 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 the above expiration date. If you have any questions, please contact me at (949) 443-6310. Sincerely, AQ u^i i 1"k ' gvahQ/,� Dawn M. Schanderl Deputy City Clerk cc: Craig Harris DRUG USE IS D 5utt .Tti(tJt a.Itln,rtt n11,/: t'lr,, (�) I;nr,> iltr� prIV1 In C,'rvhniic't� t{rt' i, r I I I u iC ACORD CERTIFICA E OF LIABILITY INSU NCE o jo jzooi PRODUCER (626) 795-9595 FAX ) 793-7864 Mutual Insurance Agency CA License # 0574081 30 N. Marengo Ave Pasadena, CA 91101 THIS CERTIFICATE ISWUED 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 BELOW. INSURERS AFFORDING COVERAGE INSURED Capistrano Gateway Church of the Nazarene P. 0. BOX 4788 Mission Viejo, CA 92692 INSURER A: GuideOne Specialty Mutual Ins INSURER BGuideOne Mutual Ins Co INSURER C: NSURER D: INSURER E'. 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. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFDECTIVE POLICY EXPIRATIONMNU LIMITS GENERAL LIABILITY 622 -600 -AD 06/30/2001 06/30/2002 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 1,000,000 CLAIMS MADE O OCCUR MED EXP (Any one person) $ 10,000 A PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS -COMPIOP AGS $ 3,000,000 17 POLICY 7 PRO-JEGT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ALTO ONLY - EA ACCIDENT $ OTHER THAN EA ACG $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 14CO1205352 10/27/2000 10/27/2001 X I TORYSUMITS I ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1,000,006 B E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMB 1,000(000 OTHER C "n mac: C" A o •� DESCRIPTION OF OPERATIONWLOCATIONSIj EHICLESIEXCWSIONS ADDED BY FcNDORSEMENTISPECIAL PROVISIOVS r m Certificate Holder the City of San Juan Capistrano and the Capistrano Valley Water-bistric&i re named as Additional Insureds as respects insured's operation o r 3 C City of San Juan Capistrano City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 30 NoneH MARFNGo AVENUE • PASADENA, CA 91101-1902 August 3, 2001 City of San Juan Capistrano City Clerk 32400 Paseo Adelanto San Juan Capistrano, Ca. 92675 Re: Insured Capistrano Gateway Church of the Nazarene Policy Description Package, 9622 -600 -AD Insurance Company GuideOne Specialty Mutual Ins Policy Term 06/30/2001 to 06/30/2002 To Whom It May Concern: In reference to the above insured, please find enclosed the following: Binder of Insurance pending issuance of new policy Evidence of Property Insurance 0 Certificate of Insurance and Additional Insured endorsement. New Policy covering Renewal Policy covering Endorsement showing If you should have any questions, please feel free to call our office. Sincerely, Maggie Enclosure (s): HJW; mj 626.795.9595 • 323.684.2630 800.362.7320 TOLL-FREE 626.793.7864 FAX WWW.MUTUALi NSAGCY.COM CA LICENSE No. 0574081 E 0 ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS 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 the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any 'occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. Copyright, Insurance Services Office, Inc., 1994 CG 20 11 01 96 Page 1 of 1 Selk By: MUTUAL INSLPANCE; 6267937864; .u1-11 OC 3:05PM; Page 213 ACORD. CERTIFICWE OF LIABILITY i PRDDUc[R 5 THIS MUTUAL I1T8URANCd AGENCY ONLY AND CONF'918 NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CA LZCEN81 NO. 0576053 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 30 NORTH XARXXW AVENUE INSURERS AFFORDING COVERAGE .., 91101-1902 .. INEURW CAPTBTRANO CATSMAY CRURCH OF INRURER A ryY7 nPn RTP eegrY R. -a A{^,.rrr+li .-c TXE DTAEARBNB 'INSURER e: CALZFQEMTA cnYnZA!"TIO TWA rn 28570 M"OUXXXTS PXWY 6221 LLNSURER C: MISSION VIS", CA 92677 NSUREH _ I. I t I CADAEOO INSURER F. COVERAGES THE POLICIES OF INSURANCE LISTER DCLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CBRTiPICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUEJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGOM43ATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IrvR TYIEOFRIHIRANCE LICY WEISER .... mt EPF mmtipptyyl POPOLx;IeawKAnON, LIAIITB .... A GENERAL LIABILITY ffff-EDf-AD 06/30/2000 06/70/2001 . EACH OCCURRENCE �I TRADDGO X COMMERCIAL GENERAL LIAU i I Y FIRE DAMAGE A" IX WN I 1000004 CLAIM$MADE I -UR �— LY_I DC NFD F%P IAnV nN Ob Md { 10000 ........_ _. _ __ I PFRSONAL.A AOV INJURY 1 10000 AGATE { CCN'L AGGi1CGAll LIMIT APPIICG PLR. MODUCT!- tOMYIJY NUG 1 1 YQICV PM1& !LOC AUTOMOBILE LIAINUTY COMBINED FINGER LIMIT ANY AUTO �I BDNiI YIK.URY e _ ALL OWNED AUTO$ .._ SCHEOVIED AUTOS IPy P4FMI HIRED AUTO! BGDRYIrvdu.l NCNOWNEDAUTOS IPY ECAKNAO MOPRITY OHMAGE i I —_._.. IPF E¢khn4 GARAGE UAMUTY jAUIOOMY kAACLIDENT E MYAUTO EA ACC 1 OTHER THAN- AVTOOMY AGG e F%CESS LIAMLDY EACH OCCURRENCE II VCCInI O G!AIMl MAGE i I AGGREGATE S DEDUCTIBLE RETENTION F I E WORKERS COMPENSATION ANO GSI C]AT21]I2�16�I99912�1E�a OOO WC STATU- i. I EMPLOYEKB' UANUTY E L. EACH ACCIDENT 1 ,,, ., 1OD000O E.L. DISEASE - EA EMPLOYEE i Ififlaofin E.L. DISEASE POLICY LIMO I OTHER OESCNRIONOF OPEMITIONSILOCATION$NEHICIMIEKCLUSIOBSADDED BV WLDOIIBEMENTISPEpAL PROWS DINS CERTIFICATE HOLDER TNS CITY OF SAM JOAN CAPISTRANO AND TNS CAPI9TRAN0 VALLBY NATER DZSTRICT ARE NAMED AS ADpITIORAL ZNSURBDS AS RSSPSCTS INSURED IS OPSIGTION - PORDE C920110196 18 ATTACJEED, CITY OF SAN JUAN CAPISTXAMO CITY CLERIC 32400 PASSO ADBLANTO DAN JUAN CAPISTRANO, CA 92675 SHOULD ANY OF THE ABOVE OFECRIBED POLICES BE CANCELLED SHORE THE E%NDATIO DATE THEREOF. THE RSUNO INSURER WILL 114041 TO MAIL 6O— GAYS WMTYM NOTICE TO THE OEMI.CATE "OLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO GBLIOATIO4 OR LABILITY OF ANY KIND UPON THE ENSURER. ITS AGENTS OR REPRESENTATIWHI. ACORD Sent By: MJTi.AL INSURANCE; 6267937864; Jul -11-00 3:06PIv1; • • Page 3/3 ADDITIONAL. INSURED -- LESSORS OF PREMISES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): 3. Additional Premium: (It no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS INSURED (Section II) is amended to 1. Any "occurrence" which takes place after you include as an insured the person or organization cease to be a tenant in that premises. shown in the Schedule but only with respect to liability arising out of the ownership, maintenance 2. Structural alterations, row construction or or use of that part of the premises leased to you demolition operations performed by or on and shown in the Schedule and subject to the behalf of the person or organization shown in following additional exclusions: the Schedule. This insurance does not apply to: ePY""�°. �ntmnnnn S...!,[, Off ft, IPJ . 191W iU A IC CG 20 11 01 96 / PhJ9 1 01 1 0 lJ Capistrano Talley Water District June 20, 2000 Reverend James Tracy Gateway Community Church 28570 Marguerite Parkway, Suite 221 Mission Viejo, California 92692 Re: Improvement and Reimbursement Agreement for Water Facilities Dear Reverend Tracy: At their meeting of June 6, 2000, the Capistrano Valley Water District Board of Directors approved the Improvement and Reimbursement Agreement for Water Facilities for the new Gateway Community Church. A copy of the Agreement has been forwarded to the Orange County Recorder's Office. A fully -executed copy is enclosed for your files. Please feel free to contact Craig Harris at 487-4305 if you have any questions. Very truly yours, Cheryl Johnson Clerk of the Board Enclosure cc: Fuscoe Engineering Contour Paving Resco Development Engineering and Building Director (with enclosure) Craig Harris (with enclosure) P.O. Box %7, San Juan Capistrano, California 92693 _� Phone 714-493-1515 32450 Paseo Adelanto • San Juan Capistrano, California 92675 FAX 714-493-3955 0 0 AGENDA ITEM June 6, 2000 TO: George Scarborough, General Manager FROM: William M. Huber, Director of Engineering & Building SUBJECT: Consideration of Improvement and Reimbursement Agreement for Water Facilities, Architectural Control 96-06 (Gateway Community Church of the Nazarene). By Motion: Approve the Improvement and Reimbursement Agreement for Water Facilities — Gateway Community Church. 2. Authorize the Chairman and Clerk of the Board to execute the Improvement and Reimbursement Agreement on behalf of the District. SITUATION A. Summary and Recommendation Gateway Community Church of the Nazarene, the current owner/developer of subject development, has obtained City approval to develop an 11.52 -acre site which includes a 25,927 SF church/pre-school and a future development site for a commercial office complex with 154,550 square feet of office space. In order to provide this project with water service, the developer was conditioned to construct domestic and non-domestic water main pipelines in Rancho Viejo Road along the entire frontage of the project site. Staff recommends the upsizing of these water main pipelines to accommodate future development. The Developer wishes to enter into an "Improvement and Reimbursement Agreement for Water Facilities — Gateway Community Church of the Nazarene" for the cost of upsizing the offsite water facilities. Staff recommends the approval of the "Improvement and Reimbursement Agreement for Water Facilities — Gateway Community Church of the Nazarene". B. Background The Developer was required by the District to construct a 12 -inch domestic water pipeline and an 8 -inch non-domestic water pipeline in Rancho Viejo Road to provide for its project's water demands. Staff recommends the upsizing of these water main pipelines to 16 -inch domestic and 12 -inch non-domestic water pipelines. The District 4�� FOR CITY COUNCIL AGCV Vv D 0 0 AGENDA ITEM -2- June 6, 2000 will only pay the cost of the upsizing, as the additional capacity would benefit other surrounding areas. The upsizing of these water main pipelines will benefit the surrounding area and provide for additional water capacity for future development. In accordance with the District's newly adopted "Water Master Plan", these water pipelines are scheduled for construction in the year 2003. The Developer has agreed to construct for the District the upsizing of the offsite water facilities in conjunction with the subject development in order to minimize construction activities along the project frontage. It is advantageous and cost effective to the District to go ahead with the water pipeline upsizing now while the Developer is constructing the proposed infrastructures and street improvements in Rancho Viejo Road. COMMISSIONBOARD REVIEW, RECOMMENDATIONS None FINANCIAL CONSIDERATIONS The District will reimburse the Developer, an amount of $96,533.35 for the cost of upsizing the water pipelines, when said water improvements are deemed complete and acceptable to the satisfaction of the City Engineer. The reimbursement cost for this project is included in the Capital Improvement Projects budget for the fiscal year 2000-01. NOTIFICATION Pastor Jim Tracy, Gateway Community Church of the Nazarene Ronald Soderling, Resco Development Jack Lancaster, Contour Paving Dino Capannelli, Fusco Engineering ALTERNATE ACTIONS By motion: Approve the Improvement and Reimbursement Agreement for Water Facilities — Gateway Community Church of the Nazarene. 2. Do not approve the Improvement and Reimbursement Agreement. 3. Refer to Staff for additional information. P:\ENG\DVLP\SP\RESCO\IMPREBRS. DOC 0 0 AGENDA ITEM -3- June 6, 2000 RECOMMENDATION By Motion: Approve the Improvement and Reimbursement Agreement for Water Facilities — Gateway Community Church of the Nazarene. 2. Authorize the Chairman and Clerk of the Board to execute the Improvement and Reimbursement Agreement on behalf of the District. Respectfully Submitted: William M. Huber, P.E. Director of Engineering & Building WMH/CLH:ch Attachments: Prepared By: Craig L. Harris Assistant Engineer 1. Improvement and Reimbursement Agreement for Water Facilities — Gateway Community Church of the Nazarene 2. Location Map PAENG\DVLP\SP\RESCO\IMPREBRS. DOC 0 0 Improvement and Reimbursement Agreement Gateway Community Church of the Nazarene Page 5 EXHIBIT A PUBLIC IMPROVEMENTS TO BE CONSTRUCTED BY DEVELOPER SUBJECT TO REIMBURSEMENT FROM DISTRICT Construction of 1585 linear feet of 16 -inch domestic water main pipeline, 1470 linear feet of 12 - inch non-domestic water main pipeline, and appurtenances in Rancho Viejo Road. SUMMARY OF REIMBURSABLE COST IMPROVEMENTS SUBJECT TO REIMBURSEMENT ESTIMATED AMOUNT Upsize Proposed 12 -inch Domestic Water Main Pipeline to 16 -inch $68,212.25 Upsize Proposed 8 -inch Non -Domestic Water Main Pipeline to 124nch $28,321.10 Subtotal $96,533.35 TOTAL $96,533.35 The surety bonds shall be posted with the City prior to issuance of Encroachment/Construction Permit for said improvements. I ArATIflW v I 1 I G1MIN0 L.\S RpMBlfS � ' .. ..... MI +— • BOND ISSUED IN THREE COUNT TS BOND 15150S PREMIUM$3,706.00is' KNOW ALL ME v BY THESE PRESENTS: FOR THE TERM of z YRS GATEWAY COMMUNITY CHURCH SUBJECT TO RENEWAL That we, _ OF THE NAZARENE as Principal, anfl DEVELOPERS INSURANCE COMPANY Corporation, creat d, organized, and existing and by virtue of the laws of the State of CALIFORNIA duly licensed to transact a general surety business in the State of California, as Surety, are held and firmly bound to th, CAPISTRANO VALLEY WATER DISTRICT, State of California, in th& uu QL_ ONE HUNDRED, EIGHTY—FIVE THOUSAND, THREE HUNDRED, TWO & 70/100 --------------- DOLLARS, lawful noney of the United States of America, to be paid to the said District for which payment well and truly to be made we bind ourselves, our heirs, executors and successors, jointly and severally. THE CONDITION OF THE FOREGOING OBLIGATION is such that whereas the above bounden Principal has agree I to do and perform the following, to -wit: Construct: nd install all of the water faciiities pursuant to Agreement for Construction of Water Fi cilities entered into on , 199_, by and between CAPISTRANO 'r :.lwf YV.T2�i ,:IS7nI:.T, enc GATEWAY COMMUNITY CHURCH OF THE NAZARENE a o:py o: which is attached hereto and made a part hereof. As ! tar, of the obligation secursd -ereby, and in acciticn to the 'ace mount scec:fiec. there shall be inciu,ied costs and reasonable expenses ana fees, including reasoname attorney's fees, mooned by Caoistr ano Valley Water District in succassfuliv enfarcing sucn obligation, all tc Ze ,exec as costs ano inciucsa in any jucgment renaerac. 2. Said Surety, for value received, hereby stipuiates and agrees that no change, axtensicn of tine, alteration or modification of the contract documents or of the work to be pecormec 3tereuneer, shall in any way afed-. its obligations or tnis bona, and it does nereoy waive notice of any, sud : change, exter Sion of time, alteraticnS or mCcitlC3ticr,s .ne =nL'act :=Laments :r :f wc,it be performed therefnder. NOW, THEi 1£FORE, the condition of this obligation is such that is the bounden Principal shall, to the satisfaction rnf the CAPISTRANO VALLEY WATER DISTRICT faithfully and properly perform ail of the work describ rd in said Agreement and in accordance with the pians and specifications approved for said work and snail pay all sums due for all damages suffered by said District' by reason of faulty or defective work or ti ie carelessness or negligence of said Principal and for the completion of any work not satisfactorily or properly performed in accordance with the Agreement between District and Principal, and guar; ntee all work for a period of one year after accsptancs in acccrdanca with said Agreement, then, a t the expiration of said guarantee period, ,his obligation shai! be null and void: otherwise to remair in full force and effect. IN WT NES: i WHEREOF said Principal and Surety have caused this bond to be executed by their officers thereunto culy authorized this L4_ day of NOVEMBER , 1999 . GATEWAY COMMUN TY CHURCH OF THE NAZARENE PRINCIPAL, _ (SEAU By. - SU .E�RANCE COMP ISEAU ay: Atto By In Fact MARIE T. ROUSSERE The premium on tris bond is Mailing Address of Surety: $ 3,706.00 17780 FITCH SUITE 200 PREMIUM IS FOR THE TERM OF IRVINE, CA 92614 TWO YEARS – SUBJECT TO (949) 263-3300— RENEWAL (Executed in Tripli=ate) 2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of CALIFORNIA County of ORANGE On SEPTEMBER 8. 2000 before me, ISABEL ZAVALA, NOTARY PUBLIC Date Name and Title of Officer (e.g., "Jane Doe. Notary Public') personally appeared RICHARD H. NANCE Names) of Signers) ❑ personally known to me – OR – IN proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in hisiher/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, 10"I'm 1AVAtA executed the instrument. CommMion 81133138 s p, NctoryPubIC—CollfgNO ! orange County WITNESS my hand and official seal. N^i Ccmm, Expires Apr 13.2001 Signalur of N Lary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: BOND NO. 815150S Document Date: NOVIIIDER 24, 1999 Number of Pages: 2WO Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: RICHARD H. NANCE ❑ Individual ❑ Corporate Officer Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney -in -Fact [X Trustee ❑ Guardian or Conservator ❑ Other: Top of Thumb here Signer Is Representing: GATEWAY COMMUNITY CHURCH 8i$JfiY01�0I�VAG\ 7a'�I�—I Signer's Name: Individual Corporate Officer Title(s): Partner — ❑ Limited ❑ General Attorney -in -Fact Trustee Guardian or Conservator ❑ Other: Signer Is Representing: RIGHT THUMBPRINT OF SIGNER 0 1995 National Notary Association • 8236 Remmet Ave., PO. Box 7184 • Canoga Park, CA 91309-7184 Prod, No. 5907 Reorder: Call Toll -Free 1800-876-6827 STATE OF CALIFORNIA SS. COUNTY OF ORANGE On NOVEMBER 24, 1999 , before me, CYNTHIA S. INGRAHAM PERSONALLY APPEARED MARIE T. ROUSSERE personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signatur�.J OPTIONAL CYNTHIA S.INGAAHAM Comm. 11188015 N r - . I NOiABY PUBLIC -CALIF OR141 Sbnementu County t _--._....... ....,I, -K...",.,15 2002 , This area for Official Notarial Seal Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER 8151sin S TITLE OF TYPE OF DOCUMENT ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL 0 ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER IS REPRESENTING: NAME OF PERSON)5) OR ENTITYQES) DEVELOPERS INSURANCE COMPANY TWO NUMBER OF PAGES NOVEMBER 24, 1999 DATE OF DOCUMENT SIGNER(S) OTHER THAN NAMED ABOVE ID -081 Rev. 6/94 ALL-PURPOSE ACKNOWLEDGEMENT POWER OF ATTORNEY OF I% MNITY COMPANY OF CALIFORIF AND DEVELOPERS INSURANCE COMPANY P.O. BOX 19725, IRVINE, CA 92623 • (949) 263-3300 N2 0 6 0 5 5 2 NOTICE: 1. All power and authority herein granted shall in any event terminate on the 31 st day of March, 2002. 2. This Power of Attorney is void if altered or if any porton is erased. 3. This Power of Attorney is void unless the seal is readable, the text is in brown ink, the signatures are in blue ink and this notice is in blue ink. 4. This Power of Attorney should not be returned to the Attorney(s)-In-Fact, but should remain a permanent part of the obligee's records. KNOW ALL MEN BY THESE PRESENTS, that except as expressly limited, INDEMNITY COMPANY OF CALIFORNIA and DEVELOPERS INSURANCE COMPANY, do each severally, but not jointly, hereby make, constitute and appoint ***James E. Mary, Virginia M. Louman, Joan M. Wynn, Michelle Haase, Cynthia S. Ingraham, Marie T. Roussere, Michael J. Hensel, Nell Amyx, jointly or severally*** the true and lawful Attorney(s)-In-Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations as sureties, bonds, undertakings and contracts of suretyship in an amount not exceeding Ten Million Dollars ($10,000,000) in any single undertaking; giving and granting unto said Allorney(s)-In-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation; and all of the acts of said Attorneyls)-In- Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Board of Directors of INDEMNITY COMPANY OF CALIFORNIA and DEVELOPERS INSURANCE COMPANY, effective as of September 24, 1986: RESOLVED, that the Chairman of the Board, the President and any Vice President of the corporations be, and that each of them hereby is, authorized to execute Powers of Attorney, qualifying the attorneys) named in the Powers of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporation when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, INDEMNITY COMPANY OF CALIFORNIA and DEVELOPERS INSURANCE COMPANY have severally caused these presents to be signed by their respective Presidents and attested by their respective Secretaries this 22nd day of December, 1998. INDEMNITY COMPANY OF CALIFORNIA DEVELOPERS INSURANCE COMPANY By ameV By Ql& umami Dani4 F. Vincenti, Jr. Dante incenti, Jr. President OpMPP0 Y0'° P sident ID ATTESTV "449— iJ4/(FI/V L By ♦By Walter Crowell Wafter Crowell - Secretary Secretary STATE OF CALIFORNIA I ) SS. COUNTY OF ORANGE I On December 22, 1998, before me, C. Hollister, personally appeared Dante F. Vincenti, Jr. and Walter Crowell, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s1 is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(tes), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS y hand and official seal. i� 1 ' C. HOLLISTER (/ pCOMM. # 1192615 Signature �Qy Notary Public -California � >yORANGE COUNTY Comm. Expires AUG. 11, 2002 CERTIFICATE The undersigned, as Senior Vice President of INDEMNITY COMPANY OF CALIFORNIA, and Senior Vice President of DEVELOPERS INSURANCE COMPANY, does hereby certify that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the provisions of the resolutions of the respective Boards Of Directors of said corporations set forth in the Power of Attorney, are in force as of the date of this Certificate. ll(ln This Certificate is executed in the City of Irvine, California, thi24 h day oI November , 1922_. INDEMNITY COMPANY OF CALIFORNIA DEVELOPERS INSURANCE COMPANY �`_ OµPANYOF ypl$Uk4N �ii2ii �i�/ //%/ ~ PO, 9 'Qi�i�'{/�/�I'/�� 44. VOe.P09C'C RY T Li/ i OCT 5 a :� BY William T Sherer ,y tee? x William T. Sherer " tine a a o s Senior Vice President oyv Op eesp,p2 Senior Vice President ID -314 REV. (12/98)