1994-0701_O C TRANSPORTATION AUTHORITY_AgreementAGREEMENT NO. C-94-797
1 AGREEMENT
2 THIS AGREEMENT, is entered effective July 1, 1994, by and between the City of
3 San Juan Capistrano ("PURCHASER") and the Orange County Transportation Authority, a
4 public corporation of the state of California ("AUTHORITY").
5 WHEREAS, AUTHORITY is experienced in the transportation of seniors, and persons
6 with disabilities, and
7 WHEREAS AUTHORITY is a provider of mass transportation services to meet the
8 special needs of the elderly and persons with disabilities; and
9 WHEREAS, AUTHORITY has entered into Agreement No. C-92-386 with a third party
10 contractor ("CONTRACTOR") to provide transportation services for the elderly pursuant
11 to the Older Americans Act of 1965, as amended; and
12 WHEREAS, AUTHORITY reimburses CONTRACTOR through Agreement No. C-92-386 with
13 funds pursuant to Article 4.5 of the Transportation Development Act of 1972 among
14 other funds to support transportation services in the county; and
15 WHEREAS, PURCHASER is desirous of purchasing "Social Services" transportation
16 service from AUTHORITY.
17 NOW THEREFORE, in consideration of the respective and mutual covenants and
18 promises hereinafter contained and made, and subject to all the terms and conditions
19 hereof, the parties hereto agree as follows:
20 1. AUTHORITY, through its Agreement with CONTRACTOR, assumes all responsibility
21 for the operation, scheduling and maintenance of any vehicles which are to be
22 operated in the performance of this Agreement and cost thereof except to the
23 extent this Agreement provides otherwise.
24 2. AUTHORITY and/or CONTRACTOR, shall obtain and maintain all licenses,
25 registrations and accreditations from agencies governing its operation, which
26 are necessary for AUTHORITY to perform its obligations under this Agreement.
DP:BY
SANJUAN. AGG
Page 1 of 6
AGREEMENT NO. C-94-797
1
3. AUTHORITY shall ensure that CONTRACTOR obtain at its sole cost and file with
2
PURCHASER, prior to exercising any right or performing any obligation pursuant
3
to this Agreement and maintain for the period covered by the Agreement, the
4
following insurance, which shall be full-coverage insurance not subject to
s
self-insurance conditions-
6
(1) Comprehensive General Liability insurance with at least One Million
7
Dollars ($1,000,000.00) per occurrence; and
s
(2) Comprehensive Automobile Liability insurance of combined single
9
limit Primary Bodily Injury and Primary Property Damage in an amount not less
10
than Two Million Dollars ($2,000,000.00) per occurrence.
11
(3) Workers' Compensation insurance with limits established and
12
required by the State of California.
13
Should any of the above described policies be canceled before the expiration
14
date thereof, the issuing company will endeavor to mail 30 day written notice
15
to the certificate holder named.
16
4. AUTHORITY, through its agreement with the CONTRACTOR, shall employ only
17
qualified drivers to operate any vehicles in performance of this Agreement.
18
Prior to employment, CONTRACTOR shall review the records maintained and made
19
available by the Department of Motor Vehicles regarding each of said drivers.
20
Each of said drivers shall possess and maintain any licenses or certificates
21
required by law and necessary for their individual performances on behalf of
22
CONTRACTOR under this Agreement. AUTHORITY, through its agreement with
23
CONTRACTOR shall be solely responsible for the supervision of said drivers in
24
the performance of their duties.
25
5. Notwithstanding any other provision of this Agreement, AUTHORITY and PURCHASER
26
agree to comply with all applicable federal, state and local laws and
DP:ev
SAN.IUAN.AG4
Page 2 of 6
AGREEMENT N0. C-94-797
1
regulations.
2
6.
AUTHORITY shall ensure that CONTRACTOR establishes, maintains, and preserves
3
records which include and substantiate costs of all labor and materials related
4
to the performance of this Agreement and documentation which substantiates
5
CONTRACTOR's performance of transportation services pursuant to this Agreement.
6
AUTHORITY, through its agreement with CONTRACTOR shall make all of the above
7
records available, upon reasonable prior notice, to PURCHASER during regular
8
business hours.
9
7.
AUTHORITY shall indemnify, defend and save harmless PURCHASER, its officers,
10
directors, employees and agents from and against any and all claims (including
11
attorney's fees and reasonable expenses for litigation or settlement) for any
12
loss or damages for bodily injuries, including death or loss of, damage to or
13
loss of use of property caused by the negligent acts, omissions or willful
14
misconduct by AUTHORITY, its officers, directors, employees, agents,
15
subcontractors or suppliers in connection with or arising out of the
16
performance of this Agreement.
17
8.
PURCHASER shall indemnify, defend and save harmless AUTHORITY, its officers,
18
directors, employees and agents from and against any and all claims (including
19
attorney's fees and reasonable expenses for litigation or settlement) for any
20
loss or damages for bodily injuries, including death or loss of, damage to or
21
loss of use of property caused by the negligent acts, omissions or willful
22
misconduct by PURCHASER, its officers, directors, employees, agents
23
subcontractors or suppliers in connection with or arising out of the
24
performance of this Agreement.
25
9.
CONTRACTOR shall pick up, transport and deliver such passengers at and to such
26
locations and at such times as are described in EXHIBIT A - STATEMENT OF
NP M
SANJUAN.AG9
Page 3 of 6
AGREEMENT N0. C-94-797
1
SERVICES - attached hereto and by this reference incorporated herein.
2
10.
For services provided by AUTHORITY under this Agreement, PURCHASER shall pay
3
AUTHORITY the amount of One Dollar and Twenty-Four Cents ($1.24) per passenger
4
trip up to but not to exceed the amount of Five Thousand, Six Hundred Dollars
5
($5,600.00), which shall be PURCHASER's total contribution under this
6
Agreement. AUTHORITY shall submit quarterly invoices to PURCHASER for payment
7
pursuant to this Agreement at the close of each of the following periods: for
8
the period July 1, 1994, through September 30, 1994; for the period
9
October 1, 1994, through December 31, 1994; for the period January 1, 1995
10
through March 31, 1995; and for the period April 1, 1995, through June 30,
1t
1995. Failure of PURCHASER to pay AUTHORITY amount due under this contract
12
within 60 days from date of invoice shall entitle AUTHORITY to, in addition to
13
any other legal remedies available to AUTHORITY, suspend or diminish its
14
performance under this Agreement if it so elects.
15
11.
All notices pertaining to this Agreement, and any communications from the
16
parties may be made by delivery of said notices in person or by depositing said
17
notices in the U.S. Mail, registered or certified mail, return, receipt
18
requested, postage prepaid and addressed as follows:
19
To AUTHORITY:
20
Orange County Transportation Authority
21
550 South Main Street
22
P.O. Box 14184
23
Orange, CA 92613-1584
24
Attention: Contracts Administrator
25
/
26
/
ON BY
SAND AN.AG4
Page 4 of 6
AGREEMENT NO. C-94-797
1
To PURCHASER:
2
City of San Juan Capistrano
3
32400 Paseo Adelanto/City Hall
4
San Juan Capistrano, CA 92675
5
Attention: Dawn Schanderl, Records Coordinator
6
12.
Any of the parties may cancel this Agreement by giving thirty (30) days written
7
notice of said cancellation to the other party hereto. In the event of
8
termination or cancellation for any reason, AUTHORITY shall return to PURCHASER
9
any money or other property allocable to the post termination/cancellation
10
period.
11
13.
The terms of this Agreement shall be one (1) year, or that portion of a year
12
commencing July 1, 1994, and expiring at the end of business or 5:00 p.m.
13
whichever occurs last on June 30, 1995.
14
14.
This document fully expresses all understandings of the parties concerning all
is
matters covered and shall constitute the total Agreement. No prior written or
16
oral provisions or understanding, between the parties shall have any force or
17
affect. No addition to or alteration of the terms of this Agreement shall be
18
valid unless made in writing and formally adopted in the same manner as this
19
Agreement.
20
/
21
/
22
/
23
/
24
/
25
/
26
/
GP:Bw
SANJUAN. AGO
Page 5 of 6
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ovav
SANJUAN.AG4
0 0
AGREEMENT NO. C-94-797
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date
first above written.
B;
M
ORANGE C NTY TRRA-NSPlO,RTATION AUTHORITY
BygOa
4 f _�'
�(/�L�
ftelieExecutive Officer
By L-'V� -
Kennard R. Smart, Ji.
General Counsel
Page 6 of 6
EXHIBIT A
1. The AUTHORITY, through its agreement with a third party
CONTRACTOR, shall schedule and operate a vehicle or vehicles
Monday through Friday within the present hours of service provided to
the identified site or sites in Item 4. Additional service within budgetary
constraints may be available outside the regular service hours.
2. The AUTHORITY may, at its discretion, utilize the assigned vehicle or
vehicles for any purpose it deems necessary at any time when senior
passengers are not being transported.
3. The AUTHORITY shall assign any equipment it feels appropriate for the
needs of the client type and reserve the right to reassign both
equipment and driver as needs change.
4. Service shall be provided to the following site or sites located at:
San Juan Capaistrano Senior Center
31421 La Matanza
San Juan Capistrano, CA 92675
5. The AUTHORITY, through its CONTRACTOR, may, at its discretion,
deny transportation to passengers who may pose a danger to
themselves, other passengers or the drivers.
0 10
6. All rides provided by the AUTHORITY through its CONTRACTOR shall
be on a space available basis. Geographic considerations may affect
the AUTHORITY's ability to schedule riders. Further, site managers
should be aware that the number of individuals assigned to a given
route may affect service quality and route integrity.
7. The AUTHORITY, through its CONTRACTOR, requires that passengers
be ready at the agreed pick-up time. The CONTRACTOR's drivers shall
wait only five minutes after the scheduled pick-up time. Passengers
who need to cancel scheduled rides, must do so at least one hour
prior to scheduled pick-up times. Additionally, a "No Show" policy
provides for removal from the service of passengers who do not
comply with this policy.
8. "Will Call" passengers must notify the CONTRACTOR by 0730 of the
morning they wish to ride.
DRBY
SANJUAN.AG4
PRODUCER
Averbeck Company
3380Shelby St.
Ontario, CA 91764
INSURED
Dave Transportation Services,
Inc.
201 E. Sandpointe, Ste. #800
Santa Ana, CA 92707
ONLY AND CONFERS NO RIGHTS UPOI
HOLDER. THIS CERTIFICATE DOES NOT
COMPANY
AGreat States Ins. Co.
COMPANY
BGreat American
COMPANY
COMPANY /
D �/ c
12
EXTEND OR
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.
(LTR
TYPE OF INSURANCE
I POLICYNUMBER
POLICY EFFECTIVE(
OATE(MM/DDJYYj
POLICY EXPIRATION
GATE(MM(00/hYj
LIMITS
AUTO ONLY -EA ACCIDENT $
GENERAL
LIABILITY
OMMERCIAL GENERAL UASiLM
CLAIMSMADE❑ OCCUR
WNER'S& CONTRACTOR'S PROT
AGGREGATE $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
GENERAL AGGREGATE S
PRODUCTS-COMP/OPAGG $
EACH OCCURRENCE $
PERSONAL&ADV INJURY S
EACHOCCURRENCE $
FIRE DAMAGE (Any one fire) $
DMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
SINGLE LIMIT
PROPERTY DAMAGE
B OTHER Blanket MAC789173601 12/31/94 12/31/95 $100,000 Limit.
mployee $1,000 Deductible.
ishonesty
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
Verification of Insurance. *10 Day Notice of Cancellation applies for
Non Payment of Premium.
City of San Juan Capistrano
Attn. Linda Evans
32400 Paseo Adelanto/ City Hall
San Juan Capistrano, CA 92675
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE
EXPIRATION DATETHEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
". _� 0 PAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUTFAILURE4"AILSUC NOTIC A CMFI\POaENOOBLIGATIONORLIABILITY
AUTHORIZED
GARAGE
LIABILRY
ANY AUTO
AUTO ONLY -EA ACCIDENT $
OTHER THAN AUTO ON LV. :....... _. _..::.<::.. _........,,..::.::
EACH ACCIDENT S
AGGREGATE $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
_-6-1-7-0-1-T9-5
EACH OCCURRENCE $
AGGREGATE $
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY I�
THE PROPRIETOR/ IAIINCL
PARTNERS/EXECUTIVE
__ _ _
GWN10071295
-0-1-7-0-1-T9-6
STATUTORVLIM ITS
EACH ACCIDENT el OOO OOO
d
DISEASE -POLICY LIMIT $1 000 000
I - — — — — — —
B OTHER Blanket MAC789173601 12/31/94 12/31/95 $100,000 Limit.
mployee $1,000 Deductible.
ishonesty
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
Verification of Insurance. *10 Day Notice of Cancellation applies for
Non Payment of Premium.
City of San Juan Capistrano
Attn. Linda Evans
32400 Paseo Adelanto/ City Hall
San Juan Capistrano, CA 92675
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE
EXPIRATION DATETHEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
". _� 0 PAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUTFAILURE4"AILSUC NOTIC A CMFI\POaENOOBLIGATIONORLIABILITY
AUTHORIZED
December 8, 1994
Orange County Transportation Authority
Attention: Contract Administrator
550 South Main Street
Orange, California 92613-1584
Dear Gentlemen:
MEMBERS OF THE CITY COUNCL
COLLENE CAMPBELL
GARY L HAUSDORFER
OIL JONES
CAROLYN NASH
JEFF VASOUEZ
CITY MANAGER
GEORGE SCARBOROUGH
•
The Workers' Compensation Certificate of Insurance, regarding the above -referenced service, is due
to expire on January 1, 1995. In accordance with your agreement, the insurance certificate needs to
be renewed for an additional period of one year.
Please forward an updated certificate to the City of San Juan Capistrano, attention City Clerk's office,
by January 6, 1995.
If you have any questions, please contact me at (714) 443-6310.
Thank you for your cooperation.
{vLVery�tr�)�ully yours,
(
/ `d,�, a��
Dawn M. Schanderl
Deputy City Clerk
cc: Cheryl Johnson, City Clerk
Linda Evans, Community Services Supervisor
32400 PASEO ADELANTO, SAN JUAN CAPISTRANO, CALIFORNIA 92675 • (714) 493.1171
Acke p. CERTIFICA OF INSURANCE ISSUE DATE (MM/DDIVV)
1101 94
PRODUCER
HIS CERTIFICATE IS ISSUED AS A MATTE OF INF RMATI N ONLY AND
"
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
k RODES—ROPER—LOVE INS. AGENCY, INC.
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
P. O. BOX 700
POLICIES BELOW.
MELBOURNE, FL 32902-0700
COMPANIES AFFORDING COVERAGE
i
ONV
LETTEROMPAA NATIONAL UNION FIRE INS CO OF PITTSBURGH PA
LETTERNY B GENERAL STAR NATIONAL / OXBRIDGE
INSURED
DAVE MANAGEMENT, INC.
COMPANY
LETTER C
4 DAVE TRANSPORTATION SERVICES, INC.
f VAN TRAN OF TUCSON, INC.
TTER"Y D
DAVE FLEET MANAGEMENT
COMPANY E
LETTER
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD j
IINDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
SI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER
LTR
POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MM/DDIVY) DATE (MM/DD/YY)
GENERAL LIABILITY
GENERAL AGGREGATE $ 5,000,000
A XCOMMERCIAL GENERAL LIABILITY MLG2367703
11/01/94 11/01/95 PRODUCTS-COMP/OP AGG. 35,000,000
CLAIMS MADE X OCCUR.
PERSONAL & ADV. INJURY
$5,000,000
OWNER'S& CONTRACTOR'S PROT.
EACH OCCURRENCE $ 5,000,000
FIRE DAMAGE (Any one (ire) IS 50,000
MED. EXPENSE (Any one person) $
AUTOMOBILE LIABILITY
COMBINED SINGLE
LIMIT $ 29500,000
A X ANY AUTO M[A2042028
11/01/94 11/01/95
ALL OWNED AUTOS
{
BODILY INJURY $ ,
SCHEDULED AUTOS
(Per person)
X HIRED AUTOS
BODILY INJURY
$
X NON OWNED AUTOS
(Per accident)
GARAGE LIABILITY
PROPERTY DAMAGE $
EXCESS LIABILITY
EACH OCCURRENCE $2,500,000
UMBRELLA FORM
AGGREGATE $
B X OTHER THAN UMBRELLA FORM NXG322881
06/01/94 11/01/95
f WORKER'S COMPENSATION
STATUTORY LIMITS
AND
EACH ACCIDENT IS
DISEASE—POLICY LIMIT $
EMPLOYERS' LIABILITY
�
DISEASE—EACH EMPLOYEE $
OTHER
fr
A PHYSICAL DAMAGE MLA2042028
11/01/94 11/01/95 $10,000. DID. COMP.
$10,000. DED. @91.L.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CITY OF SAN JUAN CAPISTRANO, ITS OFFICERS, AGENTS AND EMPLOYEES ARE
SHOWN AS ADDITIONAL INSUREDS AS RESPECTS
TO THE _
OPERATIONS OF THE NAMED INSURED ONLY
CERTIFICATE HOLDER
CANCELLATION m
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEI ANCEWLED BEFORE THE
CITY OF SAN JUAN CAPISTRANO
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WI��I
ATTN: DAWN SCHANDERL
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
RECORDS COORDINATOR
LEFT,
32400 PASEO ADELANTO CITY HALL
xau�xw tiaarr�acaraatacDadcal�awMNrs xo�NaxaDiaxxxgs�cazau�esx
SAN JUAN CAPISTRANO, CA 92675
AUTHORIZED REP ENTATIVE
`
ACORD 25-S (7190)
CACORD CORPORATION 1990
0
0
ADDITIONAL INSURED ENDORSEMENT
Attached to and forming a part of the Certificate of
Insurance dated 11/01/94
Policy: $NXG322881
Issued to: CITY OF SAN JUAN CAPISTRANO
ITS OFFICERS, AGENTS & EMPLOYEES
The Certificate Holder named above is shown as an Additional insured as
respects to the operations of the named insured only to the extent of
liability assumed by the Named Insured under the contract between the
Certificate Holder and the Named Insured pursuant to which this
certificate is issued, subject to the policy terms and conditions.
g /'-/� �(-
Richard P. Ldiie, Jr.
Authorized Representative
General Star National
CITY OF SAN JUAN CAPISTRANO
j ATTN: DAWN SCHANDERL
RECORDS COORDINATOR
32400 PASEO ADELANTO CITY HALL
SAN JUAN CAPISTRANO, CA 92675
ACORD 26-S
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL
MAIL ___3_0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT,
i
AU RIZED REPRES NTATIVE
m,ernRn mwonoennu conn I
CERTIFICA OF INSURANCE ISSUE DATE (MM/DD/VY
1/27/94
I PRODUCER r
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
K,
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
RODES-ROPER-LOVE INSURANCE AGENCY, INC.
POLICIES BELOW.
P. 0. BOX 700
COMPANIES AFFORDING COVERAGE
f MELBOURNE, FL 32902-0700
COMPANY
LETTER A NATIONAL UNION FIRE INS. CO. OF PITTSBURGH PA
COMPANY B
1 INSURED
LETTER
COMPANY
C
DAVE MANAGEMENT, INC.
LETTER
DAVE TRANSPORTATION SERVICES, INC.
COMPANY
D
VAN IRAN OF TUCSON, INC.
LETTER
DAVE FLEET MANAGEMENT
COMPANY E
LETER
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. "
ICO TYPE OF INSURANCE POLICY NUMBER
{LTR
POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MMIDDIYY) DATE (MMIDDIYY)
GENERAL LIABILITY
GENERAL AGGREGATE $ 5,000,000
A X COMMERCIAL GENERAL LIABILITY MLG5244555
02/01/94 02/01/95 PRODUCTS-COMPIOP AGG. $ 5,000,000
CLAIMS MADE 'OCCUR.
PERSONAL& ADV. INJURY $ 5'000'000
OWNER'S & CONTRACTOR'S PROT.
EACH OCCURRENCE $ 5,000,000
FIRE DAMAGE (Any one fire) $ 50,000
MED. EXPENSE (Any one person) $
AUTOMOBILE LIABILITY
COMBINED SINGLE I
LIMIT $ 2,500,000
1 A X ANY AUTO MLA2038662
02/01/94 02/01/95
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS
(Per person)
X HIRED AUTOS
BODILY INJURY
$
X NON -OWNED AUTOS
(Per accident)
GARAGE LIABILITY
PROPERTY DAMAGE $
j EXCESS LIABILITY
EACH OCCURRENCE $
UMBRELLA FORM
AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
STATUTORY LIMITS
i AND
EACH ACCIDENT $
DISEASE—POLICY LIMIT $
EMPLOYERS' LIABILITY
FDISEASE—EACH
EMPLOYEE $
OTHER
I
i A PHYSICAL DAMAGE MLA2038662
02/01/94 02/01/95 $1,0000. DDID:
1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CITY OF SAN JUAN CAPISTRANO, ITS OFFICERS, AGENTS AND EMPLOYEES ARE
j SHOWN AS ADDITIONAL INSUREDS AS RESPECTS
TO THE
L OPERATIONS OF THE NAMED INSURED ONLY
CITY OF SAN JUAN CAPISTRANO
j ATTN: DAWN SCHANDERL
RECORDS COORDINATOR
32400 PASEO ADELANTO CITY HALL
SAN JUAN CAPISTRANO, CA 92675
ACORD 26-S
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL
MAIL ___3_0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT,
i
AU RIZED REPRES NTATIVE
m,ernRn mwonoennu conn I
•
. ... .... ..... . ... .. .. ... .
. ....... ISSUE DATE(MM/DD/YY)
No . .... 712/30/93
PRODUCER
Averbeck,Company
3380 Shelby St.
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.
Ontario, CA 91764
COMPANIES AFFORDING COVERAGE
COMPANY A Great States Ins. Co.
LETTER
COMPANY
LETTER
INSURED
Dave Transportation Services, Inc.
201 E. Sandpointe, Ste. #800
COMPANY C
LETTER
COMPANY D
LETTER
Santa Ana, CA 92707
COMPANY E
LETTER
. . . . .. . .
.. . ... . . . ....
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED
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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTH
TYPE OF INSURANCE
IPDUCYNUMEIER
POLICY EFFECTIVE
DATE(MM/DD/YY)
POLICY EXPIRATION
DATE(MM/DD/YY)
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE 5
PRODUCTS-COMP/OPAGO.
COMMERCIAL GENERAL LlAaILM
=�LAIMS MADE =OCCUR.
PERSONAL &ADV. INJURY
EACH OCCURRENCE
DWNERS & CONTRACTOR'S PROT.
FIRE DAMAGE(Anyone fire) $
MED.S(PENSE (Any one mrwn) S
AUTOMOBILE
LIABILITY
ANYAUTO
COMBINED SINGLE $
LIMIT
BODILY INJURY S
(Por person)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILYINJURY $
(PerwcIdent)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY
EXCESS LIABILITY
EACH OCCURRENCE $
AGGREGATE $
UMBRELLA FORM
STATUTORYLIMITS
EACH ACCIDENT Sl 000 000
OTHER THAN UM BRELLA FOR M
AWORKER'S
COMPENSATION
AND
EMPLOYERS' LIABILITY
GWR10052794
O1 O1 94
I
17 --
T7 6 9— 5
DISEASE -POLICY LIMIT $1,000,000
DISEASE -EACH EMPLOYEE $1,000,000
OTHER
—
=
DESrRlPnONOFOPERATIONS/LOGATIONS/VEHICLES/SPECIALITEMS
Verification of Insurance. *10 Day Notice of Cancellation applies for
Non Payment of Premium.
......... . . l........
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
City of San Juan Capistrano
MAIL * 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Attn. Linda Evans
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGA-noN OR
32400 Paseo Adelanto/ City Hall
LIABILITY OF ANY WIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
San Juan Capistrano, CA 92675
AUTHORIZED REPRESENTATIVE
CM
A _ Ab AgIRL A91h
RINVU
CE IS ATE (MMIDD/VY)
3-15-93
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Sedgwicik James of Ga,, Inc.
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
Suite 500, South Mower
POLICIES BELOW.
3333 PeachtT'ee Rd. NE
COMPANIES AFFORDING COVERAGE
Atlanta, Georgia 30326
COMPANY A
LETTER National UTIion Fire Iris. Co.
COMPANY B
INSURED
LETTER
DAVE Transportation Services,
Inc COMPANY
201 East Sandpointe #800
LETTER C
Santa Ana, CA 92 707
COMPANY D
LETTER
COMPANY E
LETTER
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DD/VY) DATE (MM/DD/YY)
GENERAL LIABILITY
GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY
PRODUCTS-COMP/OP AGO. $
CLAIMS MADE OCCUR.
PERSONAL & ADV. INJURY $
OWNER'S & CONTRACTOR'S PROT.
EACH OCCURRENCE $
FIRE DAMAGE (Any one fire) if
j
MED. EXPENSE (Any one pereon) $
IIi AUTOMOBILE LIABILITY
COMBINED SINGLE
ANY AUTO
LIMIT $
ALL OWNED AUT OS
j
BODILY INJURY
Ii SCHEDULED AUTOS
(Per person) $
i HIRED AUTOS
BODILY INJURY
$
NON -OWNED AUTOS
(Per accident)
GARAGE LIABILITY
PROPERTY DAMAGE $
EXCESS LIABILITY C LM 308 5924
5/01/92 5/01/94 EACH OCCURRENCE $2 500000
I UMBRELLA FORM
AGGREGATE $2500000
X OTHER THAN UMBRELLA FORM
7 ,500,000
WORKER'S COMPENSATION
STATUTORY LIMITS
Q
EACH ACCIDENT $
fk ANO
DISEASE—POLICY LIMIT $
EMPLOYERS' LIABILITY
DISEASE—EACH EMPLOYEE $
OTHER
i
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
�3ee Attached Endorsement
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
I
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL -S 61111W 16R 441
CITY OF SAN JUAN CAP I STRANO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
DAWN SCHANDERL—RECORDS COORD.
LEFT,
32400 PASEO ADELANTO/CITY HALL
SAN JUAN CAPISTRANO, CA. 9267)
AUTHORIZED EP NTAT E
- ��O/ 6
ADM 26$ (7/90)
®ACORD CORPORATION 1990
, I g
ADDITIONAL iVSURED ENDORSEMENT
Attaching to and forming a part of the certificate of insurance dated:
3-15-93
=ssued to:
City of San Juan Capistrano
its Officers, Agents and Employees
=`.e above Certificate Holder is added as an Additional Insured to the
extent of ::ability assumed by the Named Insured under the Contract
between the Certilicafe Holder and the Named Insured pursuant to
which this Certificate is issued; however the Certificate Solder shall
not be included as an Additional insured to the extent of their
willful misconduct.
Michael G. Crandall
authorized Representative