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01-1016_CAMP COOKIE FOR CHILDREN, INC_Inprovement and Reimbursement AgrRECORDED AT THE REQUEST OF AND RETURN TO: City of San Juan Capistrano City Clerk's Department 32400 Paseo Adelanto San Juan Capistrano, CA 92675 Recorded in Official Records, Counry of Orange Darlene (Bloom, Clerk -Recorder Illllill!INIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII!IIII!IIIIIIIIIII!34.00 2002001080057 0121pm 11(27102 119 80 1412 15 0.00 0.00 0.00 0.00 28.00 0.00 0 00 0.00 IMPROVEMENT AND REIMBURSEMENT AGREEMENT FOR WATER FACILITIES - CAMP COOKIE FOR CHILDREN, INC. THIS IMPROVEMENT AND REIMBURSEMENT AGREEMENT is entered into this 16th day of October, 2001, by and between CAPISTRANO VALLEY WATER DISTRICT, hereinafter referred to as "District" and CAMP COOKIE FOR CHILDREN, INC., a not -for profit corporation, hereinafter referred to as "Developer". THIS IMPROVEMENT AND REIMBURSEMENT AGREEMENT shall be administered by the CITY OF SAN JUAN CAPISTRANO, and the CITY OF SAN JUAN CAPISTRANO, hereinafter referred to as "City", enters into this Agreement on behalf of the "District", in accordance with Resolution No. 97-10-7-1. WITNESSETH Whereas, City and Developer have entered into a license agreement dated February 6, 2001, ("License Agreement"), for the use of a City owned property located within a portion of the North Open Space (NOS) properties; and, Whereas, Developer agrees to design and construct, at its sole cost and expense of an estimated amount of $65,562, the construction of the water facilities to Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. serve the properties known as Assessor's Parcel No. 121-050-19 and 121-050-21 hereinafter referred to as "Water Improvements'; and, Whereas, because the aforementioned water improvements benefit Assessor's Parcel No. 121-050-19 and 121-050-21, City owned parcels, Developer is therefore entitled to reimbursement for a portion of those cost of improvement; and, Whereas, the reimbursement shall consist of pro-rata contributions from future NOS property users, including City of San Juan Capistrano, who will develop City properties consistent with the "NOS Master Plan" and the property to be used by Developer under the License Agreement; and, Whereas, In accordance with the proportional fair share described in this Agreement, Developer agrees to be reimbursed by future NOS property users for their proportional fair share cost of the total reimbursable amount of $47,678.40, as describe in (Exhibit "A"), to construct a 12-inch water main pipeline and appurtenances as shown and delineated upon the improvement plans entitled "Public Water Improvements For The Camp Cookie For Children"; 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 improvements; and, 2 W:kENG\DV LP\COOKIEV±EIM BU RS.DOC Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. NOW, THEREFORE, BE IT RESOLVED BETWEEN CITY, DEVELOPER AND DISTRICT AS FOLLOWS: I. REIMBURSEMENT TO DEVELOPER Developer will be required by City and District to construct water improvements in order to provide water service to the Camp Cookie project. City hereby agrees to require any future NOS property users, as a condition of development of their approved use of parcels within the remaining NOS site, to pay a proportional fair share of Developers original cost to install the water improvements necessary to provide the required water demand to its site. A proportional fair share assigned to each future NOS property user is defined to mean a proportional fair share as determined by the City Engineer and District Engineer pursuant to a methodology developed and adopted by the City Engineer and District Engineer, which said methodology shall include consideration of one or more relevant factors, e.g., linear footage, acreage basis, property use, water demands, and cost of construction, as determined by the City Engineer and District Engineer. Developer obligations to construct, under Article IV hereof, and to pay for repairs, under Article VIII hereof, are contingent upon Developer's occupancy of the property under the License Agreement, or any extensions of the License Agreement. II. IMPLEMENTATION OF FAIR SHARE REQUIREMENT Upon receipt of any development application by a NOS property user, the City Engineer and District Engineer shall make a determination of fair share pro -rata payment requirement pursuant Section I. of this Agreement. The NOS property user 3 WASUM VLMOOKIMBEIMBURS.DOC 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. shall pay the fair share payment to City upon issuance of building permits. City shall then pay this contribution to Developer within forty-five (45) days from the date of City's receipt of the property user's contribution. III. Term This Agreement, and the reimbursement provisions to Developer, shall remain in full force and effect for a period of ten (10) years from the date of approval plus any additional period of time Developer occupies property under any extensions of the License Agreement. IV. CONSTRUCTION AND COMPLETION 1. Developer shall, its sole cost and expense, construct and install within twenty-four (24) months from the effective date of this Agreement, all of the water facilities shown and delineated upon the improvement plans entitled "PUBLIC WATER IMPROVEMENTS FOR THE CAMP COOKIE FOR CHILDREN" as approved by the District Engineer of the Capistrano Valley Water District and the City Engineer of the City of San Juan Capistrano and on file with said City and by reference made a part of this Agreement as though fully set forth herein. 2. Developer shall construct said water facilities in accordance with the approved plans, District's standard specifications and under City's inspection, and shall indemnify and hold harmless all officers, employees and agents of the City and District from and against all claims, damages, losses and expenses, including attorneys' fees, arising out of or resulting from the performance of the work, and caused in whole or in part by any negligent act or omission of Developer, Contractor, or any Subcontractor, 4 W:\ENG\DV LP\COO KIE\REIM BURS. DOC 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. anyone directly or indirectly employed by any of them, or anyone for whose acts any of them may be liable, regardless of whether or not it is caused in part by a party indemnified hereunder. 3. If Developer has not completed the work within twenty-four (24) months from the effective date of this Agreement, District has the right but not the obligation, to call the security for faithful performance and complete the work. Any work performed after said twenty-four (24) months, whether by Developer, District, or others, shall be in accordance with District's standard specifications in effect as of the time the work is performed. 4. The security shall remain in effect for a minimum of 365 consecutive calendar days after all the water facilities have been completed and accepted by District, and shall continue in effect until exonerated in writing by District. It shall be incumbent upon the developer to renew the security prior to its expiration. V. USE OF WATER 1. Developer hereby expressly agrees that no water shall be used by Developer, or by Contractor or any Subcontractor, for construction purposes except through a meter provided by District. Developer acknowledges that Section 499 of the California Penal Code provides that unauthorized use of water is a misdemeanor, and District hereby states its intent to strictly enforce said Penal Code Section. 2. In addition to any criminal penalties, and not as a substitute therefore, District will charge Developer, and Developer agrees to promptly pay District, $500.00 per day for unmetered use of District's water by Developer, Contractor, or any 5 W AENG\DVLP\COOKIE\RE1MBURS.DOC 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. Subcontractor, anyone directly or indirectly employed by any of them, or anyone for whose acts anyone of them may be liable. 3. Temporary construction meters shall be provided to Developer by District at the rental rate existing at the time such meters are provided. The use of "jumpers" is expressly prohibited. 4. Developer shall notify District as soon as it is reasonably practical to install any permanent meter, and District shall provide and install same as soon thereafter as reasonably possible. The foregoing notwithstanding, the District may install any meter when District determines it is desirable to do so. VI. FEES, CHARGES, AND SECURITIES 1. Developer shall, prior to the execution of this Agreement, pay District the following sums to allow for the construction of "Line A": (a) $3,005.62 for the costs of District's plan review, inspection of construction and the control thereof, and for the testing of materials, which sum is based upon the estimated construction cost of $44,860. (b) $100 for the upsizing cost to furnishing and installation by District of all permanent water meters, which sum is based upon the following number and size of meter: one (1) 2 -inch. 2. Developer shall, prior to the construction of "Line B", pay District the following sums: 6 W AENG\DVLP\COOKIE\REIMBURS.DOC 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. (a) $991.06 for the costs of District's plan review, inspection of construction and the control thereof, and for the testing of materials, which sum is based upon the estimated construction cost of $14,792. 3. In addition to the above sums, a surety bond to secure the faithful performance of this Agreement in the sum of $49,346 is hereby approved for the construction of "Line A". Prior to the commencement of line "Line B" the Developer shall provide a surety bond to secure the faithful performance of this Agreement in the sum of $16,271.20. 3. When additional buildings on this property are constructed, Capital Improvement Charges, Water Storage Charges, Water Capacity Charges, and Meter Fees for the additional development shall be paid prior to additional service being provided. VII. GUARANTEE Developer hereby guarantees the materials and the workmanship of the water facilities for a period ending 365 consecutive calendar days after the acceptance of said water facilities by District, and hereby agrees to reimburse District for all costs associated with the accomplishment of necessary repairs, not to include normal preventative maintenance, to said water facilities which may have been made by District within the aforesaid guarantee period. 7 W :TENGXDVLP\COOK0REIM B URS. DOC 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. VIII. GENERAL 1. Developer hereby offers to dedicate to District the water facilities together with necessary easements. 2. Upon completion of the construction in accordance with the improvement plans and specifications and the dedication of the necessary easements, District agrees to accept the water facilities, whereupon said water facilities shall become property of District with obligation to repair and maintain same. 3. The terms of this Agreement shall inure to the benefit of and be binding upon the successors and assigns of the parties hereto. 4. Should either party be required to enforce any of the terms of this Agreement, it is agreed that the prevailing party shall be entitled to costs and reasonable attorneys' fees. IX. INSURANCE AND INDEMNIFICATION During the construction period and for the purpose of construction Developer and/or Contractor's shall maintain in full force and effect the following insurance: 1. Comprehensive General Liability Comprehensive general liability coverage, including premises operations, products/completed operations, broad form property damage and blanket contractual liability in the following minimum amounts: $500,000 property damage; F, W :\ENG\DV LP\COOKIE\REIMBURS.DOC •Improvement and Reimbursem*Agreement • Camp Cookie for Children, Inc. • $500,000 injury to one person/any occurrence/not limited to contractual period $1,000,000 injury to more than one person/any one occurrence/not limited to contractual period. 2. Comprehensive Automobile Liability Comprehensive automobile liability coverage, including owned, hired and non - owned vehicles in the following minimum amounts: • $500,000 property damage; • $500,000 injury to one person/any occurrence/not limited to contractual period • $1,000,000 injury to more than one person/any one occurrence/not limited to contractual period. 3. Worker's Compensation During the construction period, if Developer or Contractor employs employees to perform services under this Agreement, Developer or Contractor shall obtain and maintain, Worker's Compensation Employer's Liability Insurance in the statutory amount as required by state law. These 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 insurance policies required under this Agreement. Developer shall indemnify and hold City/District harmless from any and all claims, demands, actions, attorney's fees, costs, and expenses based upon or arising out s W AENG\DVLP\COOKI"EIMBURS.DOC Improvement and ReimbursemOlAgreement • Camp Cookie for Children, Inc. of errors, omissions, or negligent acts of Developer, its associates, employees, subcontractors, or other agents while performing services under this Agreement. In the event an action is commenced by a party to this Agreement against any other party or parties hereto to enforce its rights or obligations arising from this Agreement, the prevailing party in such action, in additional to any other relief and recovery awarded by the court, shall be entitled to recover all statutory costs plus reasonable attorney's fees. X. 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. XI. 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: CITY OF SAN JUAN CAPISTRANO Attention: City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 TO: CAMP COOKIE FOR CHILDREN, INC. Attention: Dean Daggett, Law Offices One Park Plaza, Ste. 1250 Irvine, CA 92614-8509 to W AENGXDVLMOOKOREIMBURS.DOC -Improvement and Reim bursem*Agreement Camp Cookie for Children, Inc. XII. 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. XIII. 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. XIV. CITY BUSINESS LICENSE Developer will maintain a license to do business in the City of San Juan Capistrano. XV. INDEPENDENT AGENT At all times during the term of this Agreement, Developer shall be an independent agent and shall not be an employee of the City/District. City/District shall have the right to control Engineer only insofar as the results of Developer's services rendered pursuant to the Agreement; however, City/District shall not have the right to control the means by which Developer accomplishes services rendered pursuant to this Agreement. XVI. Developer shall be responsible for all injuries to persons and for damages to real or personal property of the City/District, caused by or resulting from any activity or W AENMI)VI-MCOOKIE REIMBURS.DOC Improvement and ReimburserIMIAgreement • Camp Cookie for Children, Inc. operation of Developer, its employees or its agents during the progress of or connected with the rendition of services hereunder. Developer shall defend and hold harmless and indemnify all officers, employees and agents of City/District from all costs and claims for damages to real or personal property or personal injury to any third party resulting from the activity of itself, employees or its agents. XVII. DEVELOPER NOT AN AGENT Except as City/District may specify in writing, Developer shall have no authority, express or implied, to act on behalf of the City/District in any capacity as an agent. Developer shall have no authority, express or implied, pursuant to this Agreement, to bind City/District to any obligation. XVIII. ATTORNEYS FEES 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 the reasonable attorney's fees and costs from the other parry. 12 W:tENGkDVLP\COOKIEkR EIM BURS.DOC Improvement and ReimbursemAgreement Camp Cookie for Children, Inc. IN WITNESS WHEREOF, the parties hereto have executed this Agreement, consisting of fourteen pages, on the above date. CAMP COOKIE FOR CHILDREN, INC. PO Box 1434 San Juan Capistrano, CA 92693 760-480-8509 By:.. John Frank, President Date:e7�/ lel (Attach Notary Acknowledgement) CITY OF SAN JUAN CAPISTRANO By: Wyatt art, Mayor Attest: rg ret R. Monahan City Clerk APPROVED AS TO FORM: By: Joh Shaw, City Attorney PUBLIC AGENCY FORM OF ACKNOWLEDGEMENT State of California ) County of Orange ) ss. City of San Juan Capistrano ) (Gov't Code 40814 & Civil Code 1181) On the 16`h day of October. 2001, before me, Margaret R. Monahan, City Clerk, personally appeared Wyatt Hart. Mayor personally known to me to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signatures on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and offi ial seal. a 13 W:1ENGIDVLMC00KIEREIM5URS.D0C Monahan, City Clerk %Improvement and Reim burser*Agreement • Camp Cookie for Children, Inc. EXHIBIT A PUBLIC IMPROVEMENTS TO BE CONSTRUCTED BY DEVELOPER SUBJECT TO REIMBURSEMENT FROM FUTURE PROPERTY USERS Construction of 700 linear feet of 12 -inch water main pipeline and appurtenances. SUMMARY OF REIMBURSABLE COST IMPROVEMENTS SUBJECT TO REIMBURSEMENT ESTIMATED AMOUNT Const. 24" x 12" Wet Tap Tee & Tapping Sleeve $6,500.00 Furnish & Inst. 12" Resilient Wedge Gate Valve 3,160.00 Furnish & Inst. 12" C-900, CL. 200 Water Main 28,000.00 Furnish & inst. Commercial Fire Hydrant 3,440.00 Furnish & inst. 12" 22-1/2 Degree Bends 325.00 Const. Thrust Blocks 1,200.00 Furnish & Inst. 12" Plug 300.00 Furnish & Inst. Flange X Push -On Adapter 419.00 Subtotal $43,344.00 Engineering (10%) 4,334.40 TOTAL $47,678.40 The surety bonds shall be posted with the City/District upon the earlier of issuance of Encroachment/Construction Permit for said improvements for Camp Cookie for Children, Inc. 14 W :\ENG\DV LP\COOKIE\REIMBU RS.DOC State of CALIFORNIA County of GRANGE On o 1 before me, DATEI _ personally appeared A 0 PHII_I? J. HU1SI-l+ES. NOTARY PUBLIC EFTITLE OF OFFICER-i.a.'JANE DOE, NOTARY PUSUC'1 ❑ personally known tome -OR- 0 PHI IPJ. HUGHES rn COMM. # 1 163799 6 Novy Publm Calif_ < i ORANGE COUNTY My Commission EKP. 12/2&DI J (SEAL) ATTENTION NOTARY proved to me on the basis of satisfactory evidence to be the person(,a') whose name(e is/arm subscribed to the within instrument and acknowledged to me that he/shtiftFieq executed the same in his/herf 113*1 authorized capacity(`), and that by his/4w;itheif signature(A) on the instrumentthe person(), orthe entity upon behalf of which the person(er( 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 Tale or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number of Pages Date of Document DESCRIBED AT RIGHT: Sipner(sl Other Than Named Above WOLCOTTS FORM 63240 Rev. 3-96 (price class a 2A) ®1996 WOLCOTTS FORMS, INC. ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITYIREPRESENTATIONITWO FINGERPRINTS RIGHT THUMBPRINT (Optional) X 0 CAPACITY CLAIMED BY SIGNERIS) OINDIVIDUALIS) ❑CORPORATE _ OFFICER(S) OPARTNER(S) ❑LIMITED CGENERAL CATTORNEY IN FACT CTRUSTEE(S) OGUARDIAN/CONSERVATOR COTHER: SIGNER IS REPRESENTING: (Name of Persons) or EntityPes) RIGHT THUMBPRINT lOptionap W S CAPACITY CLAIMED BY SIGNER(S) ❑INDIVIDUAL(S) ❑CORPORATE OFFICER(S) ITIT ESI OPARTNER(S) ❑LIMITED ❑GENERAL ❑ATTORNEY IN FACT OTRUSTEE(S) ❑GUARDIAN/CONSERVATOR ❑OTHER: SIGNER IS REPRESENTING: (Name of Personls) or Entitylies) 7 IIII67775 II63240 III 8 MOW-, CERTIFICA PRODUCER Jim Montoya Insurance Agency 3"12 East Valley Parksay Eseendido CA 92027 760-746-0721 INsuILEo CAMP COOKIE FOR CHILDREN, INC. 30261 CAMINO CAPISTRANO SAN JUAN CAPISTRANO CA 92675 COVERAGES LIABILITY INS INSURER A INSURER B: D CONFERS NO RIGHTS UPON THIS CERTIFICATE DOES NOT At E COVERAGE AFFORDED BY THE INSURERS AFFORDING COVERAGE DATE (MM/D0T7 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOL18EMENT, 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. At;OREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE POLICY NUMBER I POUCYEFFECTIVE DATA INIMIDDA14diK ppLICY IRATON M LIMITS I GENE"AIABILITY COMMERCUI GENERAL �LABILITY J CLA.IMSMAOE 7X OCCUR 2YEW06595A 04!30/2002 EACH ocCUAMNCE ` ' FlRE DAMAGE (Any one Ilya) V I MED EM(Any CM POMM) 04/30/2003 ,PERSONAL&ADV INJURY AGGREGATE PRODUCTS COMP OP AGG s 1,000 000 E 100,000 S 5,000 s 1 000 000 S 1,000,000 GEN'L A/iOREGATE LIMIT APPLIES PEA! x PCULY I PFR–COTF77 LOC E AVTOMCBILE LIABILITY ! ----.I1 ANT AUTO 1 'A..L OWNED AUTOS SO Ei)ULe0 AUTOS HIRI3DAVTOS I .I AOI:-CAVNED AUTC6 I I I I COMBINED SINGLE LIMIT (Euodden0 s BODILY INJURY (Per Pe1)N S SOCILY INJURY (Per escider0 a PROPERTY DAMAGE For Accldentl is MRAOE LABILITY ANT AUTO AUTO ONLY. EA ACCIDENT s OTHER THAN EA ACC AUTO ONLY: AGG 6 S �EXCE—Z35 LABILITY CUR � CLAIMS MADE —� DE[IUCTIBLE NET ENTION s ! i EACH OCCURRENCE S AGGREGATE 3 S s E WON'E"% COMPENSATION AND EMPLOYERS' LABILITY I TA M E EACH ACCIOENT F.L DISEASE -EA EMPLOYEa S a E.L DISEASE • POLICY LIMIT • S OTTER I i I OESOMPTION OF OPERATIONS/LOCATIONSTVEHICLerMOOLVSIONS ADDED BY ENOORSEMENT/SPECIAL PROVISIONS CERTIIICATE HOLDER IS ADDITIONAL INSURED WITH RESPECT TO THE INSURED OPERATION FOR CAMP COOKIE FOR CHILDREN INC. CITY CLERK. CITY OF SAN JUAN CAPISTRANO AND CAPISTRANO VALET WATER DISTRIC 32400 PASEO ADELANTO SAN JUAN CAPISTRANO CA 92075 SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EA►IRATION PATE THEREOF, TKE WONG INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO ODUCAAV64 OR LIABgRY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 2.-5(7/97) ---_--- O ACORD CORPORATION 19841 ACORD.a .�C E Ft TIFt 7" CSF iAl eRODUCER S.^.REETER INSURANCE AGENCY P.C.BOX'600S68 SAN DIEGO CA 92160 P�R€+1F COOKIE FOR CHILDREN INC 29255 CAMINO CAPISTRANO ESCONDIDO,CA 92046 TY "ltV�tJil. r D„E(MwDonn _ 10/04- 02 [THIS CERTIFICATE I SSl1ED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEATIFlCATH HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIEB_AFFOROIN0. COVERAGE C061PANY A 'vZRCURY CASUALTY COMPANY : COMPANv . s COMPANY C coeoP.wY ' 0 THIS IS TO CERO•Y THAT THE POLICIES OF INSURANCE LISTED BELO'N HAVE. BEEN ISRUED TO THE INSURED NAMED ABOVE FOR THE POLKA PERIOD INOMATEO, NOTWITHSTANDING ANY RE:OVIRF.MENT, TERM OR CONDITION OF ANY CONTRACT OH OTIIER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AITORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO All THE TERMS, MANA EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SPOWN Y HAVE BEEN REDUCIE0 BY PAID CLAIMS, ... ._... _ __. ...... _. .....__.__. _._.. _. ._. ...,._ _. _._.. __.. _... .__ .. . I... __. - .T. _.... .__.. COI TYPE cc TE OF INSURANCE POLICY NUTABER POLICY EFFECTIVE -POLICY EXPIRATION LBRTE I DATE (AIWOOr"I DATE (NAOODrm GENERAL LIABILITY I ROOLLY INJURY OCC S _ COMPREHf.N9M TORM j— I IW71l.Y MARY A00 I E ..... ..__._... ..._.. ._ .. _. I PRFlAGES,OPERATIONS j PROPERLY DAMAN OCC S ..... _. ..., OE.RWNO EXPUNLOSIONROE COLIJJ'BE HAZARD ._.. .... NYWERTY OAMAOF AGO I $ .........._ "� IPROOUCTACMW,ETEO OPER _.I BI b PO COMHMED OCC L CONTRACTUA. I Bi E PD COMBINED A00.,_ S. INDEPENDENT CONTRACTORS RZRSONAL NJURY ADO,,... .. BROAD FORM PROPERTY DAMAGE _.. 1 ..... ............... PERSONA. INJURY J 1 AUTOMOBILE LIABILITY IIOO!LY INJURY ANY AUTO (Por F+anon) S `� ...I ALL OWNEC AUTOS (PsL a, Pan) .-!ALL -... ... _ x. ( - ' = I)OUILY INJIMY(Pa, OWNED AUiOg (GAIN Inin P'"ta PnuanOal) - KCAAPn l .. HIRED AUTOS HOPERTY DAMAGE : E .......� NON�OWNGO AUTO;P ..... I - ._..._..._. OAAAW LWIILITY GODLY NJUNY 6 A XOSCHEDULED AUTO AC11044662 PROPf:n7Y AM DAUE 8 10/04/02,12/20/02IcoMBINED 1,000,00 EXCESS UMILRY FACH OCCURRENCE ,S I UMIIRELLA FORM AOORF.OATC S OTHER THAN UMBRELLA TORN f C0RIA61ITY AND _ WC . 107H I LIMITS,_,... I. FN i ... _._...._ iasorwyWORKERS ENBWY{NS' LIABILITY _TP_Fq Cl EACH ACCIDENT THE PROPRIETOW - INCL EL OSEASE . NXICY LIMIT i PARTNERSAinCUNYF I. CaICENS U6' _ rxCL I EL DSEASP EA EMPI OVEF. 8 _ OTHER I I -- I , I , UKROMN OF OFENATIONEILOCATIONSIVl10CLELSPECML ITEMS ��— — -- �•---- OERT87O/LTp N�1L4EA;:' ( �. CkNCEGbAT10N, '. CITY OF SAN JUAN CAPISTRANO AND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CAPISTRANO VALLEY WATER DIST, EXPIRATION DATE TNEMEOP, THE IOBUwO COMPANY WILL EHOtavOR TO W'L 324 0 G ADELANTO AVE. _3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NEARED TO THE LEPI SAN JUAN C.,APSSTRANO, CA 92670 NUT FAILURE TO MAIL SUCH NOTICE &HALL IMPOSE NO OBLNIAWON ON LIABILITY OF ANY VINO UPON THE COMPANY, ITS AOENTE OR REM "FATATIVII. iAUTHORISED RIFF TIVI ' �4COg0.25N it _ -- � �4' JCACORD CORPORATION 11,84 1U/LJ/LUUL 14. J4 /OU4bUOL1UJ OCT -23-2002 WED 02;27 PM AND01 & HURISON, POLICY NtiwER: ZYB 006895A INC. JU"N rK"NK FAX N0, 3200957 COMMERCIAL GENERAL LIABILITY I , THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.; ADDITIONAL INSURED — STATE OR POLITICAL SUBDIVISIONS — PERMITS This encLyrscment tuodifios ir> .tirmico pravided ttudet the fc D..iugi COMMW:RCIAT, GENERAL LIABILITY COVERAGE PART. SCHEDULE State or Political 8rrhdiviscon: City C", Cay of San Joan Capistrano lir Capistrmn Valley Watcr District 32400 Rama Alrlanto san Jtwu Capidratto, CA 92675 (If no .arty appaans alwvc, infonuation rayuired to eootplete this mlorvumsat will bo show to the Deelarations appha,ble to this eadorsonteut.) WIIO IS AN INS 1112 it D (Section I () is :vuondul to include ss an insured any stab orpolitical subdivision shown in Sehedolev sulycct to the I.ylovilog prmisions. I. Ails iltsur4o o sppllas only with rmpeet to operation perfonued by you or on your behalf far which tho r.,lilical nul,chvision has isaved a poeni;L 2. This truuraocv dom not apply to: .,. "Bodily Injury," "property damage," "personal injury" in -advertising injury" arising Out of op", trwrfoma<I far the stale or mmnleipahtyi or b. "Roddy injury" or "property dams" included widsin the "produots-outnpleted op,`rations hnerd," (% 20 12 11 95 Copyright. bintmnee Serm,,x Office. Inc., 1984 lu/2d/Z002 14:.34 /be4H0HbU'j OCT -23-2002 WED 02:28 FM AND*N & MURISON, INC POLICY NUMBER: 'LYB 006895A JUHN F-NANK FAX NO. 32*0957 COMMERCIAL.. GENERAL- LLABIL1T� TIIJS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUL 11Y ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS This onrlrnmucut .nod:fi.v insurattco proviJ4 tuulct the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE S41to or Political Salxllvisioan City Clerlt, City of $►n!11411 CoriQrano & Car6trann valley w.ter Mairict 321400 Paso Atlelanto $an Loam Capietrmo, ('A 92675 (1l uv entry appaara aLovr, information myuirod to complav this aldpraeu.enL till Lo altoam is the Dmlaratioua applicaLlo to this cudors"nont.) WHO IS AN 1 INS LIRC-D (Sret on 11) in amvnA*J to i.cluaa as au insured any mate or political oul.divinion ellovn in t�e Se6jule, anllj,xk to 11.0 foflnavinp Qs OVtnlnlin- 1. This in+ur.,nr. 4ITbcx only with resp.cl to operation. porforro.3 Ly you or on yout bolialf for which the Bete krslitical eub lWA"t Lai lnucd a ponnik. :?. Thid imnrauce Joos not ,apply to: A. "1304 inj.vy," "Property (La.ago," "personal iajory" or %Jwrtiaing injury" &rising out of operotio is porforme.l for tho state or municlpnllty; or 1 1., 'bodily injury or "prvparty dame" inCh,tll•C Within the "pmJvekn-v,mmpIrtA operskinns Lazar:" CG 20 12 1185 001"01t, lnxtmmce Sctviecs office, L10., I m I 1!7/ LJ/ zm9Z 14: J4 /bF74CF7tf5b7 JUHN YKONK rr John R. Frank P.O. Box 460461 Escondido, CA 97146 760480-8509 FAX COVER SHEET i i DATE: TIME: AMIPM ! TO: i FAX #: FROM: C i TOTAL PAGES INCLUDING THIS COVER LETTER: IF YOU DO NOT RECEIVE ALL PAGES OR HAVE OTHER PROBLEMS WrM TRANSMISSION, PLEASE CALL ME AT (760) 490-8509. THAT IS BOTH AN OFFICE AND FAX NUMBER. MESSAGE: / If 17 f �N �I -------------- ! ! 4 ACORD' +l 'ERT Fi ¢17"E r� ti-r ,r rs� �+►�u+ E Date lmm/dd/YY) Pre r 714 289-7676 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Seltzer Insurance Service ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 1524 E. Mayfair Ave Orange, CA 92867 THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Company Claremont Liability Insurance Co. A Company Progressive Insurance B Insured BRONG01-DEB Company Fireman's Fund Insurance Company C Brongo Construction 32332 Camino Capistrano, #205 ComDpany State Compensation Ins Fund C4t1f;CiAL�E9 :. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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. POLICY POLICY CO LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LIMITS A ENERAL LIABILITY Commercial General Liability Claims Made ZOccur RMOI-20749-01 03/01/02 03/01/03 General Aggregate 8 Products-CompletedDos A Personal & Advertising Injury Each Occurrence Owner's & Connector'. Prolective Fire Damage (any 1 fire) a 100, 000 Medical Expense (any one PersonI AUTOMOBILE LIABILITY Any Auto Combined Single Limit s B All owned Autos 04756949-0 03/01/02 03/01/03 eom(ylnIuy Scheduled Autos (per person) $ Hoed Autos Non-Owned Autos Bodily Injury (per accident) Com M11 DED ,ria 1,000 Property Damage -.. GARAGE LIABILITY Auto Only - Eric Accident ..................................... Omar Than Auto only Any Auto Each Accident Anticipate EXCESS LIABILITY Each Occurrence A re ate Vmbrella Form Omer Than Umbrella Form BThe WORKERS' COMPENSATIONStatutory EMPLOYERS' LIABILITY The ProprietPartners/Exeor/ Proprietor) utive IrkA Officers are Ezcl 1663406 11/17/01 11/17/02 Uni ower EL Each Accident 1,000,000 EL Disease-Policy Limit EL Disease-Ea Employee i-ohn Ann OTHER C nland Marine ired/Rented/Eq MXI98401494 03/01/02 03/01/03 697,840 Scheduled 300,000 Any One Unit DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS Certificate Holder is named Additional Insured as with respect to workt erformed on Project known as Camp Cookie for the Children Inc. (San Juan apistrano). �l�lGAtE ltff6b�i' : CN+�ECLA7ic3� 00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3 0- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION City Of San Juan Cappistrano & OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE- Ca istrano Valley Vater District SENTATIVES. 32400 Paseo Adelanto et rized Representative San Juan Capistrano, CA 92675 A 117953 8y �n4er�uproe� iCt7? It,: i�$8 :' 10/10/2002 11:20 7142890503 PAGE 02/02 !3�yE,�yr ACCMU 1TW: 1t g3�L7 �n J�: !l,M1l E p l}jal l l`?�� 1 d1;'IyfL; F`vf3) D.le lmmlea yl . ,1 1114 h f gyp. 1 Pro E 1 239-7676 Seltzer Insurance Service 1524 E. Mayfair Ave Orange, CA 92 867COVERAGE THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE AFFORDED BY THE POLICIES BELOW, D°mReOp Claremont Liability Insurance Co. A Company Progressive Insurance B Inaeared BRONG01.-OEP c°mpRnY Fireman's Fund Insurance Company G Brongo Construction 3�2y332 Camino Capistrano, #205 Depen• State Compensation Ina Fundi �ii,�1'irl f til iii :i sS lz irc! ,Ttyi��613L+• >r 5'!�tl�..•;,f<I rs i�KIy°sr alj, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY FERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SVRJECT TO ALL THF, TERMS EXCLUSIONS AND CONDIT ONS OF SUCH POUCI S. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY POLICY CO LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIvE DATE EXPIRATION DATE LIMITS A ENER L IAB LIT Y COmme(elN Gnnernl L110114Y 1`? Clelme Med. 0O[cx.,FVaoneIAAOY;I-, RMOI-20749-01 03/01/02 03/01/03 General Alignigino 12- Don nnp FloWcv.Cemlet00Opt A ,no n q Inm a —09 Dwne1'1 E C. nradm'e PleleOlx. Each Ocmean" Fin bitm,pat Ian 11".) e Magical Ex an:n Inn pn, anon, AUTOMOBILE LIABIL TY $ Any Alto AS OwnedArne 04756949-0 3/01/02 03/01/03 Combined Single Limit I O Btow', mw, Schim ed API,, to., DFa°.1 a Hired Auto, Bad'nY lnpnY NPn.OwneO A.mc (Pat acddenrl e C�TRY f� o] t DED $ 11000 P,.Pa,IyDama,. e GARAGE LIABILITY Any At -to qmA Da .Enc Aecbem e1 Olt Than Amc Only: F'A i, l t ? £ `;i$' Fneh Attldem A R R EXCESS LIABILITY Each Oau,nnc0 u1noml. Fa,m OIN, Than U boll. Form A ,e nh B WORKERS' COMPENSATION a77 EMPLOYERS' LIABILITY TM PIeCtle1W1 Incl ParmmR/axecdlivR Offl.e em: [.cl 1663406 11/17/01 11/17/02 EL Foch Accident 00 FL DIea ae-Pdl UmII al. DIea m.F. Em I e. a OTH R C nland Marine ired/Rented/Eq MX19840149403/01/02 03(01/03 697,840 scheduled 300,000 Any One Unit P O DESCRIPTION OPERATIONSILOCATIONSNEHICLESISPECIAL ITI erti£icate Holder is named Additional Insured aswith respect to workt Mformed on Project known as Camp Cookie for the Children Inc. (San Juan iatrano). 4 w> ^� l{ 1 Y:R`! ;.. �at 00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3Ua DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Cit Of San Juan Cap is tTanO & Y Calatrano Valley Vater District 32&00 Paseo Adelanto Sya�n�M Juan Capistrano, CA 92675 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR PEPRE- SENTATIVES. D: Pr,e .Re,Fnl.Iw tryyiiyy k}p)a1] 3 '� i t] cM'" ie'" 4ef 1 f 3v h 1 i /,Y�y�1aEll U•p,�UDT J7 j' e! d1 i 1� I4 iS,w K'IF '16�4y,,4yy(n�tLi�. 1 t L}�yi'� I. 10/10/2002 11:20 714289050 • PAGE 01/02 Seltzer Insurance Service w.awer rewr x. SPMNP c ffmd w .wu aero" "d ft twlmhl c4m wm" PW&V, No^ us ,ea AMFa LFa mfid 2711 DATE : 1624 East WayA&Avenue, Omnge GA 92867 Telephone (714) 189-7676 . Fox (714) 289-0503 Selttemn0act eam wq w illil CORD I of,. 1� .IA TT'0°tl'�I 10/04/021 STREETER INSURANCE AGENCY P.O-SOX 600560 THIS CER71MCATE 95 RELIED AE A BIATMR OFF TION ONLY AND COW4R$ NO IIIDNn UPON THE DENTMIOAA MOLDER. THIS CERTIFICATE 0016 NOT AMBNO, ND SAN DIEGO CA 9216C ALTER THE CMRAQE AFF00l OT THE POLICSIE EE QQYPJIMlE AgDRp1q OOFEBu,E 00ml 1 1 I l i Bil COOKIE FOR CHILDREN INCII A MERCURY CASUALTY COMPANY COuPAuv I 29255 CAMINO CAPISTRANO ESCONDIDO,CA 92046 E "I a111-4 ICOIA,ANY 1'1 cnuPANr -.. .. + 0 ... III Ir .I THIS IB TO CETRIFY THAT THE POLICIES OF INSURANCE 1194D BELOW HAVE BEEN ISSUED TO THE INIUREO NAMFO ABOVE FOP THE POLICY PERIOD i fl I f INDICATED, NOIWITHSTAILOINO ANY REOUtREMENIT, TERM OR CONDITION OF ANY CONTRACT OR OTHEP DOCUMENT WITH RESPECT TO WHICH THIS lI CERTIFICATE MAY tllD OR MAY PERTAIN, AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TB EXCLUSIONS AND CONDITIONS Of SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN I - - -- - REDUCED BY PAID DLwIM9 - ... L� "Bot iT«Hp:NSMCE �Y 6ifGIM plgY IgPNA1p11( USERS wTB (TBA'SBtYYIr� wTS (IEBBM") B■■mA UARITY r-- DOMPRNtE141iN FOAM nU1NrNa��Ml[[wr[n[TONB lRA.0O API O PROa6 CON I -_J WD[P[ADENT CONTRACTORS BROAD FOM FROPPMY OgMBB ' PORp1Al Ill NAP" OCG � { ' -h-- BODILY NAMIN AGO B1"O NS AGE AGO DCC i.i . .. ; 11 DOI D COIBD AUG F Bi A PBIE - -- P_BAONALD,u,lWA00- t 1 AINOIO/BA MAeIATTY / ' BODILY INLAY ' ANY AUTO 1 aro.Iw.oAl I I AL. ORATED w106 IPiL.M PAN) ql aMIF.o ATTpB 1100\Y NANO I ( l IOMI TNT+ Pr1�M IA�q[r) (Iw +N'd■q - 1 NWEO AUTOR ..... .. .. 1.-. ... a _ NON.AUTO$ OAM[o I I NTOPOITY nAMIgY I t BI[TN[ LINBLITY ODDLY MANY AX' SCHED LED AUTOIAC11044662 10/04/02 i 1-2,(20/O2 COMgw DONNA'" 11, 00 I 004 yes uAeun I H Occum MMC{ I I . - , IAIIII 170"MAOIVMBAif` OTNIA THAW DMBIMLLA ISM TAIDYSSe IIABAITY Aw { II : T '- _ ({I . tj I L III AVC. it i 1.-... M P11pPRIPpIr PARBNIMi*WZUTIIIE I - -. _ . I dl-- [L DRRASC POLICY L■87 { 7T OIFCRN ALC. I [R0. i [l OBFA1f: to NR.DYEP. 1 1 I 1 1 I DESORPTION A oRB1U7B111MBiPTIo■MYBNIp►p1/BCUL nWB - I 'r CITY OF SAN JUAN CAPISTRANO AND CAFISTRRNO VALLEY WATER DIST ARE NAMED:AS II II II, ADDITT_oNAL INSURED AS THEIR INTEREST MAY APPEAR I I" N10 DAY NOTICE OF CANCELLATION FOR NON PAYMENT OF PREMIUM 11 T�* : MAMaa'1rT1on I 1 1, CITY OF SAN JUAN CAPISTRANO AND Moue An a TTy ASM Bnc� TTDAIflY Ba cA■BBuae, CAPISTRANO VALLEY WATER DIST.�TAIT 32400 ADET.ANTO AVS. wn TMNBOP. TNS ddLU** 000e■Y Bull . x" To IL DATE TTPmTN ■Beoa » TNB OMIYeOAIB AOADOI BAreh t0i SAN JUAN CAPISTRANO, CA 921 WT rAAaw■ TD MINN. No"" MALL NAOBB ND OeLOATON ON I ANY RN uPpM TN{ ODI■•M1T m ABNTB ON .YTMOIIOB RBP■BMNTATIYB • 32400 PASEo ADELANTO SAN JUAN CAPISTRANO, CA 92675 (949) 493-1171 (949) 493-1053 (FAX) TVTVTv. sanjuancapistrano. org October 15, 2002 Clerk -Recorder's Office County of Orange P.O. Box 238 Santa Ana, California 92701 JMan �//,,ryy IHonorBn IsuuBlln � 1961 1776 MEMBERS OF THE CITY COUNCIL DIANE L. BATHGATE COLLENE CAMPBELL JOHN S. GELFF MATT HART DAVID M. SWERDLIN CITY MANAGER GEORGESCARBOROUGH Re: Improvement and Reimbursement Agreement for Water Facilities — Camo Cookie for Children. Inc. Enclosed, please find the noted document for recordation, accompanied by Check No 10024 from Camp Cookie for Children, Inc. to cover the fees for recording. When placed of record, please return said documents to this office. Thank you for your assistance. Very truly yours A'AX�L �/� Monahan City cc: Crai Harris, Assistant Engineer awn Schanderl, Deputy City Clerk DRUG USE is San Juan Capistrano: Preserving the Past to Enhance the Future 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 IMPROVEMENT AND REIMBURSEMENT AGREEMENT FOR WATER FACILITIES - CAMP COOKIE FOR CHILDREN, INC. THIS IMPROVEMENT AND REIMBURSEMENT AGREEMENT is entered into this 16th day of October, 2001, by and between CAPISTRANO VALLEY WATER DISTRICT, hereinafter referred to as "District" and CAMP COOKIE FOR CHILDREN, INC., a not -for profit corporation, hereinafter referred to as "Developer". THIS IMPROVEMENT AND REIMBURSEMENT AGREEMENT shall be administered by the CITY OF SAN JUAN CAPISTRANO, and the CITY OF SAN JUAN CAPISTRANO, hereinafter referred to as "City", enters into this Agreement on behalf of the "District", in accordance with Resolution No. 97-10-7-1. WITNESSETH Whereas, City and Developer have entered into a license agreement dated February 6, 2001, ("License Agreement"), for the use of a City owned property located within a portion of the North Open Space (NOS) properties; and, Whereas, Developer agrees to design and construct, at its sole cost and expense of an estimated amount of $65,562, the construction of the water facilities to 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. serve the properties known as Assessor's Parcel No. 121-050-19 and 121-050-21 hereinafter referred to as "Water Improvements"; and, Whereas, because the aforementioned water improvements benefit Assessor's Parcel No. 121-050-19 and 121-050-21, City owned parcels, Developer is therefore entitled to reimbursement for a portion of those cost of improvement; and, Whereas, the reimbursement shall consist of pro -rata contributions from future NOS property users, including City of San Juan Capistrano, who will develop City properties consistent with the "NOS Master Plan" and the property to be used by Developer under the License Agreement; and, Whereas, In accordance with the proportional fair share described in this Agreement, Developer agrees to be reimbursed by future NOS property users for their proportional fair share cost of the total reimbursable amount of $47,678.40, as describe in (Exhibit "A"), to construct a 12 -inch water main pipeline and appurtenances as shown and delineated upon the improvement plans entitled "Public Water Improvements For The Camp Cookie For Children'; 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 improvements; and, 2 WAENGtUV MOOKIEXREIMBURSMOC 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. NOW, THEREFORE, BE IT RESOLVED BETWEEN CITY, DEVELOPER AND DISTRICT AS FOLLOWS: I. REIMBURSEMENT TO DEVELOPER Developer will be required by City and District to construct water improvements in order to provide water service to the Camp Cookie project. City hereby agrees to require any future NOS property users, as a condition of development of their approved use of parcels within the remaining NOS site, to pay a proportional fair share of Developers original cost to install the water improvements necessary to provide the required water demand to its site. A proportional fair share assigned to each future NOS property user is defined to mean a proportional fair share as determined by the City Engineer and District Engineer pursuant to a methodology developed and adopted by the City Engineer and District Engineer, which said methodology shall include consideration of one or more relevant factors, e.g., linear footage, acreage basis, property use, water demands, and cost of construction, as determined by the City Engineer and District Engineer. Developer obligations to construct, under Article IV hereof, and to pay for repairs, under Article VIII hereof, are contingent upon Developer's occupancy of the property under the License Agreement, or any extensions of the License Agreement. II. IMPLEMENTATION OF FAIR SHARE REQUIREMENT Upon receipt of any development application by a NOS property user, the City Engineer and District Engineer shall make a determination of fair share pro -rata payment requirement pursuant Section I. of this Agreement. The NOS property user 3 W :\ENG\DV LP\COO KIE\REIM BU RS.DOC 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. shall pay the fair share payment to City upon issuance of building permits. City shall then pay this contribution to Developer within forty-five (45) days from the date of City's receipt of the property user's contribution. III. Term This Agreement, and the reimbursement provisions to Developer, shall remain in full force and effect for a period of ten (10) years from the date of approval plus any additional period of time Developer occupies property under any extensions of the License Agreement. IV. CONSTRUCTION AND COMPLETION 1. Developer shall, its sole cost and expense, construct and install within twenty-four (24) months from the effective date of this Agreement, all of the water facilities shown and delineated upon the improvement plans entitled "PUBLIC WATER IMPROVEMENTS FOR THE CAMP COOKIE FOR CHILDREN" as approved by the District Engineer of the Capistrano Valley Water District and the City Engineer of the City of San Juan Capistrano and on file with said City and by reference made a part of this Agreement as though fully set forth herein. 2. Developer shall construct said water facilities in accordance with the approved plans, District's standard specifications and under City's inspection, and shall indemnify and hold harmless all officers, employees and agents of the City and District from and against all claims, damages, losses and expenses, including attorneys' fees, arising out of or resulting from the performance of the work, and caused in whole or in part by any negligent act or omission of Developer, Contractor, or any Subcontractor, 4 W AENGMDVLP\COOKIEVtEIMBURS.DOC 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. anyone directly or indirectly employed by any of them, or anyone for whose acts any of them may be liable, regardless of whether or not it is caused in part by a party indemnified hereunder. 3. If Developer has not completed the work within twenty-four (24) months from the effective date of this Agreement, District has the right but not the obligation, to call the security for faithful performance and complete the work. Any work performed after said twenty-four (24) months, whether by Developer, District, or others, shall be in accordance with District's standard specifications in effect as of the time the work is performed. 4. The security shall remain in effect for a minimum of 365 consecutive calendar days after all the water facilities have been completed and accepted by District, and shall continue in effect until exonerated in writing by District. It shall be incumbent upon the developer to renew the security prior to its expiration. V. USE OF WATER 1. Developer hereby expressly agrees that no water shall be used by Developer, or by Contractor or any Subcontractor, for construction purposes except through a meter provided by District. Developer acknowledges that Section 499 of the California Penal Code provides that unauthorized use of water is a misdemeanor, and District hereby states its intent to strictly enforce said Penal Code Section. 2. In addition to any criminal penalties, and not as a substitute therefore, District will charge Developer, and Developer agrees to promptly pay District, $500.00 per day for unmetered use of District's water by Developer, Contractor, or any 5 W :ENMDV LKCOOKI E\REI M BU RS.DOC 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. Subcontractor, anyone directly or indirectly employed by any of them, or anyone for whose acts anyone of them may be liable. 3. Temporary construction meters shall be provided to Developer by District at the rental rate existing at the time such meters are provided. The use of "jumpers" is expressly prohibited. 4. Developer shall notify District as soon as it is reasonably practical to install any permanent meter, and District shall provide and install same as soon thereafter as reasonably possible. The foregoing notwithstanding, the District may install any meter when District determines it is desirable to do so. VI. FEES, CHARGES, AND SECURITIES 1. Developer shall, prior to the execution of this Agreement, pay District the following sums to allow for the construction of "Line A": (a) $3,005.62 for the costs of District's plan review, inspection of construction and the control thereof, and for the testing of materials, which sum is based upon the estimated construction cost of $44,860. (b) $100 for the upsizing cost to furnishing and installation by District of all permanent water meters, which sum is based upon the following number and size of meter: one (1) 2 -inch. 2. Developer shall, prior to the construction of "Line B", pay District the following sums: 6 W AENG\DVLP\COOKIEViE1MBURS.DOC 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. 0 (a) $991.06 for the costs of District's plan review, inspection of construction and the control thereof, and for the testing of materials, which sum is based upon the estimated construction cost of $14,792. 3. In addition to the above sums, a surety bond to secure the faithful performance of this Agreement in the sum of $49,346 is hereby approved for the construction of "Line A". Prior to the commencement of line "Line B" the Developer shall provide a surety bond to secure the faithful performance of this Agreement in the sum of $16,271.20. 3. When additional buildings on this property are constructed, Capital Improvement Charges, Water Storage Charges, Water Capacity Charges, and Meter Fees for the additional development shall be paid prior to additional service being provided. VII. GUARANTEE Developer hereby guarantees the materials and the workmanship of the water facilities for a period ending 365 consecutive calendar days after the acceptance of said water facilities by District, and hereby agrees to reimburse District for all costs associated with the accomplishment of necessary repairs, not to include normal preventative maintenance, to said water facilities which may have been made by District within the aforesaid guarantee period. 7 W :XENGXDV LP\COOKIEXRE1M BURS.DOC Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. VIII. GENERAL 1. Developer hereby offers to dedicate to District the water facilities together with necessary easements. 2. Upon completion of the construction in accordance with the improvement plans and specifications and the dedication of the necessary easements, District agrees to accept the water facilities, whereupon said water facilities shall become property of District with obligation to repair and maintain same. 3. The terms of this Agreement shall inure to the benefit of and be binding upon the successors and assigns of the parties hereto. 4. Should either party be required to enforce any of the terms of this Agreement, it is agreed that the prevailing party shall be entitled to costs and reasonable attorneys' fees. IX. INSURANCE AND INDEMNIFICATION During the construction period and for the purpose of construction Developer and/or Contractor's shall maintain in full force and effect the following insurance: 1. Comprehensive General Liability Comprehensive general liability coverage, including premises operations, products/completed operations, broad form property damage and blanket contractual liability in the following minimum amounts: • $500,000 property damage; n W:TENGYUV LP\COOKIE\REIM BURS. DOC Improvement and Reimbursemagreement • Camp Cookie for Children, Inc. • $500,000 injury to one person/any occurrence/not limited to contractual period • $1,000,000 injury to more than one person/any one occurrence/not limited to contractual period. 2. Comprehensive Automobile Liabilitv Comprehensive automobile liability coverage, including owned, hired and non - owned vehicles in the following minimum amounts: • $500,000 property damage; • $500,000 injury to one person/any occurrence/not limited to contractual period • $1,000,000 injury to more than one person/any one occurrence/not limited to contractual period. 3. Worker's Compensation During the construction period, if Developer or Contractor employs employees to perform services under this Agreement, Developer or Contractor shall obtain and maintain, Worker's Compensation Employer's Liability Insurance in the statutory amount as required by state law. These 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 insurance policies required under this Agreement. Developer shall indemnify and hold City/District harmless from any and all claims, demands, actions, attorney's fees, costs, and expenses based upon or arising out s W:\ENG\DVLMCOOK1E\RE1MBURS.DOC Improvement and Reimbursemagreement Camp Cookie for Children, Inc. of errors, omissions, or negligent acts of Developer, its associates, employees, subcontractors, or other agents while performing services under this Agreement. In the event an action is commenced by a party to this Agreement against any other party or parties hereto to enforce its rights or obligations arising from this Agreement, the prevailing party in such action, in additional to any other relief and recovery awarded by the court, shall be entitled to recover all statutory costs plus reasonable attorney's fees. X. 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. XI. 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: CITY OF SAN JUAN CAPISTRANO Attention: City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 TO: CAMP COOKIE FOR CHILDREN, INC. Attention: Dean Daggett, Law Offices One Park Plaza, Ste. 1250 Irvine, CA 92614-8509 10 W :\ENG\DV LP\COO KIE\REIM B U RS.DOC Improvement and Reimbursemogreement • Camp Cookie for Children, Inc. XII. 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. XIII. 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. XIV. CITY BUSINESS LICENSE Developer will maintain a license to do business in the City of San Juan Capistrano. XV. INDEPENDENT AGENT At all times during the term of this Agreement, Developer shall be an independent agent and shall not be an employee of the City/District. City/District shall have the right to control Engineer only insofar as the results of Developer's services rendered pursuant to the Agreement; however, City/District shall not have the right to control the means by which Developer accomplishes services rendered pursuant to this Agreement. XVI. INDEMNITY Developer shall be responsible for all injuries to persons and for damages to real or personal property of the City/District, caused by or resulting from any activity or 11 W AENG\DVLMCOOKIE\REIMBURS.DOC Improvement and Reimbursem0greement 10 Camp Cookie for Children, Inc. operation of Developer, its employees or its agents during the progress of or connected with the rendition of services hereunder. Developer shall defend and hold harmless and indemnify all officers, employees and agents of City/District from all costs and claims for damages to real or personal property or personal injury to any third party resulting from the activity of itself, employees or its agents. XVII. DEVELOPER NOT AN AGENT Except as City/District may specify in writing, Developer shall have no authority, express or implied, to act on behalf of the City/District in any capacity as an agent. Developer shall have no authority, express or implied, pursuant to this Agreement, to bind City/District to any obligation. XVIII. ATTORNEYS FEES 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 the reasonable attorney's fees and costs from the other party. 12 W:\ENGXDVLP\C00K1E\RE1MBURS.D0C Improvement and Reimbursemeoreement Camp Cookie for Children, Inc. IN WITNESS WHEREOF, the parties hereto have executed this Agreement, consisting of fourteen pages, on the above date. CAMP COOKIE FOR CHILDREN, INC. PO Box 1434 San Juan Capistrano, CA 92693 760-480-8509 By: John Frank, President Date: (Attach Notary Acknowledgement) 13 W:\ENG%DV LMCOOK1BREIMB URS.DOC CITY OF SAN JUAN CAPISTRANO By: 1 Wyatt art, Mayor Attest: '2'h' rg ret R. Monahan City Clerk APPROVED AS TO FORM: By. � Joh IShaw, City Attorney Improvement and Reimbursem*greement Camp Cookie for Children, Inc. EXHIBIT A PUBLIC IMPROVEMENTS TO BE CONSTRUCTED BY DEVELOPER SUBJECT TO REIMBURSEMENT FROM FUTURE PROPERTY USERS Construction of 700 linear feet of 12 -inch water main pipeline and appurtenances. SUMMARY OF REIMBURSABLE COST IMPROVEMENTS SUBJECT TO REIMBURSEMENT ESTIMATED AMOUNT Const. 24" x 12" Wet Tap Tee & Tapping Sleeve $6,500.00 Furnish & Inst. 12" Resilient Wedge Gate Valve 3,160.00 Furnish & Inst. 12" C-900, CL. 200 Water Main 28,000.00 Furnish & inst. Commercial Fire Hydrant 3,440.00 Furnish & inst. 12" 22-1/2 Degree Bends 325.00 Const. Thrust Blocks 1,200.00 Furnish & Inst. 12" Plug 300.00 Furnish & Inst. Flange X Push -On Adapter 419.00 Subtotal $43,344.00 Engineering (10%) 4,334.40 TOTAL $47,678.40 The surety bonds shall be posted with the City/District upon the earlier of issuance of Encroachment/Construction Permit for said improvements for Camp Cookie for Children, Inc. 14 W :\ENG\DV LP\COOKIE\REIM BURS.DOC State of CALIWNIA County of ORANGE On o I before me, (DATE) personally appeared Ch1 - PHIUP •1. 1-10641ES. NOTARY PUBLIC ❑ personally known to me -OR-Cl�- PHILIP J. HUGHES y COMM. # 1163799 > 6 s NomyPublic Ca6romia ] ewe ORANGE CouMrr MyCommissionfixg,12128101 (SEAL) ATTENTION NOTARY OF OFFICER-i.e.-JANE DOE, NOTARY PUBLIC') OF Proved to me on the basis of satisfactory evidence to be the personal whose namel?� Is/ate subscribed to the within instrument and acknowledged to me that he/shettl•3eq executed the same In his/herhtTea, authorized capacity(ii�l, and that by his/h�r- signature(b) on the instrument the person(d1, or the entity upon behalf of which the person(sf acted, executed the instrument. my hand and official seal The information requested below and in the column to the right is OPTIONAL. Recording of this document is not required by law and is also optional. It could, however, prevent fraudulent attachment of this certificate to any unauthorized document. THIS CERTIFICATE MUST BE ATTACHED TO THE DOCUMENT DESCRIBED AT RIGHT: Title or Type of Document Number of Pages Date of Document Signers) O[har Than Named Above WOLCOTTS FORM 83240 Rev. 3-94 (price tees 8-2A) 01994 WOLCOTTS FORMS, INC. ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITY/REPRESENTATIONi O FINGERPRINTS RIGHT THUMBPRINT lOptlonall 0 0 CAPACITY CLAIMED BY SIONER(S) OINDIV IDUAL(S) nCORPORATE OFFICER(S) OPARTNER(S) ❑LIMITED OGENERAL ❑ATTORNEY IN FACT OTRUSTEE(S) O GUA RDIAN/CONSERVATOR OOTHER: SIGNER IS REPRESENTING: IName of Peraonls) or Entitylies) RIGHT THUMBPRINT (Optional) 3 0 CAPACITY CLAIMED BY SIONERIS) OINDIVIDUAL(S) OCORPORATE OFFICER(S) ITITLESI OPARTNER(S) DLIMITED ❑GENERAL ❑ATTORNEY IN FACT ❑TRUSTEE($) D G UA RD IAN/CONSERVATOR ❑OTHER: SIGNER IS REPRESENTING: Mame of Person(s) or Entitylies) 7 III�IIIIIII VIII I VI II 0 i B 10024 CAMP COQKIE FOR. CHILDREN, INC. CALIFORNIA BANK B TRUST A NON PROFIT ORGANIZATION SAN JUAN CAPISTRANO OFFICE (760) 480-8509 SAN JUAN CAPISTRANO, CALIFORNIA 92675 P.O. BOX 460682 16-339-1220 ESCONDIDO, CA 92046 10!2472001 PAY TO THE ORDER OF Orange County Recorder $ ..34.00 ` E Thirty-Four and 0011DOLLARS 9 3 E 2 E G O NO UN y MEMO i 4 xo 1120 100 2411• 1:122003391;1:' 3 14 18 2 1110 10/16/01 AGENDA ITEM D 7 TO: George Scarborough, City Manager FROM: Amy Amirani, Public Works Director SUBJECT: Consideration of Improvement and Reimbursement Agreement for Water Facilities (Camp Cookie for Children, Inc.) RECOMMENDATION By Motion: 1. Approve the Improvement and Reimbursement Agreement for Water Facilities — Camp Cookie for Children, Inc, 2. Authorize the Mayor to execute the Agreement on behalf of the City; and, 3. Direct the City Clerk to forward the Agreement to the Orange County Recorder for recordation. SITUATION A. Summary and Recommendation Camp Cookie for Children, Inc. (hereinafter referred to as "Developer"), a non-profit organization that is a current property user within the North Open Space (NOS) area, has acquired approval by the City to develop a portion of the NOS into an equestrian center for the exclusive use of a non-profit organization dedicated to assisting disadvantaged youth. There are certain offsite and onsite water improvements associated with the development of the equestrian center. The water improvements include the construction of a 12 -inch water main and appurtenances in the proposed alignment of the shared common entrance roadway to the NOS area. The Developer has agreed to pay for such construction with the understanding that any future NOS property user shall be required to pay their fair share participation, in accordance with the subject agreement - hence they would share the use of the constructed water system in order to provide adequate water capacity to their site. The processing of this fair share participation shall be on a pro -rata basis as stipulated in the "Improvement and Reimbursement Agreement for Water Facilities — Camp Cookie for Children, Inc.". This shall be accomplished pursuant to a methodology FOR CITY COUNCIL AGENDAS AGENDA ITEM • -2- • October 16, 2001 Camp Cookie for Children, Inc. that includes consideration of one or more relevant factors, e.g., linear footage, acreage basis, property use, water demands, and cost of construction, as stipulated in Section I, 'Reimbursement To Developer" of the subject agreement with the Developer. The Developer wishes to enter into an "Improvement and Reimbursement Agreement for Water Facilities — Camp Cookie for Children, Inc." for the construction cost of the 12 -inch water main and appurtenances. Staff recommends the approval of the Improvement and Reimbursement Agreement for Water Facilities — Camp Cookie for Children, Inc. B. Background The City Council approved the "License Agreement' between the City and the developer on February 6, 2001, which allows the Developer to use the NOS property as disclosed. The Developer has agreed to construct the water improvements in conjunction with the subject development in order to provide the required Orange County Fire Authority (OCFA) water improvements necessary for fire protection. The construction of the water main pipeline will be constructed as a public water system. The public water system will benefit the City owned NOS property, by providing the additional water capacity needed for future development at said City owned property. COMMISSION/BOARD REVIEW, RECOMMENDATIONS The Environmental Administrator, the Design Review Committee, the Planning Commission, and the City Council have previously reviewed and approved the Camp Cookie for Children, Inc. project. FINANCIAL CONSIDERATIONS All applicable development fees have been paid and the required sureties posted with the District. NOTIFICATION John Frank, Camp Cookie for Children, Inc. John Burgess, The Burgess Engineering Group ALTERNATE ACTIONS W:\ENG\DVLP\SP\COOKI E\IMPREBRS. DOC AGENDA ITEM 0 -3- • October 16, 2001 Camp Cookie for Children, Inc. By motion: 1. Approve the Improvement and Reimbursement Agreement for Water Facilities— Camp Cookie for Children, Inc. 2. Do not approve the Improvement and Reimbursement Agreement. 3. Refer to Staff for additional information. RECOMMENDATION By Motion: 1. Approve the Improvement and Reimbursement Agreement for Water Facilities — Camp Cookie for Children, Inc, 3. Authorize the Mayor to execute the Agreement on behalf of the City; and, 3. Direct the City Clerk to forward the Agreement to the Orange County Recorder for recordation. Respectfully Submitted: Prepared By: CYVI,�-QNVLUtitlit �V Amy Amirani Craig L. Harris Public Works Director Assistant Engineer AA/CLH:ch Attachments: 1. Improvement and Reimbursement Agreement for Water Facilities — Camp Cookie for Children, Inc. 2. Location Map W:\ENG\DV LP\SP\COOKIE\I MPREBRS.DOC 0 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 Ll IMPROVEMENT AND REIMBURSEMENT AGREEMENT FOR WATER FACILITIES - CAMP COOKIE FOR CHILDREN, INC. THIS IMPROVEMENT AND REIMBURSEMENT AGREEMENT is entered into this 16th day of October, 2001, by and between CAPISTRANO VALLEY WATER DISTRICT, hereinafter referred to as "District" and CAMP COOKIE FOR CHILDREN, INC., a not -for profit corporation, hereinafter referred to as "Developer". THIS IMPROVEMENT AND REIMBURSEMENT AGREEMENT shall be administered by the CITY OF SAN JUAN CAPISTRANO, and the CITY OF SAN JUAN CAPISTRANO, hereinafter referred to as "City", enters into this Agreement on behalf of the "District", in accordance with Resolution No. 97-10-7-1. WITNESSETH Whereas, City and Developer have entered into a license agreement dated February 6, 2001, ("License Agreement"), for the use of a City owned property located within a portion of the North Open Space (NOS) properties; and, Whereas, Developer agrees to design and construct, at its sole cost and expense of an estimated amount of $65,562, the construction of the water facilities to 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. sere the properties known as Assessor's Parcel No. 121-050-19 and 121-059-21 hereinafter referred to as "Water Improvements'; and, Whereas, because the aforementioned water improvements benefit Assessor's Parcel No. 121-050-19 and 121-050-21, City owned parcels, Developer is therefore entitled to reimbursement for a portion of those cost of improvement; and, Whereas, the reimbursement shall consist of pro -rata contributions from future NOS property users, including City of San Juan Capistrano, who will develop City properties consistent with the "NOS Master Plan" and the property to be used by Developer under the License Agreement; and, Whereas, In accordance with the proportional fair share described in this Agreement, Developer agrees to be reimbursed by future NOS property users for their proportional fair share cost of the total reimbursable amount of $47,678.40, as describe in (Exhibit "A"), to construct a 12 -inch water main pipeline and appurtenances as shown and delineated upon the improvement plans entitled "Public Water Improvements For The Camp Cookie For Children"; 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 improvements; and, 2 W :\ENGGDV LP\COO KI E\REI M BU RS. DOC Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. NOW, THEREFORE, BE IT RESOLVED BETWEEN CITY, DEVELOPER AND DISTRICT AS FOLLOWS: I. REIMBURSEMENT TO DEVELOPER Developer will be required by City and District to construct water improvements in order to provide water service to the Camp Cookie project. City hereby agrees to require any future NOS property users, as a condition of development of their approved use of parcels within the remaining NOS site, to pay a proportional fair share of Developers original cost to install the water improvements necessary to provide the required water demand to its site. A proportional fair share assigned to each future NOS property user is defined to mean a proportional fair share as determined by the City Engineer and District Engineer pursuant to a methodology developed and adopted by the City Engineer and District Engineer, which said methodology shall include consideration of one or more relevant factors, e.g., linear footage, acreage basis, property use, water demands, and cost of construction, as determined by the City Engineer and District Engineer. Developer obligations to construct, under Article IV hereof, and to pay for repairs, under Article VIII hereof, are contingent upon Developer's occupancy of the property under the License Agreement, or any extensions of the License Agreement. II. IMPLEMENTATION OF FAIR SHARE REQUIREMENT Upon receipt of any development application by a NOS property user, the City Engineer and District Engineer shall make a determination of fair share pro -rata payment requirement pursuant Section I. of this Agreement. The NOS property user 3 W :\ENG\D V LP\C 00 KI E V i EI M 8 U R S. DO C 0 0 Improvement anq Reimbursement Agreement Camp Cookie for CMdren, Inc. shall pay the fair share payment to City upon issuance of building permits. City shall then pay this contribution to Developer within forty-five (45) days from the date of City's receipt of the property user's contribution. 111. Term This Agreement, and the reimbursement provisions to Developer, shall remain in full force and effect for a period of ten (10) years from the date of approval plus any additional period of time Developer occupies property under any extensions of the License Agreement. IV. CONSTRUCTION AND COMPLETION 1. Developer shall, its sole cost and expense, construct and install within twenty-four (24) months from the effective date of this Agreement, all of the water facilities shown and delineated upon the improvement plans entitled "PUBLIC WATER IMPROVEMENTS FOR THE CAMP COOKIE FOR CHILDREN" as approved by the District Engineer of the Capistrano Valley Water District and the City Engineer of the City of San Juan Capistrano and on file with said City and by reference made a part of this Agreement as though fully set forth herein. 2. Developer shall construct said water facilities in accordance with the approved plans, District's standard specifications and under City's inspection, and shall indemnify and hold harmless all officers, employees and agents of the City and District from and against all claims, damages, losses and expenses, including attorneys' fees, arising out of or resulting from the performance of the work, and caused in whole or in part by any negligent act or omission of Developer, Contractor, or any Subcontractor, 4 W :\ENG\DV LP\COO KI E\R EI M BU RS.DOC 0 0 Improvement and Reimbursement Agreement Camp Cookie for Chl"Idren, Inc. anyone directly or indirectly employed by any of them, or anyone for whose acts arly of them may be liable, regardless of whether or not it is caused in part by a party indemnified hereunder. 3. If Developer has not completed the work within twenty-four (24) months from the effective date of this Agreement, District has the right but not the obligation, to call the security for faithful performance and complete the work. Any work performed after said twenty-four (24) months, whether by Developer, District, or others, shall be in accordance with District's standard specifications in effect as of the time the work is performed. 4. The security shall remain in effect for a minimum of 365 consecutive calendar days after all the water facilities have been completed and accepted by District, and shall continue in effect until exonerated in writing by District. It shall be incumbent upon the developer to renew the security prior to its expiration. V: USE OF WATER 1. Developer hereby expressly agrees that no water shall be used by Developer, or by Contractor or any Subcontractor, for construction purposes except through a meter provided by District. Developer acknowledges that Section 499 of the California Penal Code provides that unauthorized use of water is a misdemeanor, and District hereby states its intent to strictly enforce said Penal Code Section. 2. In addition to any criminal penalties, and not as a substitute therefore, District will charge Developer, and Developer agrees to promptly pay District, $500.00 per day for unmetered use of District's water by Developer, Contractor, or any 5 W AENG\DVLP\COOKIE\REIM8URS.DOC • 0 Improvement and Reimbursement Agreement Camp Cookie for CNIc ren, Inc. Subcontractor, anyone directly or indirectly employed by any of them, or anyone for whose acts anyone of them may be liable. 3. Temporary construction meters shall be provided to Developer by District at the rental rate existing at the time such meters are provided. The use of "jumpers" is expressly prohibited. 4. Developer shall notify District as soon as it is reasonably practical to install any permanent meter, and District shall provide and install same as soon thereafter as reasonably possible. The foregoing notwithstanding, the District may install any meter when District determines it is desirable to do so. VI. FEES, CHARGES, AND SECURITIES 1. Developer shall, prior to the execution of this Agreement, pay District the following sums to allow for the construction of "Line A": (a) $3,005.62 for the costs of District's plan review, inspection of construction and the control thereof, and for the testing of materials, which sum is based upon the estimated construction cost of $44,860. (b) $100 for the upsizing cost to furnishing and installation by District of all permanent water meters, which sum is based upon the following number and size of meter: one (1) 2 -inch. 2. Developer shall, prior to the construction of "Line B", pay District the following sums: 6 W :\ENG\DV LP\COOKIE\R EIM BU RS.DOC Improvement and Reimbursement Agreement Camp Cookie for ChTdren, Inc. (a) $991.06 for the costs of District's plan review, inspection of construction and the control thereof, and for the testing of materials, which sum is based upon the estimated construction cost of $14,792. 3. In addition to the above sums, a surety bond to secure the faithful performance of this Agreement in the sum of $49,346 is hereby approved for the construction of "Line A". Prior to the commencement of line "Line B" the Developer shall provide a surety bond to secure the faithful performance of this Agreement in the sum of $16,271.20. 3. When additional buildings on this property are constructed, Capital Improvement Charges, Water Storage Charges, Water Capacity Charges, and Meter Fees for the additional development shall be paid prior to additional service being provided. VII. GUARANTEE Developer hereby guarantees the materials and the workmanship of the water facilities for a period ending 365 consecutive calendar days after the acceptance of said water facilities by District, and hereby agrees to reimburse District for all costs associated with the accomplishment of necessary repairs, not to include normal preventative maintenance, to said water facilities which may have been made by District within the aforesaid guarantee period. W:\ENG\DVLP\COOK1EARE1MBURS.DOC 11 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. VIII. GENERAL 9 1. Developer hereby offers to dedicate to District the water facilities together with necessary easements. 2. Upon completion of the construction in accordance with the improvement plans and specifications and the dedication of the necessary easements, District agrees to accept the water facilities, whereupon said water facilities shall become property of District with obligation to repair and maintain same. 3. The terms of this Agreement shall inure to the benefit of and be binding upon the successors and assigns of the parties hereto. 4. Should either party be required to enforce any of the terms of this Agreement, it is agreed that the prevailing parry shall be entitled to costs and reasonable attorneys' fees. IX. INSURANCE AND INDEMNIFICATION During the construction period and for the purpose of construction Developer and/or Contractor's shall maintain in full force and effect the following insurance: 1. Comprehensive General Liability Comprehensive general liability coverage, including premises operations, products/completed operations, broad form property damage and blanket contractual liability in the following minimum amounts: • $500,000 property damage; s W :\ENG\DV LP\COO KIE\R EIM B UR S.DOC Improvement and Reimburseffit Agreement Camp Cookie for Children, Inc. $500,000 injury to one person/any occurrence/not limited to contractual period $1,000,000 injury to more than one person/any one occurrence/not limited to contractual period. 2. Comprehensive Automobile Liability Comprehensive automobile liability coverage, including owned, hired and non - owned vehicles in the following minimum amounts: • $500,000 property damage; • $500,000 injury to one person/any occurrence/not limited to contractual period $1,000,000 injury to more than one person/any one occurrence/not limited to contractual period. 3. Worker's Compensation During the construction period, if Developer or Contractor employs employees to perform services under this Agreement, Developer or Contractor shall obtain and maintain, Worker's Compensation Employer's Liability Insurance in the statutory amount as required by state law. These 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 insurance policies required under this Agreement. Developer shall indemnify and hold City/District harmless from any and all claims, demands, actions, attorney's fees, costs, and expenses based upon or arising out s W AENG\DV LP\COOKIE\REIMBURS.DOC Improvement and Reimburse•t Agreement • Camp Cookie for Children, Inc. of errors, omissions, or negligent acts of Developer, its associates, employees, subcontractors, or other agents while performing services under this Agreement. In the event an action is commenced by a party to this Agreement against any other party or parties hereto to enforce its rights or obligations arising from this Agreement, the prevailing party in such action, in additional to any other relief and recovery awarded by the court, shall be entitled to recover all statutory costs plus reasonable attorney's fees. X. 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. XI. 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: CITY OF SAN JUAN CAPISTRANO Attention: City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 TO: CAMP COOKIE FOR CHILDREN, INC. Attention: Dean Daggett, Law Offices One Park Plaza, Ste. 1250 Irvine, CA 92614-8509 to W :\ENG\DV LP\COOKIE\R EIM B URS. DOC Improvement and ReimbursemeAgreement • Camp Cookie for Children, Inc. XII. 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. XIII. 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. XIV. CITY BUSINESS LICENSE Developer will maintain a license to do business in the City of San Juan Capistrano. XV. INDEPENDENT AGENT At all times during the term of this Agreement, Developer shall be an independent agent and shall not be an employee of the City/District. City/District shall have the right to control Engineer only insofar as the results of Developer's services rendered pursuant to the Agreement; however, City/District shall not have the right to control the means by which Developer accomplishes services rendered pursuant to this Agreement. EX7 A Developer shall be responsible for all injuries to persons and for damages to real or personal property of the City/District, caused by or resulting from any activity or 11 Improvement and ReimbursemeAgreement • Camp Cookie for Children, Inc. operation of Developer, its employees or its agents during the progress of or connected with the rendition of services hereunder. Developer shall defend and hold harmless and indemnify all officers, employees and agents of City/District from all costs and claims for damages to real or personal property or personal injury to any third party resulting from the activity of itself, employees or its agents. XVII. DEVELOPER NOT AN AGENT Except as City/District may specify in writing, Developer shall have no authority, express or implied, to act on behalf of the City/District in any capacity as an agent. Developer shall have no authority, express or implied, pursuant to this Agreement, to bind City/District to any obligation. XVIII. ATTORNEYS FEES 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 the reasonable attorney's fees and costs from the other party. 12 W:\ENG\DVLP\C00K1E\RE1MBURS.D0C 0 0 Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. IN WITNESS WHEREOF, the parties hereto have executed this Agreement, consisting of fourteen pages, on the above date. CAMP COOKIE FOR CHILDREN, INC. PO Box 1434 San Juan Capistrano, CA 92693 760-480-8509 (Attach Notary Acknowledgement) 13 W:\ENG\DV LP\COOKI E\REI MBU RS.DOC CITY OF SAN JUAN CAPISTRANO M Attest: Wyatt Hart, Mayor Margaret R. Monahan City Clerk APPROVED AS TO FORM: By: Joh haw, City Attorney Improvement and Rei mburseoAgreement • Camp Cookie for Children, Inc. EXHIBIT A PUBLIC IMPROVEMENTS TO BE CONSTRUCTED BY DEVELOPER SUBJECT TO REIMBURSEMENT FROM FUTURE PROPERTY USERS Construction of 700 linear feet of 12 -inch water main pipeline and appurtenances. SUMMARY OF REIMBURSABLE COST IMPROVEMENTS SUBJECT TO REIMBURSEMENT ESTIMATED AMOUNT Const. 24" x 12" Wet Tap Tee & Tapping Sleeve $6,500.00 Furnish & Inst. 12" Resilient Wedge Gate Valve 3,160.00 Furnish & Inst. 12" C-900, CL. 200 Water Main 28,000.00 Furnish & inst. Commercial Fire Hydrant 3,440.00 Furnish & inst. 12" 22-1/2 Degree Bends 325.00 Const. Thrust Blocks 1,200.00 Furnish & Inst. 12" Plug 300.00 Furnish & Inst. Flange X Push -On Adapter 419.00 Subtotal $43,344.00 Engineering (10%) 4,334.40 TOTAL $47,678.40 The surety bonds shall be posted with the City/District upon the earlier of issuance of Encroach ment/Construction Permit for said improvements for Camp Cookie for Children, Inc. 14 um =11rfl11YO 11[eislouiI41:1XI , W 11:1:'1916103 0 State of - CALIFORNIA County of ORANGE E On vc r a ct-1 before me, PHILIP J. HLNkWS. NOTARY PUBLIC (DATE) (NAME/TITLE OF OFFICER-i.e.'JANE DOE, NOTARY PUBUC'1 personally appeared ---S vN AJ EQ IU K ❑ personally known to me -OR- Pl­ PHILIP). HUGHES C mQOMM. # 1163799 > >Nctay Public Callfomia ORANGE COUNTY Conmyyjo,l exp. 17R8/DI (SEAL) /i All a 01 Ile] Moff] 11M Proved to me on the basis of satisfactory evidence to be the person($) whose name(al Is/e►e— subscribed to the within instrument and acknowledged to me that he/sheftFrep executed the same in his/herftleir authorized capacity(iec,►, and that by his/her0herr signature(if) on the instrument the person(d), or the entity upon behalf of which the person() 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 MUST BE ATTACHED TO THE DOCUMENT DESCRIBED AT RIGHT: Tale or Type of Document Number of Pages Date of Document Slgnerls) Other Than Named Above WOLCOTTS FORM 63240 Rev. 3-94 )Price clave B 2AI 1990 WOLCOTTS FORMS, INC. ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITY/REPRESENTATION/TWO FINGERPRINTS RIGHT THUMBPRINT (Optional) CAPACITY CLAIMED BY SIGNERIS) DINDIVIDUAL(S) ❑CORPORATE OFFICERISI RITU SI OPARTNER(S) ❑LIMITED ❑GENERAL ❑ATTORNEY IN FACT OTRUSTEE(S) ❑GUARDIAN /C ON S ER V A TOR ❑OTHER: SIGNER IS REPRESENTING: (Name of Penon(.) or Entitylies) RIGHT THUMBPRINT (Optional) 0 CAPACITY CLAIMED BY SIGNER(S) DINDIVIDUALISI ❑CORPORATE OFFICER(S) (TITLES) ❑PARTNERI$) ❑LIMITED ❑GENERAL ❑ATTORNEY IN FACT DTRUSTEEISI D GUARDIAN/CONSERVATOR DOTHER: SIGNER IS REPRESENTING: (Name of Pereon(s) or Entity0ec) �; \:_' C C1 T t� s.. Dawn Schanderl To: Amy Amirani; Craig Harris; Kathleen Springer; Jack Galaviz Subject: Camp Cookie Everything has been straightened out with Camp Cookie regarding insurance. HOWEVER, regarding the reimbursementlimprovement agreement insurance will have to be in place once construction begins. It will be provided by Brongo. I have spoken to both John Frank and Brongo and we seem to be on the same page. Thanks to all of your efforts FROM BFlOiZO CONSTBUC.TIOH INC PHONE NO. : '345 4430620 Oct. 04 2002 02:17Pt1 P2 ' MCCORGf ..y na4=i". `x.Wr»Y„v+r «a:.'.1I,�iM, L$,+.pnA=,. ro E 714 259— 7 6 Seltzer Insurance Service THIS CERTIFICATE Ib ISSUED Ab A ATTER OF INFORMATION M 1,524 E. Mayfair Ave ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE ange, CA 92867 COVERAGE AFFORDED BY THE POLICIES BELOW. CWP.Y Claremont Liability Insurance Co. A CamPeny progressive Insurance 8 Insured BRDNVDL-�roa "' Firemanls Fund Insurance Company Brongo Construction C State Compensation Ins Fund 32332 Camino Capistrano, $205 ICpx^Y SO..Y» HEMIN�' , h ♦ M. THIS IS TO CERTIFY THAT YHE POLICIES OF INSVRANCC LISTED BROW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY INOICATEO. NOTWRHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE WSVRANCE AFFORDED BY THE POLICIES DESCRIBED MERSIN IS SUBJECT TO ALL THE TERMS AC USIONE AND CONOITIONS CH POVCES. LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. POLICY POLICY CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LINBTS LTM DATE DATE ERAL LIABILITY GLnml Agamate t Cmmaroal GaM01 La1,1111 RMOI-20749-01 03/01/02 03/01/03 Proof ..CeR1 0 A �r Claims MadA �Oe u, P"onxl d Adw V I vN fadf Oewmnq Owner's E CemNeNry ryotactiw RPI O&TWW 1 1 .'bel MOV081 Exp-m"(Wy aro pqrsf# UTOM LE UAIRLITY Any AUW Dananod SI g[6 Limn s Bodey10Y NI OWr1W AV(t 04756949-0 ,103/01/02 03/01/03 SPhMWd AW.. Iwr ptrwnl Bodily INUrY HIM AUfet MWQ. AW A0W IPm ecebam) Prepmry Dame" QARAGIELIABILITY— Al"A Only - Ex Aawem Otho TRtn Avco Onh, A.V AYIo 40 A00"M A09MRS EXCESS IABIL Each Ocwacnm A ab UmbIWID Po" Other TW UmMeEa Fam WORKERS' COMPENSATION a EMPLOYERS' LIABUITY 1663406 11/17/01 11/17/02 Mt.,E FLE Aacidam El fNaaaac.POREy Lvrtit M Pros WW/ Partwid1m Wlw Ina{ 'xeaaa•Ee E to WS aa' el HER nlan$ Marin® 198401494 03/01/02 03/01/03 697,840 Scheduled C irsd/Rented/Eq 300,000 Any One Unit DESCRIPTION W OPE-UT-18WS-101TIONSP4EHICL SPEC 17 MS ertificate Holder is named Additional Insured with respects to operations E the named insured. 007 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30• DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT, BUT FAILURE TO MAK SUCH NOTICE SMALL IMPOSE NO OBLIGATION City Of San Juan Capistrano & OR LIABILITY OF ANY KWD UPON THE COMPANY, ITSAGENTSORREPRE- r Capistrano Valley Water District SENTATIVES. 32400 Paseo Adelanto U EprcSCUTab" San Juan Capistrano, CA 92675 �AJI. :�p 1 y b �'+1 irvrr �& -,vy,. �Y.x rtnI♦+r NA;" T eae Yl .�3i ♦ I ^ nn 11TJ. ' wW ♦+.iinil����MY �`w�r2M�P� � 09/25/2002 12:57 958-a59-9919 SH SPIEGLEP INS PAGE 01/01 7855 IVANHOE AVENUE, SUITE 480 LA JOLLA, CA 92037 TELEPHONE (858) 459-8834 FAX (858) 459-9019 CA D.O.I. LICENSE *0671012 LM Tb: Camp Cookie for Children, Inc. From: Betty Hall Phone: 780490-0509 Date: September25,2002 Re! Workers' e comments: Steven H Spiegler ` Insurance Services, Inc, Attic John Frank 1 Fac: 780480-1099 POIJOY TYPO: Workers' Compensation For the Purposes of San Juan Capistrano Per our conversation, this is to confirm that as of this date our office has submitted a Workers' Compensation application to the State Compensation Insurance Fund and will be providing a quotation as soon as it is received. I trust that this Is sufficient, but N you require anything further, please let me know. MEMORANDUM TO: Meg Monahan, City Clerk Craig Harris, Assistant Engineer FROM: Dawn Schanderl, Deputy City Clerk DATE: February 6, 2002 SUBJECT: Camp Cookie - Insurance per Improvement/Reimbursement Agreement Status Update: 1. Automobile certificate of insurance - amounts do not seem to match what is required per agreement. (Copy attached) 2. Workers compensation - Brongo must name City/CVWD as certificate holders and reference project on certificate. 3. D�- General liability - Notice of intent not to renew effective 4/30/02 (copy attached). � c 4j2.�+102. 4. Endorsement needed adding City/CVWD as additional insureds. 5. Copy of insurance requirements attached Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. VIII. GENERAL 1. Developer hereby offers to dedicate to District the water facilities together with necessary easements. 2. Upon completion of the construction in accordance with the improvement plans and specifications and the dedication of the necessary easements, District agrees to accept the water facilities, whereupon said water facilities shall become property of District with obligation to repair and maintain same. 3. The terms of this Agreement shall inure to the benefit of and be binding upon the successors and assigns of the parties hereto. 4. Should either party be required to enforce any of the terms of this Agreement, it is agreed that the prevailing party shall be entitled to costs and reasonable aftomeys' fees. IX. INSURANCE AND INDEMNIFICATION During the construction period and for the purpose of construction Developer and/or Contractor's shall maintain in full force and effect the following insurance: 1. Comprehensive General Liability Comprehensive general liability coverage, including premises operations, products/completed operations, broad form property damage and blanket contractual liability in the following minimum amounts: • $500,000 property damage; a W :ENG\DV LP\COO KIE\REI M BU RS.DOC Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. • $500,000 injury to one person/any occurrence/not limited to contractual period • $1,000,000 injury to more than one person/any one occurrence/not limited to contractual period. 2. Comprehensive Automobile Liability W Comprehensive automobile liability coverage, including owned, hired and non - owned vehicles in the following minimum amounts: • $500,000 property damage; • $500,000 injury to one person/any occurrence/not limited to contractual period • $1,000,000 injury to more than one person/any one occurrence/not limited to contractual period. 3. Worker's Compensation During the construction period, if Developer or Contractor employs employees to perform services under this Agreement, Developer or Contractor shall obtain and maintain, Worker's Compensation Employer's Liability Insurance in the statutory amount as required by state law. These 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 insurance policies required under this Agreement. Developer shall indemnify and hold City/District harmless from any and all claims, demands, actions, attorney's fees, costs, and expenses based upon or arising out 9 W AENG\DV LP\COOKIE\REIMBURS.DOC Improvement and Reimbursement Agreement Camp Cookie for Children, Inc. of errors, omissions, or negligent acts of Developer, its associates, employees, subcontractors, or other agents while performing services under this Agreement. In the event an action is commenced by a party to this Agreement against any other party or parties hereto to enforce its rights or obligations arising from this Agreement, the prevailing party in such action, in additional to any other relief and recovery awarded by the court, shall be entitled to recover all statutory costs plus reasonable attorney's fees. X. 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. XI. 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: CITY OF SAN JUAN CAPISTRANO Attention: City Clerk 32400 Paseo Adelanto San Juan Capistrano, CA 92675 TO: CAMP COOKIE FOR CHILDREN, INC. Attention: Dean Daggett, Law Offices One Park Plaza, Ste. 1250 Irvine, CA 92614-8509 to W :\ENG\DV LP\COOKIE\REIMBU RS.DOC T . ACOR ERTIFICA7 E PRouuDER STREETER �N'URANCE AGENCY P.O. BOX 6 S68 SAN DIEGO CA. IM MP COOKIE FOR CHILDREN, P.O.BOX 460682 ESCONDIDO,CA 92046 +CfSYERAQ�S -'. THIS IS TO CERTIFY THAT THE POLICIES OF INSUR, INDICATED, NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN T EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. DO DT AMeN EXTEND OR TYPE OF INSURANCE FO. IILGENMAL LIARMI I_ COMPREHENSNE FORM PREMISESpPERATIONS UNDERGROUND rti EXPLOSION 8 CNLAPSE HAZARD i ! PRODUCTWOMPLETED OPER I - CONTRACTUAL' ~^ INDEPENDENT CONTRACTORS .--y BROAD FORM PROPERTY DAMAGE PERSONAL INXIRY iLUTOMOBAF LIABEJTY - -__{I ANY AUTO ALL OWNED AUTOS (Private Pass) �- —. ALL OWNED AUTOS THE Pi%LICY PER('D I (OMb Oran Private Passenger - r HIRED AUTOS —' -,EL NOWOYMED AUTOS IO ALL THE TE:RM., GARAGE LIABILITY AIX SCHEDULED AUTO,AC11044 -i EXCESS LIABRI , UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND y V EEELOYERB' LIABNETY THE PROPRIETOR/ PARTNERSrE%ECUTIVE -- OFFICERS ARE: E%CL _ DINER DESCRWrION OF OPFRA'nONSfLOCATgNSNEHICLMSPECIAL VVEN ... X0.3 1•� ' I IYJ lJ IC7MlV�.rE -_ _ DATE(UNI100rrh 5 '--111i---$ - _ _GE OCC 01. 23/02 --A GE AGO of AS A RATTER OF INFORMATION E PiG�TTS UPON T-44 CERTIFICATE .. r. + IY AGO • IN ,c is `I; DOES' DT AMeN EXTEND OR I _ ill[ F .IPGROED P Y THE ItLICIES BELOW. FcORDING CQ)fERkMS _ ..... _ _ OMPA$ R, Ln ra THE Pi%LICY PER('D cl r .CT TO NHICH RHI" -,EL - ! :' ,. IO ALL THE TE:RM., I riff I ERTIF"ME. HOLDER:. ,: - ADDITIONAL INSURED CITY CLERK,CITY OF SAN JUAI & CAPISTRANO VALLEY WATER 1. 32400 PASO ADELANTO SAN JUAN CAPISTRANO,CA9267 H'nc\ E 2.0, 000 E 5:0,000 ;E E 1" 0,000 W IE E - - ------ ------ -=I CE _ _ E _ IATA I OIH I H , T'. 1, _i' —_.— ICY LIMB_ - a :MPLOW Ii S IT ' ItO WLICIIS BE CANCEII En BEFORE THE IF :JINL SOMP,NY WILT ENDEAVOR TO MAIL '.1 I +e CERTIFICA M HOLDER NAMED 'O THE I FAt— IMPOIE NO OBLIGATION OR LIABILRY ( i 1bl" ITS /`-MENNTTTSS OOR/R REPRESENTATIVES. ITS _ ...r EGG —._ 5 '--111i---$ - _ _GE OCC —T--_ --A GE AGO S 'vJd ED OCC E ED AGG _ 15 .. r. + IY AGO S E 2.0, 000 E 5:0,000 ;E E 1" 0,000 W IE E - - ------ ------ -=I CE _ _ E _ IATA I OIH I H , T'. 1, _i' —_.— ICY LIMB_ - a :MPLOW Ii S IT ' ItO WLICIIS BE CANCEII En BEFORE THE IF :JINL SOMP,NY WILT ENDEAVOR TO MAIL '.1 I +e CERTIFICA M HOLDER NAMED 'O THE I FAt— IMPOIE NO OBLIGATION OR LIABILRY ( i 1bl" ITS /`-MENNTTTSS OOR/R REPRESENTATIVES. 'Genesis Indemnity Insurance Company Notice of Cancellation/Nonrenewal Camp Cookie for Children, Inc. PO Box 460682 Escondido, CA 92046 ® Notice of Intent Not to Renew Policy No.: ZYB0053 Policy T m: 04/30/01 to 04/30/02 Agent: Allen Financial Date of Notice: 01/24/02 12:01 a.m. 12:01 a.m. You are cor ance with the terms and conditions of the policy identified above that this insurance is terminated effective on the date of cancellation or non -renewal shown hereon, and after that date no further coverage will be provided thereunder. Reason: General Agent no longer represents company. Barry Starbrckq Vice President of Underwriting Colorado Western Insurance Company as Service Office for Genesis Indemnity Insurance Additional Insureds: Rancho Capistrano City Clerk - City of San Juan Capistrano a N En e�%�%L3- /�� Ln M C 1 3 O N Box 886 • 3895 Upham Street, Suite 100 • Wheat Ridge Colorado 80034-0886 (303) 425-5950 • Fax (303) 425.4297 10/10/2002 14:45 JOHN FRANK 7477 Pursuant to our conversation, please fax to our office the exact verbage that you need on the endorsement to our insurance policy that you requested. We will give this to our agents, and get the proper document to you later today. Sorry for the confusion �► ��m�1� r mrd ���d `�l� C��yof' i ad'A14JYVYZAdzl-lud t . OJAZA CAMP COOKIE for CR LDREN, x INC.1 A NON-PROFIT ORGANIZA'T'ION P Where Kids Go to Horse Around! Mailing Address: P- O- Box 460682 Escondido, CA 92046 Ranch Address: 30261 Camino Capistrano San Juan Capistrano. CA 92675 Phone(760)480-8509 Fax (760)480-1099 !, N'N-N canit) ookie.orH 2002 Winner of the Disneyland Community Service Award for Youth Programs! FACSIMILE TRANSMITTAL SHE£T 1 i) Dawn bRl)N Q;' Kathy Johnson City of San Juan Capistrano 10-10-02 1X NCMef.R 101 Al. N(1 01P1(II c INI. LI -DIV(. 1'I1\'IA 949-493-1053 1 'UONI N( N131 II- I ,ndorselmenT ❑ (IR(.FN'I' IZ POR RI.\'11!W ❑ PI.I-. \SI1 ❑ PLI 1>I RI. PLI' ❑PLP..\}I. lo (v( LP. Dear Dawn Pursuant to our conversation, please fax to our office the exact verbage that you need on the endorsement to our insurance policy that you requested. We will give this to our agents, and get the proper document to you later today. Sorry for the confusion �► ��m�1� r mrd ���d `�l� C��yof' i ad'A14JYVYZAdzl-lud t . OJAZA Sample Endorsement POLICY NUMBER: 1i COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Ccs.{ Of SQA, c�'V� c�C-� ) � ���� City of XYZ, its ofcials, eVloyees and agents Oct ) s lQ (1 va 1S I S V- ( L (If no entry appears above information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. -T[lS I S j u Sr a e4 the +y p e . S6-rn P le CG 20 10 11 85 Copyright, Insurance Services Office, Inc. 1984 CAMP COOKIE for CHILDR£N, Inc. A Non -Profit Orgaaixi tion Ranch Mail: P.O. Box 1434 San Juan Capistrano, CA 92693 (949) 661-5897 Administrative Mail: P. O. Box 460682 Escondido, CA 92046 (760) 480-8509 October 7, 2002 Regular Mail Mr. Jack Galaviz Ms. Amy Amirani Mr. Craig Harris City of San Juan Capistrano 32400 Paseo Adelante San Juan Capistrano, CA 92675 RE: Insurance Dear Madam and Sirs, Pursuant to your letters of September 10, 2002 and September 24, 2002 I am enclosing the requested information. From the Contractor doing the work on the water line, Brongo, attached is a copy of his insurance: $2,000,000 General Liability, $1,000,000 Auto Liability, and $1,000,000 Workers Compensation. Also attached are Camp Cookie's $1,000,000 Automobile policy (increased from $500,000 per your request,) $1,000,000 General Liability, and the Worker's Comp Submission to Speigler Insurance. We hope that this will comply with the requirements set forth in your letters. If you have any further questions please call me. Yours truly, Johan R. Frank President cc: Dean Daggett Dawn Schanderl To: Jack Galaviz; Kathleen Springer Subject: Camp Cookie Status on insurance is still the same as the last memo dated February 6, 2002: Automobile certificate amounts do the match what is required in agreement. Do not have general liability endorsement (City/CVWD Additional insureds) Workers compensation I 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, GA 92675 (949) 493-1171 (949) 493-1053 (FAX) www.sanjuancapistrano.org November 19, 2001 Camp Cookie for Children, Inc. Attention: Laurie/John Frank Via Fax: 760-480-8509 MEMBERS OF THE CITY COUNCIL DANE L. BATHGATE JOHN S. GELFF COLLENE CAMPBELL MATT HART DAVID M. SWERDLIN CITY MANAGER GEORGE SCARBOROUGH Re: Improvement and Reimbursement Agreement for Water Facilities — Camp Cookie for Children, Inc. Thank you for your fax transmittal, received today. Unfortunately, the policy declarations that were sent do not provide the evidence needed to confirm the types and extent of coverage, nor the endorsements needed to meet the terms of the agreement (pages 6 through 10). Please forward (or instruct your insurance carrier to forward): 1. A Certificate of Insurance, naming the City of San Juan Capistrano Certificate Holder, for the Comprehensive Automobile Liability coverage. (-t 2. Though we have received a Certificate of Insurance for Comprehensive General Liability coverage, still outstanding is a General Liability Endorsement Form indicating that the City of San Juan Capistrano and Capistrano Vall�y­Water District have been legally added as additional insured to the insurance policies required: —`.,\ I , t ('( 3. Workers Compensation coverage evidence, I understand frgm your note, will be sent under separate cover from Brongo Construction./VWD aS Also outstanding, and required to begin work under this agreement, are suret-y bonds curs e�'J the faithful performance of the agreement, as stipulated on Page 7 of the agreement. Upon receipt of these documents, an executed agreement will be issued. J Sincerely, ! Meg M an, M City erk 'i cc: athleen Springer, Administrative Assistant & Amy Amirani, Public Works Director i DRUG USE IS 11/21/2001 16:48 7604888509 t, {ROP! : DFONCz7 INC STATE COMMIALATWIa INItC ILANC{ PHLWF NO. JOHN FRANK 949 -re FY1r;l H2 A O. Boa Y20W. JAN MANCIV;0. CA 90141 -080 - FUND CXR AIX Die' WORKII MI COII�BNSA7'ION INSUR.&NCE Brougo Cont; ioa lg1CY nVAtOtJI 16a3a J6 32132 paiep apietrano Suite za CVAttr1Cw7L LanArS. it/17/02 Mao Caplctrano, CA 92675 TrM N t0 Qw* that v1a have waved a void VMxken' Competvaffan lnwnnee 0611e} In a tort" approved by !re CalltanM Inewrnwe COrtvnYeievidw 10 the aaployer rwmvd below W the posey p*wA IrWbated. Tyle ealiey 181101 subd to aarumlebon by the Fund rscept upon 39 days advance Writam mficq to the emplovay. yes will view aiw you 10 drys aaven, Mice wwuM this POMW be eanceflad prior to its rwrrrw expiladon. This oer9krz of irrsurarl0e is not an ineurame, poky and done net amend, OXWIO or alter +he Govera" ettardau by the paliclo0 !leaf hens. Notwlthstandinp any requyemem, toren a uaMRran at any -nbapt or othy doewnere vrth reaped to which this 00006114 of yallaanrn may be iaaued or may pertain, the insurance aMrndoit by the puades deaMho,' h&cfn R sublar to d1 eie turas, swdusians end conditions of such pu6Ga- 1 AUTHORIZED RWREBENTATIye EMPLOYGA'S LIABILITY LIMIT INCLUDING DEFENSE COSTS_ $1,000,800 PER OCCURRENCE- CHDOWMENT /0018 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 11/17/01 IS ATTACHED TO AND PORM8 A PART OF THIS POUCY. NAM£ OF ADDITIONAL INSURED: CNOORSOMENT 12000 ENTITLED GERTIFICAT! HOLDERS NOTICE EFFECTIVE 11/17/03 IS ATTACH&C TO AND FORM A PART OF THIS POLICY. ENDORSEMENT N 2570 ENTITLlO WAIWR OP SUMMATION EFF£CTME , Q� Fg11D IS ATTACHED TO AND FOR1fa A PAINT Of THI>t POLICY V TPARTY NAME: \ d f.IN'LOYiR V Srongo conPcruotjofi 32 )37 CC74zo Capistrano Buibo 5 Sanan Capistrano, CA 92675 &W 6J -C, sett CJ! ...P ErsRM ur LIAMU i Y INSUft..JCE I f TRS CEATRFNCATE MOW ALG" lZEawr" xam"MAMS "OQ nm muxg z" ORO" P.O. Aaz 9957 PlLsntTe ,_mss _jjetl. fa S7 �. .._ RIPIR�Y Camp Ceatts for Children Zac. PO Box I434 Rata JtEan Capistraae, CA 93693 DAre W6tRRIN AFFFOpDWO COVERAGE =era lmDMMMMI! zt a co THE POLICIES OF INSURANCE LIMO WOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDNCATEO. NOTVWTHSTANDSIG ANY REOUN"WINT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC ISM 81 T MIRTH RESPECT TO RANCH THIS CERTIRCATE MAY BE ISSUED OR MAY PERTAIN, THE NSUMNCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE Taw^ EXCLUSIONS AND COWMONS OF SUCH POUC". AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAMS, A aNeaaL LLAMDTY J•Ip-5l27114fbs COMWV C OWVML LIAYUTY CUVMSIAME ❑ OCCUR 001% AOGAEQILTE LIMIT AMIV4 PER PUUCY PRIT LOC AIITOtoomm AMILTY —� -'-- – MYAUTO AIL UMIEO AUT08 SL MEM ED µRas MRw AUTOS MOH -(TUNE AUTON wr U�DFY ANY AUTO — OCCUR E_ J CWM4MADf I RtTMTIOM FYORNMIFCOYVMtfNID IYRrtOYFy' "AMU" BnBf 0!/30/7001 B9/w2ai;7 LEIKi` °CcuMFHeE ._�t 1ppeppL RITE OMAAOf IA,ptwtllnl t leeODL MFn EIv tlrvwteJ t y -__ SiQpL PEflSOMAT aAUV11UURY_ t _ _ 7000_lt])AQjj10L OfMFRAL AOTWEGAYE _ t _ 2,7Q11jjJROLOL h1ODLICT!_CONPLOr A00 t _ 2eDOeeL COMNNEO DNSTR LIMB t I6tttidmU No0E.YIM.14gY E P+PMtsV 80pLYmmY t P'waWRl PROPERTY OAEIAGE t Ptrtee4hq AOTOMLY FAACCIOENT OTHBRTHAN -CA AEC- ALITOONLY: sac t EACH OCCURAdCFi t — — AGORLOATE VVEVTATO- EA EACH ACOOFMT _ { _ F 1. OISEABE PA EMKOTIETI E F.L DIYASF PpLICY LIMIT E ` _.1 09C01`7w.; OPe111TOMPAOCATONBNMP[ISIYICLI♦IIOMl IL80ED.Y BInO1MRN0VFMFw WIFION4ON[ Certificate holder to additftmal insured with Tespscts to tate insureds operations. City Cl or* City of Rsh ju" catpistraso 37100 Psso AdalAato Ban Juga Capistrano, CA 97675 ACORD :ANCELLATION to -n.,, LOVLD MY OV THE AYOW OLPCtPYLO IWLFAPP ft GANCLLLPD P oRk THF EXPIRATION MTV TNMNr_ TW WMaYO MMNIMI W U MMMAVOR W MNL " OAYi MTI(Tal APTIGE ro TNA.DaTTf1C-IT LOM1 PtAM a TO TW ILFr, wr FAR IRF TO 00 w 4100. NP[m 4LMrm om LITY ar RANO UPOR ME MD:LMHL ITS Adis OR ATIVd. ACORD CORPORATION 1988 ALLhN kLNAMAL os71uru1 wtu t2:01 fAA ua2se2h3Zll �a "zmxTTY INSURANCE COMPSNY 695 E. MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE EQUINE RENEWAL CERTIFICATE NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE (303)425-5950 PO BOX 460682 04-02-415 AGENT ESCONDIDO, CA. 92046 ALLEN FINANCIAL (602)992-1570 POLICY NUMBER: ZYBODS329A INSURANCE GROUP POLICY PERIOD: 12'r01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 1,595 POSTED FEE 1,6 "75 INSURANCE IS PROVIDED ONLY FOR THOSE COVERAGES FOR WHICH A SPECIFIC AMOUNT OF INSURANCE IS INDICATED. WE WILL PROVIDE THE INSURANCE DESCRIBED IN THIS POLICY IN RETURN FOR THE PREMIUM AND COMPLIANCE WITH ALL APPLICABLE POLICY PROVISIONS - POLICY DESCRIPTION: 22222 - CARE, CUSTODY OR CONTROL - EQUINE 40047 - PLEASURE AND SHOW HORSES OWNED 44228 - WAGON RIDES 47221 - RIDING INSTRUCTION 49950 - ALL STATES - ADDITIONAL INTEREST 99111 STABLES - BOARDING, BRF.EDINC,, TRAI NG OR SALES COVERAGE DESCRIPTION LIMIT EACH OCCURRENCE 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS/COMPLETED OPNS 2,000,000 PERSONAL & ADV. INJURY 1,000,000, MEDICAL PAYMENTS 5,000 DMG-PREMISE RENTED TO YOU 100,000 CARE -CUSTODY CONTROL OCC. 5,000 CARE-CUSTODY-CONTROI, AGG. 25,000 SUBJECT TO FOLLOWING FORMS AND ENDORSEMENTS: CG22/36 11/85 CC21/39 10/93 CG2I/50 09/89 G1 146 01/97 GT -147 01/97 GI 148 01/97 11,00/21 11/94 IL02/70 08/97 CG21/60 09/98 CG21/44 07/98 CG21/47 07/98 CG21/49 07/98 01-114 04/96 GI 145 04/96 CG20/12 07/98 CG21/46 07/98 CG20/26 11/85 CC03/00 10/93 PREMIUM 1,595 DEDUCTIBLE 250 This poWw 1s- •ub)/ot to u tvkknum mimed promium. Plggtir m8d your endorsement carefully. CG24/02 .11/94 GT -105 01/97 G1 254 01/97 TLOO/17 11/8S CG00/01 07/98 CG21/16 0"7/98 CG00/57 09/99 G1-113 04/96 GI 121 12/97 G1 1S1C. OS/00 ;F:RVICh,' COMPANY: COLORADO WESTERN iN`.i(MANCF COMPANY )ATE OF ISSUE- 05/04/2001 15/04/01 15:00:37 COUNTERSIGNED PREMIUM- 1,595 AMTROR I Zpai. P'1'ATI VF, WED 12:01 FAX 6029928927 P.O Box 9957 Phoe'L-x, AZ 85068 ca r'riew(4leC �rou .com ALLEN FINANIAL 41UUI Arr Allen Financial Insurance Group The Equestrian Gro�p Ph 'MI one 4 (602) 992.1570 gonp.com Fax' (602) 992.3327 WAIS (300) 874-9191 Fax Cover Page To " Fax Number: q 4q (4 9 31 Q Company ( �_ From Carrie Wright --- -�_- includingo cover paoe: xess2u, ��,ca_;C, 05/18/01 WED 12:37 FAX 6029928327 ALLEN F'INANIAL GENESIS INDEMNITY INSURANCE COMPAVY 695 E- MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE EQUINE RENEWAL CERTIFICATE NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE OFFIC (303)425-5950 PO BOX 460682 04-02-415 AGENT ESCONDIDO, CA- 92046 ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY NUMBER: ZYB005329A POLICY PERIOD: 124Ul A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 1,595 o PDSTED FEE 80 1,675 INSURANCE IS PROVIDED ONLY FOR THOSE COVERAGES FOR WHICH A SPECIFIC AMOUNT OF INSURANCE IS INDICATED. WE WILL PROVIDE THE INSURANCE DESCRIBED IN THIS POLICY IN RETURN FOR THE PREMIUM AND COMPLIANCE WITH ALL APPLICABLE POLICY PROVISIONS. POLICY DESCRIPTION: 22222 CARE, CUSTODY OR CONTROL - EQUINE 40047 - PLEASURE AND SHOW HORSES OWNED 44228 WAGON RIDES 47221 - RIDING INSTRUCTION 49950 ALL STATES - ADDITIONAL INTEREST 99111 STABLES BOARDING, BREEDING, TRAINING OR SALES COVERAGE DESCRIPTION EACH OCCURRENCE GENERAL AGGREGATE PRODUCTS/COMPLETED OPNS PERSONAL, & ADV- INJURY MEDICAL PAYMENTS DMG-PREMISE RENTED TO YOU CARE -CUSTODY -CONTROL OCC. CARE -CUSTODY -CONTROL AGG. LIMIT 1,000,000 2,000,000 2,000,000 1,000,000 5,000 100,000 5,000 25,000 SUBJECT TO FOLLOWING FORMS AND ENDORSEMENTS: PREMIUM DEDUCTIBLE 1,595 This po9ey is auwaet to a minlmum aatnsd Pmmium. Plallss read your endotsement cardulty. 250 CG21/36 11/85 CG21/39 10/93 CG21/50 09/89 CG24/02 11/94 GI 105 01/97 GI -146 01/97 GI 147 01/97 G1 148 01/97 GI -154 01/97 IL00/17 11/85 II,00/21 11/94 IL02/70 08/97 CC21160 09/98 CG00/01 07/98 CC21/16 07/98 CG21/44 07/98 CG21/47 07/98 CG21/49 07198 CG00/57 09/99 GI -113 04/96 GI 114 04/96 GI -145 04/96 CC20/12 07/98 1,7--121 12/97 GI -1510 05/00 CO21/46 07/98 CG20/26 11/85 C003/00 10/93 SERVICE COMPANY: COLORADO WESTERN INSURANCE COMPANY PREMIUM: 1,595 DATF. OF ISSUE: 05/04/2001 COUNTERSIGNED- �i1'PIVF. 05/04/01 15:00:37 05/18/01 WED 12:37 FAX 6029928527 ALLEN FINANIAL DECLARATIONS - CONTINUED ZYB00532A CAMP COOKIE FOR CHILDREN, INC. 04/30/01 TO 04/30/02 MORTGAGE CLAUSE: IF A MORTGAGEE IS NAMED IN THIS POLICY, WE WILL CONTINUE THIS INSURANCE FOR THE MORTGAGEE'S INTEREST FOR TEN DAYS AFTER WRITTEN NOTICE OF TERMINATION TO THE MORTGAGEE AND THEN THIS POLICY WILL TERMINATE. 01 ADDITIONAL INSURED RANCHO CAPISTRANO 29251 CAMINO CAPISTRANO SAN JUAN CAPISTRANO, CA_ 92675 02 ADDITIONAL INSURED CITY CLERK CITY OF SAN JUAN CAPISTRANO 32400 PASO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 05/04/01 [5--00:37 / 1 WED 12:57 FAX 8029928527 ALLEN FINANIAL ACS. CERTIFICAS OF LIABILITY INSURANCE � °"" ^M'"1ie1 1 TMs OURTW"TE 16 ISSUED AB A MATTER OF 10WOIMATION BODILY INJURY ONLY AND COWOW NO FAMTS UPON THE CERTIFICATE AZJAW 1l>OBCLIL lBiB R CAM HOLOM. THIN CEITWICATE DDM NOT ABRORD. EXTEND OR 7AN IOUS022IA1F ($ODP ALTER TIRE COVERAGE AFFORDED MY THE POUCIES BELOW. INSISIFRS AFFORDING COVEMOE P.O. Box 9PS> Camp Cookie for Children Ine. y PO BOX 1134 NSIAILR e: -- San JU" Capistrano, CJ 93693UIBLIR CRe OTHER THAN IN9URFN D+ AUTOONLY: AGG S -- OVERAGM THE POLIMS OF WWRIAHCE ANY REOUIREMBIT. TEMA O MAY PERTAIN. THE N WWW BELOW HAVE KIM OWED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW IHSTAfNOING ITM OF ANY CONTRACT OR OTHER DOCUMENT WIRR RESPECT To V&"W TMS CMWICATE MAY BE rAUEO OR WM BY THE POLICIES DESCRIBED HEREIN 1$ SUB.IECT TO ALL THE TEN4S. EXCLUSIONS AND CONDITIONS OF SUCH I MAY HAVE BEEN AEDUCED BY PAID CLAM- A27 LAM - 1fin' mM-572271-1lffi I04/30/2001 I04/30/3002 �10COMMERCIAL ONYENAL LIABILITY CLAMSMADE 1-1 OCCUR OMIT APPLITS PER: ANYAVTD ALL OWNED AUTOS SCHWULW AUTOS HIRED AUTOS 14 Mq M"TOS 1 ILAWUTY AW AUTO OCCUR E CWMSMAOF OEOUCTISIE NFT[NnoN B W OIMiN:"al eYMATMNMND 9DROYMW" UANIITY �] CONSWIED SINGLE OMIT I IEA AKLdI.+11 BODILY INJURY e IPW Pa.s I WOpDYNJNiT DW AeeMllRl RNOYERTY DAMAGF T i'e ACWaHI — AUTO ONLY -FA ACCIOFM E OTHER THAN AUTOONLY: AGG S -- FAd1 OCCUAIdCE B AWREswTE Certificate holder is additional insured with respects to the issursda operations. Ic FTHLF/C,a 1 lAIA�HpRAI Ae,�ep: ew�V city clerk City of Ban Juan Capistrano 33400 Paso Adelasto Bas Jtran Capistrano, CA "IF75 WACELLATION Ts -ng.. m -►4, MWUOI AMY M M ABOW MISCRUM IOMC6 K CALICBIEO IMPOSE THE HDaMTION OAT[ THWAM. TIE uwkwm IMaN191 WILL IBOEAWR EO MAR Aa- - DAw W wrm NOTICE m M OFINCA LDLs aMMD TO TIE LST, MIT FA IAX TO m SO MAUL SINSS wTna. TnM d1OF POND UPON THEInumum. ITS AGENTS ON ACORD A CQRQ., C MTIFICAW, PRODUCER STREETER INSURANCE AGENCY P.O. BOX 600568 SAN DIEGO CA 92160 *@MP COOKIE FOR CHILDREN, P.O.BOX 460682 ESCONDIDO,CA 92046 DATE (MIND Orrn ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANY A COMPANY CDWMY L—C COMPANY D CflY,ERAQE5 .. 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. COI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE (PONCE MU'VIATION LIMITS LTR DATE (MMfOOfYY) DATE (MWDDNY) GENERAL LIABILITY BODILY INJURY ODD S COMPREHENSIVE FORM ISI BODILY INJURY AGG S PREWSES/0PERATIONS PROPERTY DAMAGE OCC UNDERGROUND EXPLOSION & COLLAPSE HAZARD R PERTY DAMAGE AGO i PRODUCTS/COMPLETED OPER Z T PO COMBINED DOC s CONTRACTUAL 81 & PI) COMBINED ASS INDEPENDENT CONTRACTORS PERSONAL INJURY AGG s BROAD FORM PROPERTY DAMAGE DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL MMIS ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC-1.0 BEFORE THE CITY CLERK, CITY OF SAN JUAN CAPISTRANO IDIPIRATION DATE THEREOF, THE ISSUING COMPANY WILl. ENDEAVOR TO WAL & CAPISTRANO VALLEY WATER DISTRICT 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 32400 PASO ADELANTO BUT FAILURE TO MAIL SUCH NOTICE WALL IMPOSE NO OBLIGATION OR LIABILITY SAN JUAN CAPISTRANO,CA92675 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, ,AUTOMOSILE LIABILITY BODILY INJURY s MY AUTO (P., 250,000 ALL DINNED AUTOS (Private Pam) BODILY INJURY ALL OWNED AUTOS Per accident) $ 500,000 (Omer roan Private Passenger) HIRED AUTOS f i PROPERTY DAMAGE I S 100,000 NON -OWNED AUTOS GARAGE LIABILITY BODILY INJURY & PROPERTY 1;12/2 $ AIX�SCHEDULED AUTOIAC11044662 112/2/01 02 COMBINEDDAMAGE UCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE s OTHER THAN UMBRELLA FORM WORKERS COMPENSATION ANDWC STAN- OTH I I EMPLOYERS, LIABILITY TORY LIMITS ER EL EACH ACCIDENT THE PROPRIETOR/ INCL EL DISEASE - POLICY LIMIT S PARTNERSFYECUTIME OFFICERS ARE EXCL EL DISEASE - EA EMPLOYEE II OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL MMIS ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC-1.0 BEFORE THE CITY CLERK, CITY OF SAN JUAN CAPISTRANO IDIPIRATION DATE THEREOF, THE ISSUING COMPANY WILl. ENDEAVOR TO WAL & CAPISTRANO VALLEY WATER DISTRICT 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 32400 PASO ADELANTO BUT FAILURE TO MAIL SUCH NOTICE WALL IMPOSE NO OBLIGATION OR LIABILITY SAN JUAN CAPISTRANO,CA92675 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, ACORD CERT- II`IC k., . .._.. . : PRODUCER STREETER INSURANCE AGENCY P.O. BOX 600568 SAN DIEGO CA 92160 II`I�ICE DATE (MINDD/Y1T 01/23/02 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 I COMPANY A MERCURY CASUALTY COMPANY *tNMP COOKIE FOR CHILDREN, INC. COMPANY P.O.BOX 460682 B ESCONDIDO, CA 92046 COMPANY C m COMPANY D ¢ n C77 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOPW' HOLIa=PERIM INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH REBPFjC$T� WHW THI� CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE�k.to_ALL THE)TERMSI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE : POLICY NUMBER FDUOY EFFECTIVE IPOLICY EXPIRATION C CO DATE (MNIDDIYYi DATE (MLVDD/YY) !, GENERAL LIABILITY ! BODILY INJURY OCC E COMPREHENSIVE FDRM �!1 BODILY INJURY AGO E PREMISESX)PERATIONS PROPERTY DAMAGE OCC 5 ^�I UNDERGROUND EXPLOSION & COLLAPSE HAZARD PROPERTY DAMAGE AGG E EXCESS LIABILITY '1, li '', PRODUCTS/COMPLETED OPER 5 UMBRELLA FORM �— AGGREGATE BI & PD COMBINED OCC E AUTOMOBILE LIABILITY CONTRACTUAL E t t WC STAN- 0TH-' BI & PD COMBINED AGO g 1i) i (Per Perin) INDEPENDENT CONTRACTORS - EMPLOYERS' PERSONAL INJURY AGO 5 BROAD FORM PROPERTY DAMAGE EL EACH ACCIOENT 1 $ EXCESS LIABILITY '1, li '', PERSONAL INJURY 5 UMBRELLA FORM �— AGGREGATE 5 AUTOMOBILE LIABILITY ' BODILY INJURY E t WC STAN- 0TH-' My ALTO 1i) i (Per Perin) R T V LIMB 250,000 EMPLOYERS' 1 EL EACH ACCIOENT 1 $ ALL OWNED AUTOS (Private Paso) l BODILY INJURY 5 PARTNERStEXECUTIVE OFFICERS ARE'. EXCL EL DISEASE - EA EMPLOYEE ALL OWNED AUTOS1, (Per accitlent) S 500,000 (OTer man Private Passenger) 1 HIRED AUTOS PROPERTY DAMAGE 5 100,000 NON -OWNED AUTOS -.. GARAGE LIABILITY .................. .. ...,.-. ......... BODILY INJURY & .. R i n i n. n / n / n n PROPERTY DAMAGE', g EXCESS LIABILITY '1, li '', EACH OCCURRENCE 5 UMBRELLA FORM �— AGGREGATE 5 OTHER THAN UMBRELLA FORM 4 t WC STAN- 0TH-' WORKERS COMPENSATION AND MPENSA R T V LIMB EMPLOYERS' 1 EL EACH ACCIOENT 1 $ THE PROPRIETOR/ !�_ INCL 1� EL DISEASE -POLICY LIMIT 5 PARTNERStEXECUTIVE OFFICERS ARE'. EXCL EL DISEASE - EA EMPLOYEE E ADDITIONAL INSUREDSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY CLERK, CITY OF SAN JUAN CAPISTRANO IOUNRATI DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL & CAPISTRANO VALLEY WATER DISTRICT 10 DAYS WRITTEN NOTICE TO THE CERTMICATE HOLDER NAMED TO THE LEFT, 32400 PASO ADELANTO BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY SAN JUAN CAP I S TRANO , CA9 2 6 7 5 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, CIO Cuut a:jusm CITY OF SRN JURN CRPISTRR 4933955 3a40o P"e* ^De""To iAN JUAN CAPAa'flUNa. W 02075 (940) 402-1171 (940) 4WIC53 (PING www.isAAjuaacapia rallo.orj November 18, 2001 Camp Cookie for Children, Inc. Attention: Laurte/John Fronk Via Fax: 760480 -Mg p.5 NBAIII61/ Wil[ V 016 JOHNOAAF WriaT NANT aMyla N. iMa7lalN CITY AAAKMMI 60MM WASINOIgWN Re: Improvement and Reimbursement Agreement for Water Facilities —Camp Cookie for Children, Inc. Thank you for your fax transmittal, received today. Unfortunately, the policy declarations that were sent do not provide the evidence needed to confirm the types and extent of coverage, nor the endorsements needed to meet the terms of the agreement (pages 6 through 10). Please forward (or Instruct your insurance carrier to forward): A!;61Feate-of: Cnsurance;. naming the City of San Juan Capistrano Certificate Holder, for the Comprehensive Automobile Liability coverage. 2. Though we have received a Certificate of Insurance for Comprehensive General Liability coverage, stilt outstanding is a General Liability Endorsement Form indicating that the City of San Juan Capistrano and Capistrano Valley Water District have been legally addgd as additional insured to the trtsuronoe policies required. 3.:,.W6r ers ComperlsaUon coverage evidence. I understand from your note, Mil be sent under separate cover ffn'Brongo Construction. Also outstanding, and required to begin work under this agreement, are surety bonds to secure the faithful performance of the agreement, as stipulated on Page 7 of the agreement. Upon receipt of these documents, an executed agreement will be issued. Sincerely, Springer, Administrative Assistant & Amy Amirani, Public Works Director onus usz rs �.m. r GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE EQUINE AMENDED NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE OFFICE (303)467-8508 PO BOX 460682 04-02-415 ESCONDIDO, CA. 92046 ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY NUMBER: ZYBOO5329A POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 TOTAL 0 FOLLOWING CHANGES ARE EFFECTIVE WITH THIS AMENDED DECLARATION. PLEASE ATTACH THIS AMENDED DECLARATION TO YOUR POLICY. PRESENT AMOUNT OF ACTION CHANGE DESCRIPTION INSURANCE -------`---------------------------------------------------------------------------------------- CHANGES TO POLICY DESCRIPTION EFFECTIVE 1/22/01: DELETED AI #1; CHANGES MADE TO AI #2 OTHER INTEREST DELETED ADDITIONAL INSURED RANCHO CAPISTRANO 29251 CAMINO CAPISTRANO SAN JUAN CAPISTRANO, CA. 92675 OTHER IN{'ERES'� CHANGED ADDITIONAL INSURED CITY CLERK WATER DISTRICT MANAGER CITY OF SAN JUAN CAPISTRANO 32400 PASO ADELANi'O SAN JUAN CAPISTRANO, CA. 92675 01/24/02 16:09:49 GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. PO BOX 460682 ESCONDIDO, CA. 92046 POLICY NUMBER: ZYB005329A NON -ASSESSABLE EQUINE AMENDED COMPANY SERVICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL (602)992-1570 OFFICE INSURANCE GROUP POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 0 INSURANCE IS PROVIDED ONLY FOR THOSE COVERAGES FOR WHICH A SPECIFIC AMOUNT OF INSURANCE IS INDICATED. WE WILL PROVIDE THE INSURANCE DESCRIBED IN THIS POLICY IN RETURN FOR THE PREMIUM AND COMPLIANCE WITH ALL APPLICABLE POLICY PROVISIONS. POLICY DESCRIPTION: EFFECTIVE 1/22/01: DELETED Al #1; CHANGES MADE TO 22222 - CARE, CUSTODY OR CONTROL - EQUINE 40047 - PLEASURE AND SHOW HORSES - OWNED 44228 - WAGON RIDES 47221 - RIDING INSTRUCTION 49950 - ALL STATES - ADDITIONAL INTEREST 99111 - STABLES - BOARDING, BREEDING, TRAINING OR COVERAGE DESCRIPTION LIMIT EACH OCCURRENCE 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS/COMPLETED OPNS 2,000,000 PERSONAL & ADV. INJURY 1,000,000 MEDICAL PAYMENTS 5,000 DMG-PREMISE RENTED TO YOU 100,000 CARE -CUSTODY -CONTROL OCC. 5,000 CARE -CUSTODY -CONTROL AGG. 1 1 25,000 SUBJECT TO FOLLOWING FORMS AND ENDORSEMENTS: CG21/36 11/85 CG21/39 10/93 CG21/50 09/89 GI -146 01/97 GI -147 01/97 GI -148 01/97 IL00/21 11/94 IL02/70 08/97 CG21/60 09/98 CG21/44 07/98 CG21/47 07/98 CG21/49 07/98 GI -114 04/96 GI -145 04/96 CG20/12 07/98 CG21/46 07/96 CG20/26 11/85 CG03/00 10/93 SERVICE COMPANY: COLORADO WESTERN DATE OF ISSUE: 01/24/2002 01/24/02 16:09:49 Al #2 SALES PREMIUM 1,595 -------25U This policy is subject to a minimum earned premium. Please read your endorsement carefully, CG24/02 11/94 GI -105 OZ/ GI -154 01/97 IL00/17 11/ CG00101 07/96 CG21/16 07/ CG00/57 09/99 GI -113 04/ GI -121 12/97 GI -151C 05/ COMPANY COUNTERSIGNED: 5 GENESIS INDEMNITY INSURANCE COMPANY STAMFORD, CONN 06904 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. POLICY NUMBER: ZYB005329A FORM OF BUSINESS : CORPORATION COMPANY SERVICE OFFICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY PERIOD: 12:01 A.M. STANDARD TIME AT THE INSURED PREMISES. FROM 04/30/2001 TO -04/30/2002 AMENDED EFFECTIVE: 04/30/2001 ------------------------------------------------------------------------------- PREMIUM CLASS BASIS RATE PREMIUM 22222 UNITS 40047 ANIMALS 44228 GROSS SALES 47221 UNITS 1 PREM/OP 385.000 385 ALL OTHER 10 PREM/OP 16.800 168 ALL OTHER INCL INCL 200 PREM/OP 38.400 300 ALL OTHER INCL INCL 3 PREM/OP 28.670 86 ALL OTHER INCL INCL ---------------------------------------------------------------------------- THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENT COMPLETE THE ABOVE NUMBERED POLICY. CW -101 SD (6/94) GENESIS INDEMNITY INSURANCE COMPANY STAMFORD, CONN 06904 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS (CONTINUED ON NEXT PAGE) NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE OFFICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY NUMBER: ZYB005329A POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 FORM OF BUSINESS : CORPORATION -------------------------------------------------------------------------------- PREMIUM CLASS BASIS RATE PREMIUM 49950 OTHER 99111 UNITS 1 PREM/OP 75.000 75 ALL OTHER 200,000 PREM/OP 2.905 581 ALL OTHER INCL INCL TOTAL PREMIUM 1,595 ----------- ---------------------------------------- --------- ---------- - THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS --,----- TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. -I CW -101 SD (6/94) DECLARATIONS - CONTINUED ZYB00532A 04/30/01 TO 04/30/02 CAMP COOKIE FOR CHILDREN, INC. MORTGAGE CLAUSE: IF A MORTGAGEE IS NAMED IN THIS POLICY, WE WILL CONTINUE THIS INSURANCE FOR THE MORTGAGEE'S INTEREST FOR TEN DAYS AFTER WRITTEN NOTICE OF TERMINATION TO THE MORTGAGEE AND.THEN THIS POLICY WILL TERMINATE. 02 ADDITIONAL INSURED CITY CLERK WATER DISTRICT MANAGER CITY OF SAN JUAN CAPISTRANO 32400 PASO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 01/24/02 16:09:49 Dawn Schanderl From: Jack Galaviz Sent: Monday, August 26, 2002 7:27 AM To: Dawn Schanderl Subject: RE: Camp Cookie ? I didn't think so! I talked to John Franks on Wednesday and asked him to please get his required insurance documents submitted and that is what I received. -----Original Message ----- From: Dawn Schanderl Sent: Friday, August 23, 2002 9:01 AM To: Jack Galaviz Subject: Camp Cookie ? Good Morning!!!!! FYI the insurance stuff re camp cookie - I don't know what this applies to - the city isn't mentioned anywhere, it's not a certificate etc, etc, etc. 1 Dawn Schanderl From: Dawn Schanderl Sent: Friday, August 23, 2002 9:01 AM To: Jack Galaviz Subject: Camp Cookie ? Good MorningMH FYI the insurance stuff re camp cookie - I don't know what this applies to - the city isn't mentioned anywhere, it's not a certificate etc, etc, etc. rte eUO2 9:39RM CITY OF SRM JURN CRPISTRR 4933955 07400 ►,u90 Aas1J,NYO Hw Juu, VANSTmANO. CA 92076 ("s) 491-t 171 to") 496.1oss (Ma www Jonf„ailcapistrano.orj November 19. 2001 Camp Cookie for Children, Inc. Attention: Laude/John Frank Via Fax: 760480.8509 p.5 w9;� !OIN�W NC16 MaT ' R� DAM W SWIFO.Ni CITY M1 IMP O@DM 40AWF MM Re: Improvement and Reimbursement Agreement for Water Facilities —Camp Cookie for Children, Inc. Thank you for your tax transmittal, received today. Unfortunately, the policy declarations that were sent do not provide the evidence needed to confirm the types and extent of coverage, nor the endorsements needed to most the terms of the agreement (pages 6 through 10). Please forward (or Instruct your insurance carrier to forward): A eitlftestg::t ..tiistrrande;. naming the City of San Juan Capistrano( Certificate Holder, for the Comprehensive Automobile Liability coverage. 2. Though we have received a Certificate of Insurance for Comprehensive General Liability coverage, still outstanding is a General Liability Endorsement Form indiceting that the City of San Juan Capistrano and`Capistrano Valley Water District have been legally added as additional insured to the Insurance policies required, 3.:,Vttprkers Cbrt+perlisaU (average evidence,.l understand from your note, Mil be sent under separate ©over f1rom'Bron96 Construction. Also outstanding, and required to begin work under this agreement, are surety bonds to secure the faithful performance of the agreement, as stipulated on Page 7 of the agreement. Upon receipt of these documents, an executed agreement will be issued. Sincerely, Springer, Administrative Assistant & Amy Amirani, Public Works Director amus usa GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE EQUINE AMENDED NAME INSURED: CAMP COOKIE FOR CHILDREN. INC. PO BOX 460682 ESCONDIDO, CA. 92046 POLICY NUMBER: ZYB005329A COMPANY SERVICE OFFICE (303)467-8508 04-02-415 ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 TOTAL 0 FOLLOWING CHANGES ARE EFFECTIVE WITH THIS AMENDED DECLARATION. PLEASE ATTACH THIS AMENDED DECLARATION TO YOUR POLICY. PRESENT AMOUNT OF ACTION CHANGE DESCRIPTION INSURANCE ------------------------------------------------------------------------------------------------ CHANGES TO POLICY DESCRIPTION EFFECTIVE 1/22/01: DELETED AI #1; CHANGES MADE TO AI #2 OTHER INTEREST DELETED ADDITIONAL INSURED RANCHO CAPISTRANO 29251 CAMINO CAPISTRANO SAN JUAN CAPISTRANO, CA. 92675 OTHER INTEREST CHANGED ADDITIONAL INSURED CITY CLERK WATER DISTRICT MANAGER 32400 PASO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 01/24/02 16:09:49 CITY OF SAN JUAN CAPISTRANO GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE EQUINE AMENDED NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE OFFICE (303)425-5950 PO BOX 460682 04-02-415 AGENT ESCONDIDO, CA. 92046 ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY NUMBER: ZYB005329A POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 0 INSURANCE IS PROVIDED ONLY FOR THOSE COVERAGES FOR WHICH A SPECIFIC AMOUNT OF INSURANCE IS INDICATED. WE WILL PROVIDE THE INSURANCE DESCRIBED IN THIS POLICY IN RETURN FOR THE PREMIUM AND COMPLIANCE WITH ALL APPLICABLE POLICY PROVISIONS. POLICY DESCRIPTION: EFFECTIVE 1/22/01: DELETED AI #1; CHANGES MADE TO AI 42 22222 - CARE, CUSTODY OR CONTROL - EQUINE 40047 - PLEASURE AND SHOW HORSES - OWNED 44228 - WAGON RIDES 47221 - RIDING INSTRUCTION 49950 - ALL STATES - ADDITIONAL INTEREST 99111 - STABLES - BOARDING, BREEDING, TRAINING OR SALES COVERAGE DESCRIPTION LIMIT EACH OCCURRENCE 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS/COMPLETED OPNS 2,000,000 PERSONAL & ADV. INJURY 1,000,000 MEDICAL PAYMENTS 5,000 DMG-PREMISE RENTED TO YOU 100,000 CARE -CUSTODY -CONTROL OCC. 5,000 CARE -CUSTODY -CONTROL AGG. 25,000 SUBJECT TO FOLLOWING FORMS AND ENDORSEMENTS: CG21/36 11/85 CG21/39 10/93 CG21/50 09/89 GI -146 01/97 GI -147 01/97 GI -148 01/97 IL00/21 11/94 IL02/70 08/97 CG21/60 09/98 CG21/44 07/98 CG21/47 07/98 CG21/49 07/98 GI -114 04/96 GI -145 04/96 CG20/12 07/98 CG21/46 07/96 CG20/26 11/85 CG03/00 10/93 PREMIUM DEDUCTIBLE 1,595 This policy Is subject to a minimum earned premium. Please read your endorsement carefully. CG24/02 11/94 GI -154 01/97 CG00/01 07/98 CG00/57 09/99 GI -121 12/97 SERVICE COMPANY: COLORADO WESTERN INSURANCE COMPANY DATE OF ISSUE: 01/24/2002 COUNTERSIGNED 01/24/02 16:09:49 GI -105 I1,00/17 CG21/16 GI -113 GI -151C 250 01/97 11/85 07/98 04/96 05/00 PREL41LTM: 595 AUTHORIZED REPRESENTATIVE GENESIS INDEMNITY INSURANCE COMPANY STAMFORD, CONN 06904 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. POLICY NUMBER: ZYB005329A FORM OF BUSINESS : CORPORATION COMPANY SERVICE OFFICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 -------------------------------------------------------------------------------- PREMIUM CLASS BASIS RATE PREMIUM 22222 UNITS 40047 ANIMALS 44228 GROSS SALES 47221 UNITS 1 PREM/OP ALL OTHER 10 PREM/OP ALL OTHER 200 PREM/OP ALL OTHER 3 PREM/OP ALL OTHER 385.000 16.800 INCL 38.400 INCL 28.670 INCL 385 168 INCL 300 MP INCL 86 INCL ------------------------------------------------------------------------------ THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE iIIUMBERED POLICY. CW -101 SD (6/94) GENESIS INDEMNITY INSURANCE COMPANY STAMFORD, CONN 06904 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS (CONTINUED ON NEXT PAGE) NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. POLICY NUMBER: ZYB005329A FORM OF BUSINESS : CORPORATION COMPANY SERVICE OFFICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 0,1!30/2002 AMENDED EFFECTIVE: 04/30/2001 -------------------------------------------------------------------------------- PREMIUM CLASS BASIS RATE PREMIUM 49950 OTHER 1 PREM/OP 75.000 75 ALL OTHER 99111 UNITS 200,000 PREM/OP 2.905 581 ALL OTHER INCL INCL TOTAL PREMIUM 1,595 --------------------------------------------------------------------------------I THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS,M TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. CW -101 SD (6/94) DECLARATIONS - CONTINUED ZYB00532A 04/30/01 TO 04/30/02 CAMP COOKIE FOR CHILDREN, INC. MORTGAGE CLAUSE: IF A MORTGAGEE IS NAMED IN THIS POLICY, WE WILL CONTINUE THIS INSURANCE FOR THE MORTGAGEE'S INTEREST FOR TEN DAYS AFTER WRITTEN NOTICE OF TERMINATION TO THE MORTGAGEE AND THEN THIS POLICY WILL TERMINATE. 02 ADDITIONAL INSURED CITY CLERK WATER DISTRICT MANAGER 32400 PASO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 01/24/02 16:09:49 CITY OF SAN JUAN CAPISTRANO ACORDCERTIFICATE QI" PRODUCER . STREETER INSURANCE AGENCY P.O. BOX 600568 SAN DIEGO CA 92160 KTMP COOKIE FOR CHILDREN, INC. P.O.BOX 460682 ESCONDIDO,CA 92046 THIS CERTIFICATE IS ISSUED AS ONLY AND CONFERS NO RIGH HOLDER. THIS CERTIFICATE DOE I COMPANY A COMPANY B COMPANY C COMPANY D CASUALTY DATE (Iffl YY) UPON THE CERTIFICATE NOT AMEND, EXTEND OR BY THE POLICIES BELOW. UVa�GlFREICS ... ,. 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. COPOLICY EFFECTWE POLIOY EKRRATION TYPE OF INSURANCE POLICY NUMBER LTB I DATE (MEVDOMT I GATE (MNTOM() ' LIMITS GENERAL LUUMISTY J BODILY INJURY OCC S COMPREHENSIVE FORM BODILY INJURY AGG E PREMISESIOPERATIONS'� (PROPERTY DAMAGE OCC I,S - UNDERGROUND 'EXPLOSION 8 COLLAPSE HAZARD �i PROPERTY DAMAGE AGO S PRODUCTSICOMPLETED OPER ~—y BI 8 PO COMBINED OCC S CONTRACTUAL BI 8 PD COMBINED AGG Y I VNDEPENDEM CONTRACTORS - - - - 4 PERSONAL INJURY AGG E r� BROAD FORM PROPERTY DAMAGE PERSONAL INJURY AUTOMOBRE WBILRY INJURY NJURY E ANY AUTO pNJ (Per 2 5 0, 0 0 0 ALL OWNED AUTOS (Private Pass) ALL OWNED AUTOS I_ (Oter tan Private Passenger) BODILY INJURY (Pe, acckenU S 500,000 HIRED AUTOS NON -OWNED AUTOS - PROPERTY DAMAGE I E 100,000 GARAGE LIABILITY BODILY INJURY & A X' SCHEDULED AUTO AC11044662 12/2 01 !!12/2/02 COMBINED E EECESS WBILffY EACH OCCURRENCE E UMBRELLA FORM �'. AGGREGATE S Ji OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIASILLTY THE PROPRIETOR( '.INCL PARTNERS,EXECUTNE OFFICERS ARE EXCL OTHER ADDITIONAL INSURED CITY CLERK,CITY OF SAN JUAN CAPISTRANO & CAPISTRANO VALLEY WATER DISTRICT 32400 PASO ADELANTO SAN JUAN CAPISTRANO,CA92675 'EL EACH ACCIDENT EL DISEASE - POLIC' EL DISEASE - EA EM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MALL 10 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. AUTHOFU= REPRESENTATIVE /J l) / /J AC-ORD.CERTIFICATE QF PRODUCER ..: STREETER INSURANCE AGENCY P.O. BOX 600568 SAN DIEGO CA 92160 0I COOKIE FOR CHILDREN,INC. P.O.BOX 460682 BSCONDIDO,CA 92046 ONLY AND CONFERS NO RIGHTS UPON HOLDER. THIS CERTIFICATE DOES NOT A ALTER THE COVERAGE AFFORDED BY TH I COMPANY A MERCURY CASUALTY COMPANY COMPANY B COMPANY C COMPANY D DATE (MI CERTIFICATE 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. CO TYPE OFLTFI NISUMNCE POLICY NUMBER POLICY EFFECTIVE DAIS (NWDDMT POLICY EXPWATION I DATE (MM'OD/YY) I LIMBS 1 GENERAL IUABIIU Y ~- COMPREHENSIVE FORM PREMISES/OPERATIONS :UNDERGROUND EXPLOSION 8 COLLAPSE HAZARD PRODUCTS/COMPLETED OPER ANY AUTO BODILY INJURY OOC S BODILY INJURY AGO $ PROPERTY DAMAGE OCC $ PROPERTY DAMAGE AGS S BI 6 PD COMBINED OCC S CONTRACTUAL INDEPENDENT CONTRACTORS - BROAD FORM PROPERTY DAMAGE DE}CRPTKIN OF ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I'I CITY CLERK, CITY OF SAN JUAN CAPISTRANO EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL & CAPISTRANO VALLEY WATER DISTRICT 10 DAYS WRITTEN NOTICE TO THE CERTDiCAM HOLDER NAMED TO THE LEFT, 32400 PASO ADELANTO BUT FAILURE TO MAIL SUCK NOTICE SHALL IMPOSE NO OBLIGATION OR LMBILRY SAN JUAN CAP I STRANO , CA9 2 6 7 5 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. L AUTOMOSI E LIABILITY _ BODILY INJURY S ANY AUTO (Per perexl) 250,000 BODILY INJURY ALL OWNED AUTOS (P,Ivata Pass) �i' �— ALL OWNED AUTO$ - (Pe, accident) $ 500,000 .—J (011ier than Private Passenger) PROPERTY DAMAGE S HIRED AUTOS —. NON -OWNED AUTOS - i 100,000 00,000 DIIJPERLV LIABILITY AISCHEDULED ,GARAGE X'AUTO AC11044662 12/2/01 1,12/2/02 PR DAMAGE (COMBINED s EXCESS LUIBILITY EACH OCCURRENCE $ UMBRELLA FORM. ~— AGGREGATE I S OTHER THAN UMBRELLA FORM I$ WORKERS COMPENSATION AND I TWO STA 02- Y R EMPLOYERS' I LBM.ITY EL EACH ACCIDENT IS THE PROPRIETOR/ INCL �'I EL DISEASE . POLICY LIMIT IS PARTNERS/EXECUTIVE OFFICERS ARE. EXCL EL DISEASE - EA EMPLOYEE S DE}CRPTKIN OF ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I'I CITY CLERK, CITY OF SAN JUAN CAPISTRANO EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL & CAPISTRANO VALLEY WATER DISTRICT 10 DAYS WRITTEN NOTICE TO THE CERTDiCAM HOLDER NAMED TO THE LEFT, 32400 PASO ADELANTO BUT FAILURE TO MAIL SUCK NOTICE SHALL IMPOSE NO OBLIGATION OR LMBILRY SAN JUAN CAP I STRANO , CA9 2 6 7 5 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE EQUINE AMENDED NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE OFFICE (303)467-8508 PO BOX 460682 04-02-415 ESCONDIDO, CA. 92046 ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY NUMBER: ZYB005329A POLICY PERIOD: 12:01 A.M. STANDARD TINE, .. _ AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 TOTAL 0 FOLLOWING CHANGES ARE EFFECTIVE WITH THIS AMENDED DECLARATION. PLEASE ATTACH THIS AMENDED DECLARATION TO YOUR POLICY. PRESENT AMOUNT OF ACTION CHANGE DESCRIPTION INSURANCE CHANGES TO POLICY DESCRIPTION EFFECTIVE 1/22/01: DELETED Al #1; CHANGES MADE TO AI #2 OTHER INTEREST DELETED ADDITIONAL INSURED RANCHO CAPISTRANO 29251 CAMINO CAPISTRANO SAN JUAN CAPISTRANO, CA. 92675 OTHER INJERESP CHANGED - - - ADDITIONAL INSURED CITY CLERK WATER DISTRICT MANAGER CITY OF SAN JUAN CAPISTRANO 32400 PASO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 01/24/02 16:09:49 GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE EQUINE AMENDED NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. PO BOX 460682 ESCONDIDO, CA. 92046 POLICY NUMBER: ZYB005329A COMPANY SERVICE OFFICE (303)467-8508 04-02-415 ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT TRE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 TOTAL 0 FOLLOWING CHANGES ARE EFFECTIVE WITH THIS AMENDED DECLARATION. PLEASE ATTACH THIS AMENDED DECLARATION TO YOUR POLICY. PRESENT AMOUNT OF ACTION CHANGE DESCRIPTION INSURANCE ------------------------------------------------------------------------------------------------ CHANGES TO POLICY DESCRIPTION EFFECTIVE 1/22/01: DELETED Al #1; CHANGES MADE TO Al #2 OTHER INTEREST DELETED ADDITIONAL INSURED RANCHO CAPISTRANO 29251 CAMINO CAPISTRANO SAN JUAN CAPISTRANO, CA. 92675 OTHER IgERRSP CHANGED ADDITIONAL INSURED CITY CLERK WATER DISTRICT MANAGER 32400 PASO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 01/24/02 16:09:49 CITY OF SAN JUAN CAPISTRANO GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. PO BOX 460682 ESCONDIDO, CA. 92046 POLICY NUMBER: ZYB005329A NON -ASSESSABLE EQUINE AMENDED COMPANY SERVICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL (602)992-1570 OFFICE INSURANCE GROUP POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 INSURANCE IS PROVIDED ONLY FOR THOSE COVERAGES FOR WHICH A SPECIFIC AMOUNT OF INSURANCE IS INDICATED. WE WILL PROVIDE THE INSURANCE DESCRIBED IN THIS POLICY IN RETURN FOR THE PREMIUM AND COMPLIANCE WITH ALL APPLICABLE POLICY PROVISIONS. POLICY DESCRIPTION: EFFECTIVE 1/22/01: DELETED Al #1; CHANGES MADE TO AI #2 22222 - CARE, CUSTODY OR CONTROL - EQUINE 40047 - PLEASURE AND SHOW HORSES - OWNED 44228 - WAGON RIDES 47221 - RIDING INSTRUCTION 49950 - ALL STATES - ADDITIONAL INTEREST 99111 - STABLES - BOARDING, BREEDING, TRAINING OR SALES COVERAGE DESCRIPTION EACH OCCURRENCE GENERAL AGGREGATE PRODUCTS/COMPLETED OPNS PERSONAL & ADV. INJURY MEDICAL PAYMENTS DMG-PREMISE RENTED TO YOU CARE -CUSTODY -CONTROL OCC. CARE-FUSTODY-CONTROL AGG. M6006% 1,000,000 2,000,000 2,000,000 1,000,000 5,000 100,000 5,000 25,000 SUBJECT TO FOLLOWING FORMS AND ENDORSEMENTS: PREMIUM DEDUCTIBLE --------- ---------- 250 1,595 This policy is subject to a minimum eamed premium. Please read your endorsement carefully. CG21/36 11/85 CG21/39 10/93 CG21/50 09/89 CG24/02 11/94 GI -105 01/97 GI -146 01/97 GI -147 01/97 GI -148 01/97 GI -154 01/97 IL00/17 11/85 IL00/21 11/94 IL02/70 08/97 CG21/60 09/98 CG00/01 07/98 CG21/16 07/98 CG21/44 07/98 CG21/47 07/98 CG21/49 07/98 CG00/57 09/99 GI -113 04/96 GI -114 04/96 GI -145 04/96 CG20/12 07/98 GI -121 12/97 GI -151C 05/OC CG21/46 07/96 CG20/26 11/85 CG03/00 10/93 SERVICE COMPANY: COLORADO WESTERN INSURANCE COMPANY DATE OF ISSUE: 01/24/2002 COUNTERSIGNED: AUTHORIZED 01/24/02 16:09:49 59� GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE EQUINE AMENDED NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE OFFICE (303)425-5950 PO BOX 460682 04-02-415 AGENT ESCONDIDO, CA. 92046 ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY NUMBER: ZYB005329A POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 0 INSURANCE IS PROVIDED ONLY FOR THOSE COVERAGES FOR WHICH A SPECIFIC AMOUNT OF INSURANCE IS INDICATED. WE WILL PROVIDE THE INSURANCE DESCRIBED IN THIS POLICY IN RETURN FOR THE PREMIUM AND COMPLIANCE WITH ALL APPLICABLE POLICY PROVISIONS. POLICY DESCRIPTION: EFFECTIVE 1/22/01: DELETED Al #1; CHANGES MADE TO AI #2 22222 - CARE, CUSTODY OR CONTROL - EQUINE 40047 - PLEASURE AND SHOW HORSES - OWNED 44228 - WAGON RIDES 47221 - RIDING INSTRUCTION 49950 - ALL STATES - ADDITIONAL INTEREST 99111 - STABLES - BOARDING, BREEDING, TRAINING OR SALES COVERAGE DESCRIPTION LIMIT ------------------------- EACH OCCURRENCE 11/94 ----------- 1,000,000 GENERAL AGGREGATE GI -154 2,000,000 PRODUCTS/COMPLETED OPNS 11/8E 2,000,000 PERSONAL & ADV. INJURY CG21/16 1,000,000 MEDICAL PAYMENTS 09/99 5,000 DMG-PREMISE RENTED TO YOU GI -121 100,000 CARE -CUSTODY -CONTROL OCC. 05/OC 5,000 CARE -CUSTODY -CONTROL AGG. 25,000 SUBJECT TO FOLLOWING FORMS AND ENDORSEMENTS: CG21/36 11/85 CG21/39 10/93 CG21/50 09/89 GI -146 01/97 GI -147 01/97 GI -148 01/97 IL00/21 11/94 IL02/70 08/97 CG21/60 09/98 CG21/44 07/98 CG21/47 07/98 CG21/49 07/98 GI -114 04/96 GI -145 04/96 CG20/12 07/98 CG21/46 07/96 CG20/26 11/85 CG03/00 10/93 PREMIUM DEDUCTIBLE --------- ---------- 25C 1,595 This policy Is subject to a minimum earned premium. Please read your endorsement carefully. CG24/02 11/94 GI -105 01/9j GI -154 01/97 IL00/17 11/8E CG00/01 07/98 CG21/16 07/9E CG00/57 09/99 GI -113 04/9E GI -121 12/97 GI -151C 05/OC SERVICE COMPANY: COLORADO WESTERN INSURANCE COMPANY DATE OF ISSUE: 01/24/2002 COUNTERSIGNED: AUTHORIZED REPRESENTATIVE 01/24/02 16:09:49 GENESIS INDEMNITY INSURANCE COMPANY STAMFORD, CONN 06904 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. POLICY NUMBER: ZYB005329A FORM OF BUSINESS : CORPORATION COMPANY SERVICE OFFICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY PERIOD: 12:01 A.M. STANDARD TIME AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 ------------------------------------------------------------------------------- PREMIUM CLASS BASIS RATE PREMIUM 22222 UNITS 40047 ANIMALS 44228 GROSS SALES 47221 UNITS 1 PREM/OP ALL OTHER 10 PREM/OP ALL OTHER 200 PREM/OP ALL OTHER 3 PREM/OP ALL OTHER 385.000 16.800 INCL 38.400 INCL 28.670 INCL 385 168 INCL 300 Iv INCL 86 INCL ------------------------------------------------------------------------- ---- THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. CW -101 SD (6/94) GENESIS INDEMNITY INSURANCE COMPANY STAMFORD, CONN 06904 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE OFFICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY NUMBER: ZYB005329A POLICY PERIOD: 12:01 A.M. STANDARD TIME AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 FORM OF BUSINESS : CORPORATION ------------------------------------------------------------------------------- PREMIUM CLASS BASIS RATE PREMIUM 22222 UNITS 40047 ANIMALS 44228 GROSS SALES 47221 UNITS 1 PREM/OP ALL OTHER 10 PREM/OP ALL OTHER 200 PREM/OP ALL OTHER 3 PREM/OP ALL OTHER 385.000 16.800 INCL 38.400 INCL 28.670 INCL ES -E 168 INCL 300 P INCL 86 INCL ------------------------------------------------------------------------- ---- THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. CW -101 SD (6/94) GENESIS INDEMNITY INSURANCE COMPANY STAMFORD, CONN 06904 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS (CONTINUED ON NEXT PAGE) NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. COMPANY SERVICE OFFICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY NUMBER: ZYB005329A POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/3.0/2002 AMENDED EFFECTIVE: 04/30/2001 FORM OF BUSINESS : CORPORATION -------------------------------------------------------------------------------- PREMIUM CLASS BASIS RATE PREMIUM 49950 OTHER 1 PREM/OP 75.000 75 ALL OTHER 99111 UNITS 200,000 PREM/OP 2.905 581 ALL OTHER INCL INCL - TOTAL PREMIUM 1,595 -------------------------------------------------------------------------------� THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. CW -101 SD (6/94) GENESIS INDEMNITY INSURANCE COMPANY STAMFORD, CONN 06904 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS (CONTINUED ON NEXT PAGE) NAME INSURED: CAMP COOKIE FOR CHILDREN, INC. POLICY NUMBER: ZYB005329A FORM OF BUSINESS : CORPORATION COMPANY SERVICE OFFICE (303)425-5950 04-02-415 AGENT ALLEN FINANCIAL INSURANCE GROUP (602)992-1570 POLICY PERIOD: 12:01 A.M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2001 TO 04/30/2002 AMENDED EFFECTIVE: 04/30/2001 -------------------------------------------------------------------------------- PREMIUM CLASS BASIS RATE PREMIUM 49950 OTHER 1 PREM/OP 75.000 75 ALL OTHER 99111 UNITS 200,000 PREM/OP 2.905 581 ALL OTHER INCL INCL TOTAL PREMIUM 1,595 -------------------------------------------------------------------------------- THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. CW -101 SD (6/94) I DECLARATIONS - CONTINUED ZYB00532A 04/30/01 TO 04/30/02 CAMP COOKIE FOR CHILDREN, INC. MORTGAGE CLAUSE: IF A MORTGAGEE IS NAMED IN THIS POLICY, WE WILL CONTINUE THIS INSURANCE FOR THE MORTGAGEE'S INTEREST FOR TEN DAYS AFTER WRITTEN NOTICE OF TERMINATION TO THE MORTGAGEE AND THEN THIS POLICY WILL TERMINATE. 02 ADDITIONAL INSURED CITY CLERK WATER DISTRICT MANAGER CITY OF SAN JUAN CAPISTRANO 32400 PASO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 01/24/02 16:09:49 i DECLARATIONS - CONTINUED ZY1300532A 04/30/01 TO 04/30/02 CAMP COOKIE FOR CHILDREN, INC. MORTGAGE CLAUSE: IF A MORTGAGEE IS NAMED IN THIS POLICY, WE WILL CONTINUE THIS INSURANCE FOR THE MORTGAGEE'S INTEREST FOR TEN DAYS AFTER WRITTEN NOTICE OF TERMINATION TO THE MORTGAGEE AND THEN THIS POLICY WILL TERMINATE. 02 ADDITIONAL INSURED CITY CLERK WATER DISTRICT MANAGER CITY OF SAN JUAN CAPISTRANO 32400 PASO ADELANTO SAN JUAN CAPISTRANO, CA. 92675 01/24/02 16:09:49 Genesis Indemnity Insurance Company Notice of Cancellation/Nourenewal Camp Cookie for Children, Inc. Policy No.: ZYB005329A PO Box 460682 Escondido, CA 92046 Policy Term: 04/30/01 to 04/30/02 ❑ Notice of Cancellation ❑x Notice of Intent Not to Renew Agent: Allen Financial Date of Notice: 01/24/02 Effective 12:01 a.m. Effective 04/30/02 at 12:01 a.m. You are hereby notified in accordance with the terms and conditions of the policy identified above that this insurance is terminated effective on the date of cancellation or non -renewal shown hereon, and after that date no further coverage will be provided thereunder. Reason: General Agent no longer represents company. 4 ; � � Barry Starbuck Vice President of Underwriting Colorado Western Insurance Company as Service Office for Genesis Indemnity Insurance Additional Insureds: Rancho Capistrano City Clerk - City of San Juan Capistrano N - m m rn m _ o o' N Box 886 • 3895 Upham Street, Suite 100 • Wheat Ridge Colorado 80034-0886 (303) 425-5950 - Fax (303) 4254297 01/14/2002 11:14 7604808509 JOHN FRANK PAGE 01 CAMP COON= !Oi' C10XM R=, =CZ. PO Box 1434, San Juan CapW"no, CA 92693 (948) 347.0000 or (750) 48"WO FAX COVER SMMT DATE: I -14 -4> 2. TRa: FAX #: 9N� -AW 3 - 9:;i1 aG - (ALAS TOTAL PAGES IIHCLIIDiNG T$IS COVF.St LETTEit'._ IF YOU DO NOT RECEIVE ALL PAGES OR HAVE OTHER PROBLEMS WrM TRANSMISSION, PLEASE CALL (760) 480-8509. THAT LS BOTH THE OFFICE AND FAX NUMBER MESSAGE: OM/1 �/AI I I�IYGCc An/�A �II7 ATIA•1 /1G TIJC Vera 110 pgiiiil 1, OW- OM/1 �/AI I I�IYGCc An/�A �II7 ATIA•1 /1G TIJC Vera 01/14/2002 11:14 7604808509 JOHN FRANK PAGE 02 CAMP COOKIE for C3 , IENC. PO Box 1434, San Juan Capistrano, CA 92693 (949) 347-0006 or (/60) 480.9509 FAX COVER SHEET DATE: 11-11-0/ TIME: //;To .►m UlL�Mm - - . FAX#: l qi- q23— 4463 • 914-L113-106-1 FROM: l Al/QaE XPfvs.-Wr,L TOTAL PAGES INCLUDING THIS COVER LETTER IF YOU DO NOT RECEIVE ALL PAGES OR HAVE OTHER PROBLEMS WITH TRANSMISSION, PLEASE CALL (760) 480-8509. THAT IS BOTH THE OFFICE AND FAX NUMBER. MESSAGE: 900n VAI I INTFFR ORC;ANUATION OF THE YEAR 01/14/2002 11:14 7604808509 JOHN FRANK PAGE 03 Ak Policy Number AC 11044662 Named Iremed: CAMP COOKIE FOR CHILDREN INC MERCURY CASUALTY COMPANY COMMERCIAL AUTOMOBILE POLICY DECLARATIONS MAILED TO CAMP COOKIE FOR CHILDREN INC P 0 BOX 460682 ESCONDIDO CA 92046 Producer: STREETER INS. AGCY. 2301 I1 P 0 BOX 600568 SAN DIEGO CA 92160 TELEPHONE. (619) 281-2628 Nature of Business! NON PROFIT CAMP FOR DISABLED CHILDREN Named Insured ie: CORPORATION The insurance afforded to each vehicle is limited to such coverages as ere Indicated by specific premium chargee in the Vehicle Schedule. The limit of the company's liability shall be as stated herein subject to all the terms at this policy having reference thereto. COVERAGES PREMIUMS Bodily Injury / Property Damage Liability Coverage 5 1 , 580 Uninsured Motorist - Bodily In)ury Coverage 5 142 Uninsured Motorist - Property Damage Coverage 9 28 Collision Deductible Waiver Coverage S Medical Expense Coverage S 45 Comprehensive Coverage s Collision Coverage S Towing and Labor Coverage s Rental Car Benefit Coverage s Hired Auto Coverage s Employer's Non -Ownership Coverage S Filing and/or Certificate Fees $ California Insurance Guarantee Association Charge $ Total Premium and Fees 5 1 , 795 Endorsements designated by the form numbers shown below are attached to and made a part of this policy: UC -10 06/2000 UC -46 IMPORTANT INFORMATION EFFECTIVE 12/28/2000 This amended policy declarations page replaces all declarations with prior effective data, Reason(s) Amended ADD DRIVER(s) Your Notice of Premium Due is enclosed. Any premium due and the due date are indicated on the billing portion the same or of the statement. UC -2 6/2000 Date Mailed: 02/27/2001 01/14/2002 11:14 7604808509 JOHN FRANK PAGE 04 Vehicle Schedule lint MERCURY CASUALTY COMPANY Pobey Number Policy Period Producer Name and Code A 11044662 2/20/2000 12/20/2001 STREE INS. AG 23 Named Insured: CAMP COOKIE FOR CHILDREN INC Description of Vehicles Vr Make BodyType / Tonna2e Model 6wv Serial Number cost or Value r` ' aw 1 1986 1/2 T PICK L J 7FL24 9JP088426 1 /2 U 2 19781DATSUN 12DR MLS30436696 12/2000 U ` Garaging Address ("Same" means kept at mailing address) 1 29255 CAMINO CAPISTRANO SAN JUAN CAPISTRANO CA 92675 2 29255 CAMINO CAPISTRANO SAN JUAN CAPISTRANO CA 92675 Van LP/All Names and Addresses of Loma PayeselLPl, Additional lntersatelAl) end Registered Owners(RO) COVERAGES PREMIUMS l-iebility RI 11 250 ,000 each person a 500,000 each accident PD 4 100 ,000 each occident or 6 000 Combined Single Limit van N 1 Veh N 2 Veh N Ver, X Veh is Vah J 866 714 Uninsured Motorist - 81 p ,000 Combined Single Limit 6 100 000 each parson $ 300.000 each accident 36 106 Uninsured Motonst - PD 6 3500 Maximum 8 20 Collision Deductible wawa, Excess Medical Expense providing For Aelmbursemem 10 Company 8 1000 each arson ❑ No Excess, No Reimbursement 19 26 omprehenonre • Deductiblelsl Vah Vsh Ven Ven Veh Veh Colasion - Deductlblelal VM Vah VM Veh Veh Veh Towing and Labor - Amount Per Disablement Vah Vah VM Von Veh Veh Asntsl Car Benate 9 each day t Maximum Premiums Per Vehicle 929 666 UC -28 7/1906 Date Mailed? 02/27/2001 01/14/2002 11:14 7604808509 JOHN FRANK A41% MERCURY CASUALTY COMPANY POLICY DRIVING RECORD INFORMATION THE DRIVERS SHOWN BELOW ARE LISTED FOR INFORMATION PURPOSES ONLY. THIS FORM DOES NOT CHANGE, ALTER OR AMEND THE POLICY IN ANY WAY. IF THERE ARE ANY CHANGES IN DRIVERS, PLEASE NOTIFY YOUR PRODUCER. NAMED INSURED CAMP COOKIE FOR CHILDREN INC PAGE 05 POLICY NUMBER AC 11044662 PRODUCER STREETER INS. AGCY. EFFECTIVE DATE : 12/28/2000 CODE 2301 DRIVER NAME LICENSE NO. DATE OF BIRTH VIOL. DATA '•-'---- CODE VIOL. DATE ----- CODE VIOL DATE -------- CODE 1. JOHN R FRANK 2. KATHRYN JOHNSON 3. COOKIE NUBBS 4. JOHN C WATKINS UC -4 9/1998 M0582276 08/21/1946 N0321485 03/05/1949 Po674652 12/21/1948 M0894180 12/21/1946 01/14/2002 11:14 7604808509 JOHN FRANK PAGE 06 Cala Herft From: Meg Monahan soft Wednesday, October 17, 20012:09 PM To: Craig Harris "ke t Recording Few Camp Cookie Check 1e nled@ CIA to 0ronye County Recorder Amount- SU.00 Just send it over when you have it Thanks, Meg CAMP COOKIE FOR CHILDREN, INC. OrWW Courlr Recorder 1004=1 1002 New Co mi ruchon:Fsee 6 Permlb 34.00 LlmGWk&Truvt 3100 CAMP COOKIE FOR CHILDREN, INC. Omwe Coady Remder 19444=01 10 0 2 d New C mire llon:Feee i Pamhe 3100 CaIRenYe Banc i Trwr 34.00 11D.wirr mm S -ft ..e. ......r,,..,. 01/14/2002 11:14 7604808509 JOHN FRANK PAGE 07 TRANSMISSION VERIFICATION REPORT TIME : 11/19/2001 12:51 DATE.TIME T 11/19 12:49 FAX NO./NAME COOKIE DURATION 00:02:00 PAGE(S) 05 RESULT MODE STANDARD - ECM _ �- 01/14/2002 11:14 7604808509 JOHN FRANK PAGE 08 TRANSMISSION VERIFICATION REPORT TIME : 11/19/2001 12:48 DATE,TIME 11/19 12:45 FAX N0./NAME 19494931053 DURATION 00:02:04 PAGE(S) 05 RESLT OK MODrz STANDARD ECM 01/14/2002 11:14 7604000509 JOHN FRANK PAGE 09 TRANSMISSION VERIFICATION REPORT TIME : 11/19/2001 12:45 DATE,TIME 11/19 12:42 FAX N0,/NAME 19494934053 DURATION 00:02:06 PAGE(S) 05 RESULT OK MODE STANDARD ECM r^ 01/14/2002 11:14 7604808509 JOHN FRANK STATE P.O. Box 420807, SAN FRANCISCO, CA 94142-0807 CONIPW4111A77014 IM3URA N CE FUND czRTmcAn oa wollams' col1l msATIom wsuiuNcz Brongo Construction POIJCYRUNOM 1663406 32332 Csino Capistrano Suite 205 CBR7MCA78B1'"J31 11/17/02 San Juan Capistrano, CA 92675 PAGE 10 This is to cis" that we haw issued a valid Workers' Compensetlon Insurance poky In • form spprwed by Me CMNa gs Insurance Commissioner to the employer named below for the policy period Ind , , . This policy is not subled to csncelleeon by the Fund except upon 30 days advance wrlMsn notice to the employer. We will also MWe you 30 days advanOs' mi should this policy be cenc@M prior to ft normal explrellon. This cenlAots of Insurance Is not an Irieurence po0cy and does mat amend, esland or s1Isr Mrs wverapa aftrded by 1hs policies listed herein. Notwithstanding any rogWrliment, limn or oonftw of any cenbsd or ~ doormerd with rasped to which Mlle oertlMcele of Insurance mey De Issued or mry pepsin, to Insurance slforded by ON policies dose nbIE hereln is "Object to 80 111% lerm s. esciusions and eondltlOns of such poNcin. I AUTHORIzED REPRESEwrATME EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS:, $1,M,000 PER OCCURRENCE. ENDORSEMENT 1110015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 11/17/01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: ENDORSEMENT 02065 ENTITLED CERTIFICATE HOLDERS NOTICE EFFECTIVE 11/17/01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT * 2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE IS ATTACHED TO,AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: �MPLOYEP ;gtongo Const X2332 Canino /Suite 205 II Sen Juan Cap. ------------ , CA 92675 r?.�T�7i � xis cit r 01/14/2002 11:14 I1 7604808509 1' JOHN FRANK PAGE 11 Aft 6 I Y,... .. Ph* OftWn:Tax and P" Troch WWnp.„: •; .: -' Tn►nG� PIaW d ;;: Trnfdo COMM and ftnaps Trost block eoncMb : RoW saN +;� i T*MPaa�r/yAlpW Q-IQ�-J BaYMp.IN ,• r •. A. S&N QQ.�w=014, tf. '„.0; I WaM TaP/MIx 12� "8a�M01/IN1'�it ' tl� Otl + % o) I E 01/14/2002 11:14 7604808509 WELLS SUPPLY CWPANY Lill Ll ww,%v% snob Amm ch wm�♦l: Ib�AMllsawll P40 034 50� MWA44NOW &tMK Moja WdWAWlWM JOHN FRANK PAGE 12 QUOTATION wR�,1�.J._ CMfilflOM OOOolVA r arR rwonem""aMums "C:ql W? 'PI•ACN 01/14/2002 11:14 7604B0B509 JOHN FRANK PAGE 13 WELLS Slimy CIJMMAOn�r asmb1 mmww ^ a rMAMI, tlMrtb ?�r�0�07a+nt1 fYw(7�l6M11 LM'.MOJiir�1.: AYY[In1l�lMAO�A) . QUOTATION oats,.,��,l,� gAre++wmee►ase�va �M�7/IQiIIP�.{IIfW1d WbM01 1001 -CJ'A*N r 01/14/2002 11;14_ .7604008509 JOHN FRANK PAGE 14 wEUABLWKY,CO+rPAHT »_"mw&� QUOTATION PLUM Mori WW AMOM ► cunarawa +o►rmi wu++o QL•►.1[aL� Ga.J'St �rro .. is AN uUn/ G�iI1 S'►X�alO czeIdf• wOP"YCW &P60AM wvl9�bl Ibbl 'ZI'�►N Clear Day Dawn Schanderl From: Meg Monahan Sent: Monday, January 14, 2002 10:49 AM To: Craig Harris Cc: Jack Galaviz; Dawn Schanderl Subject: Camp Cookie Page 1 of 1 Camp cookie water facilities contract seems to have us all running in various directions duplicating the same efforts. In this particular circumstance, let's funnel all questions from Camp Cookie to Craig Harris. If you receive updated information on insurance, bonds, etc, please send a copy to Craig. He can let them know when they've met their requirements. This way, we'll all avoid repeating all the same steps & calls and avoid any miscommunications. Thanks Craig! Meg Monahan X 6308 1/14/2002 ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PRODUCER ALLEN FINANCIAL INSURANCE GROD 2 POLICY NUMBER 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 THE EQUESTRIAN GROUP LIMITS A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE P.O. Box 9957 04/30/2001 INSURED Camp Cookie for Children Inc. FIRE DAMAGE (A".fire) f INSURER A: INSURER B: PO Box 1434 INSURER C: San Juan Capistrano, CA 92693 INSURER D: INSURER E: CLAIMSMADE OCCUR 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. (NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFECTVE POLICY EXPIUTION LIMITS A GENERAL UABIUTY ZYB 0053291 04/30/2001 04/30/2002 EACH OCCURRENCE f1000000 FIRE DAMAGE (A".fire) f COM MERCIAL GENERAL LIABILITY CLAIMSMADE OCCUR MEDEXPIAM.P.... ,1 551)1)0 PERSONAL It ADV INJ URY S GENERAL AGGREGATE S GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGO 5201100006 POLICY " LOC AUTOMOBILE UASIUTY COMBINED SINGLE LIMIT ANY AUTO (E....id ` BODILY I N J ALL OWNED AUTOS SCHEDULED AUTOS (Per ",..n)_1 HIRED AUTOS— T BODILYINJORV- " O NON-OWNEDAUTOS (Per eccitlenIl, rI- m F. - PROPERTI,OAIdRG['-m� S CD IPenccidat)b GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 6 OTHERTHAN EA S ANYAUTO AUTO ONLY: AGG S EXCESS UABILITY EACH OCCURRENCE 6 OCCUR EICLAIMSMADE AGGREGATE $ S 6 DEDUCTIBLE S RETENTION S WORKERSCOMPENSATIONAND WCSTATU- OTH. "Y LIM TFR EMPLOYERS- UABIUTY E.L. EACH ACCIDENT 6 E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE -POLICY LIMIT $ A OTNEI ZYB 005329A 04/30/2001 04/30/2002 5000 CCC Occ. Care -Custody -Control 25000 CCC Agg. DESCRIPTIONOF OP nONS/WCATIONS/VEHCLES/EXCLU&ONSADDED BYEEIDORSERIMT/SPECIALPROVI&ONS Deac. of Operations: Wagon Rides, Riding Instruction & Horse Boarding Certificate holder is additional insured as premises owner. CERTIFICATE HOLDER i I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION Tn_„_.. .,......_ e.._ .T___O_..__. ..a .--- City Clerk SWUM ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of San Juan Capistrano & DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2a DAYS WRITTEN Capistrano Valley Water Dist. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL 32400 Paso Adelanto IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR San Juan Capistrano, CA 92675 REPRESENTATIVES. AUTWD ED TAYIVE 1 ACORD 25-S )7197) 1 ' ACORD CORPORATION 1988 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. 171971 AV RD CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER 2 POLICY NUMBER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ALLEN FINANCIAL INSURANCE GROII LIMITS A HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR THE EQUESTRIAN GROUP 04/30/2001 04/30/2002 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE P.O. Box 9957 COMMERCIAL GENERALLIABILITY INSURED Camp Cookie for Children Inc. INSURER A: INSURER B: PO Box 1434 INSURER C: San Juan Capistrano, CA 92693 INSURER D: INSURER E: 911911 rOVERAGES 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 ATEIMMFECTNE OLICYID PDATEIMPMATION LIMITS A OFNEIAL LIABILITY EYB 005329A 04/30/2001 04/30/2002 EACH OCCURRENCE II FIRE DAMAGE wny ane(iral S COMMERCIAL GENERALLIABILITY MED EXP (Any one Parson) S �1 CLAIMSMADE LZ_jOCCUfl PERSONAL SADVINJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO 8 POLICY PRO- LOC AUTOMOeIELIABILITV COMBINED SINGLE LIMIT S ANYAUTO IEa accMeMl BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per penonl S BODILY INJURY S HIRED AUTOS NON -OWNED AUTOS (Par accidancl PROPERTY DAMAGE $ (Per accid.m) GARAGE UABIUTY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC g ANYAUTO AUTOONLY: AGO S EXCESS UABILITY EACH OCCURRENCE S AGGREGATE 6 OCCUR CLAIMSMADE S 8 DEDUCTIBLE g RETENTION S WORKERSCOMPENBATIONAND WCSTATU- OTH- EMKOVERS' UAmuTY E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT S A OTHER ZZ9 005329A 04/30/2001 04/30/2002 5000 ` CCC Occ. Cars -Custody -Control 25000 i CCC Agg. C N DESCRIPTION OFOPL rGNS/LOCATIONSNMCLES CLUMONSADDEDBYENDOMMMT/SPECIAL RgVIMONS ;a m O - — m Desc. of Operations., Wagon Rides, Riding Instruction & Horse Boarding - TO m Certificate holder is additional insured as premises oAmer. XF o _1 a City Clerk Water District Manager City of San Juan Capistrano 32400 Paso Adelanto San Juan Capistrano, CA 92675 (7197) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEIIEOF, THE ISSUING mMSRER WILL ENDEAVOR TO MAUL 3a— DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SKIUL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policylies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATIONISWAIVED, 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 (7/97) • 0 OCTOBER 16, 2001 THROUGH JUNE 30, 2001 IN THE AMOUNT NOT TO EXCEED $50,400 ANNUALLY APPROVED (BOYS & GIRLS CLUB OF CAPISTRANO VALLEY, INC AND CAMP FIRE BOYS AND GIRLS, ORANGE COUNTY COUNCIL) (600.30) —�. IMPROVEMENT AND REIMBURSEMENT AGREEMENT FOR WATER FACILITIES — CAMP COOKIE FOR CHILDREN, INC.; APPROVED; MAYOR AUTHORIZED TO EXECUTE THE AGREEMENT ON BEHALF OF CITY; AND CITY CLERK DIRECTED TO PROCESS RECORDING OF AGREEMENT (600`60) 8. ST&S OF NEW DEVELOPMENT APPLICATIONS REPORT RECEIVED AND FILED (440.10) 9. RESOLUTION NO. 01-10-16-03 ADOPTED ENTITLED "A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN JUAN CAPISTRANO, CALIFORNIA, APPROVING SUBMITTAL OF APPLICATION FOR GRANT FUNDS PARK PLAYGROUND ACCESSIBILITY AND RECYCLING GRANT PROGRAM UNDER THE SAFE NEIGHBORHOOD PARKS, CLEAN WATER, CLEAN AIR, AND COASTAL PROTECTION BOND ACT OF 2000" (PROPOSITION 12) (810.60/920.40) 10. ACQUISITION OF MICROSOFT OFFICE XP SOFTWARE FROM CMAS APPROVED VENDOR, SOFTCHOICE CORPORATION APPROVED (SOFTCHOICE) (380.40) 11. HISTORIC TOWN CENTER PARK RENTAL FEES REDUCED BY 75% FOR THE FAMILY FAIR HOSTED BY PARA TODAS ON SATURDAY, NOVEMBER 3, 2001 (390.30) PUBLIC HEARINGS: PUBLIC HEARING REGARDING TENTATIVE TRACT MAP 16168; REZONE 01-08; AND FLOOD PLAIN LAND USE PERMIT FOR A PROPOSED SUBDIVISION ADJACENT TO RANCHO DEL AVION MOBILE HOME PARK AND VILLAGE ALIPAZ NEIGHBORHOOD CONTINUED TO NOVEMBER 6, 2001 (VILLAGE ALIPAZ, LLC) (420.40/460.20/550.10) Project Description: The Public Hearing for this item was opened at the Council meeting of September 18, 2001, continued to October 2, 2001, and continued to this meeting. Council Action: Mayor Hart invited public testimony. There being no response, the following action was taken. Moved by Mayor Hart, seconded by Mayor pro tem Swerdlin and passed unanimously, 5-0, to continue the public hearing to the meeting of November 6, 2001. CC Minutes 3 10-16-01 08/21/02 11:53 $`7607467968 002/002 GENESIS INDEMNITY INSURANCE COMPANY 695 E. MAIN STREET STAMFORD, CONN 06904 NON -ASSESSABLE TRAIL RIDES AMENDED NAME INSURED: DAN WINNE & JOHN FRANK DBA HAPPY TRAIL STABLE & CAMP COOKIE FOR CHILDREN, INC. 727 RUSTIC RD ESCONDIDO, CA- 92024 POLICY NUMBER: 2YE006895A COMPANY SERVICE OFFICE (303)425-5950 04-02-297 AGENT ANDERSON AND MURISON, INC. (323)255-2333 POLICY PERIOD: 12:01 A -M. STANDARD TIME, AT THE INSURED PREMISES. FROM 04/30/2002 TO 04/30/2003 AMENDED EFFECTIVE: 04/30/2002 PREMIUM CHANGE TO EXPIRATION DATE $ 0 FEE 0 INSURANCE IS PROVIDED ONLY FOR THOSE COVERAGES FOR WHICH A SPECIFIC AMOUNT OF INSURANCE IS INDICATED_ WE WILL PROVIDE THE INSURANCE DESCRIBED IN THIS POLICY IN RETURN FOR THE PREMIUM AND COMPLIANCE WITH ALL APPLICABLE POLICY PROVISIONS. POLICY DESCRIPTION: EFFECTIVE 7-8-02. INSURED'S NAME *AMENDED & ADDITIONAL INSURED *ADDED LOCATION: 12115 BLACK CANYON RD; SAN DIEGO, CA 40046 - SADDLE ANIMALS - HORSES 44227 - TRAIL RIDES AND WAGON RIDES 44228 - HAY WAGON RIDES 99111 - HORASE BOARDING COVERAGE DESCRIPTION ---- ------------------ EACH OCCURRENCE GENERAL AGGREGATE PRODUCTS/COMPLETED OPNS PERSONAL & ADV- INJURY MEDICAL PAYMENTS DMG-PREMISE RENTED TO -zOU LIMIT 1,000,000 1,000,000 1,000,000 1,000,000 5,000 100.000 SUBJECT TO FOLLOWING FORMS AND ENDORSEMENTS: CG2l/39 10/93 CG21/50 09/89 CG24/02 11/94 GI -114 01/97 GI -145 01/97 GI -146 01/97 IL00/17 11/85 IL00/21 11/94 IL02/70 08/97 CGOO/57 09/99 CG21/16 07/96 GI -134 04/96 CG21/36 01/96 CG24/07 01/96 CG21/69 01/02 GI -151B 04/97 CG03/00 01/96 PREMIUM DEDUCTIBLI --------- ---------- 3,040 -------- 3,040 25( This policy is subject to a minimum earned premium. Please read your endorsement carefully. GI -105 01/97 GI -147 01/97 CG21/47 07/98 GI -186 01/01 CG20/12 07/98 SERVICE COMPANY: COLORADO WESTERN INSURANCE COMPANY DATE OF ISSUE: 07/24/2002 COUNTERSIGN 07/24/02 16:07:24 GI -113 01/9' GI -148 01/97 GI -164 06/9E CG00/01 10/07 CG21/46 07/9E I 3, Doc AUTHORIZED REPRESENTATIVE 08/21/02 11:53 $7607467968 1&01/002 Montoya Insurance Agency 1672 E. Valley Parkway, Escondido, CA 92027 To; acK aA-h) -z Phone• Fax phone: bate —�� D Z Number of pages including cover sheet: From: Jim Montoya Phone: 760-746-0721 Fax phone: 760-746-7968 REMARKS.* ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please comment