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11-0301_FIESTA ASSOCIATION, SJC_Insurance CertificateClient#: 1251543 305SJCFIESTA ACORM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/0512010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE Hp ,E�.. IMPORTANT: If the certificate holder is an ADDIT L 1911Fth=poilcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain po I Ies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER [ TAC a AME: 714 578-7000 13B&T Insurance Services PHONE Fax (AIC, No, Extl: (A/C, Na : of Orange County E-MAIi. �1DARESS: 680 Langsdorf Drive Suite 100 )I.� f CUSTOMER ID #: Fullerton, CA 92831 INSURED San Juan Capistrano Fiesta Association P.O. Box 532 San Juan Capistrano, CA 92675 INSURER(S) AFFORDING COVERAGE MAIC # INSURER A: Western Heritage Insurance Comp. 37150 INSURER B I INSURER C INSURER 0: _ INSURER E: _ .. .. COVERAGES CERTIFICATE NUMBER- RFVIRtnN N111VIRT=rr 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 OFANY 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. 1 SR I TYPE OF INSURANCEPUBR LTRN 11 WVD POLICY EFF POLICY EXP POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY SCP0821755 1012912010 10/2912011 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY � AGE TO RENTEp PREMISES (Ea accurrence $50,000 CLAIMS -MADE L J OCCUR MED EXP (Any one person)$1,000 $1,000,000 B11PD Ded:500 PX PFRSONAL & ADV INJURY GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PIOP AGG $ = POLICY F I PRO 1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO $� I BODILY INJURY (Per person) ALL OWNED AUTOS - - , 3 E = BODILY INJURY (Per acc€dent) SCHEDULED AUTOS ""____._.,,,_......___ PROPERTY DAMAGE ......,,,,...,.... HIRED AUTOS (Per accident) $ $ NON -OWNED AUTOS E 3 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ $ ._ _ DEDUCTIBLE [[ RETENTION $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS' L,IIABILITY YI N I TOALIMIT ER 9 W S ANY PROPR[ETORIPARTNFFUEXECUTIVE❑ ' E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? NIA ----- _ -.- $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE if yes, describe under DE SCR€PTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Swallows Day Parade Certificate Holder is named as Additional Insured as respects to general liability as required by written (See Attached Descriptions) GILKIIt GAIIn San Juan Capistrano Community Redevelopment Agency and The City of San Juan Capistrano 32400 Paseo Adelanto ACORD 25 (2009/09) 1of 2 #S 58613151M 58613 G2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE + 0'1988-2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD DOLUC DESCRIPTIONS (Continued from Page 1) I contract per attached policy form. AMS 25.3 (2009109) 2 of 2 #S5861315/M5861302 ATTACHED TO AND FORMING APART OF ENDORSEMENT EFFECTIVE DATE OR NAMED INSURED AGENT NO. POLICY NUMBER {q A.M. STANDARD TIME} you and such person or organization have agreed in SCP08217.55 10/29/10 SAN JUAN CAPIS RANO 04040 (The above information is required only when this endorsement is issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -OWNERS, LESSEES OR CONSTRACTORS---AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section Il Who Is An Insured is amended to in- of, or the failure to render, any professional clude as an additional insured any person or organi- architectural, engineering or surveying services, zation for whom you are performing operations when including: you and such person or organization have agreed in writing, and executed such a contract or agreement a• The preparing, approving, or failing to prepare prior to the time of an occurrence giving rise to a or approve, maps, shop drawings, opinions, claim, that such person or organization be added as reports, surveys, field orders, change orders an additional insured on your policy. Such person or or drawings and specifications; and organization is an additional insured only with respect b. Supervisory, inspection, architectural or engi- to liability for "bodily injury," "property damage" or neering activities. "personal and advertising injury„ caused, in whole or 2. "Bodily injury" or "property damage" occurring in part, by: after: 1. Your acts or omissions; or a. All work, including materials, parts or equip - 2, The acts or omissions of those acting on your ment furnished in connection with such work, behalf; on the project (other than service,ainte- in the performance of your ongoing operations for the nance or repairs) to be performed by or on additional insured. behalf of the additional insured(s) at the site of the covered operations has been com- B. With respect to the insurance afforded to these addi- pleted; or tional insureds, the following additional exclusions b. That portion of "your work" out of which the in - apply: jury or damage arises has been put to its in - This insurance does not apply to: tended use by any person or organization I. "Bodily injury," "property damage" or "personal other than another contractor or subcontrac- arsd advertising injury" arising out of the rendering tor engaged in performing operations for aprincipal as a part of the same project. AUTHORIZED REPRESENTATIVE Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 WHI 21-0517 (07-08) DATE Client#: 1251543 305SJCFIESTA ACID, CERTIFICATE TE OF LIABILITY INSURANCE Y) I MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 02125109D PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION BB&T Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of Orange Count g Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 680 Langsdorf Drive Suite 100 A Fullerton, CA 92831 INSURERS AFF'OWNG COVERAGE MAIC # INSURED San Juan Capistrano Fiesta Association P.O. Box 532 INSURERA: Western Heritage Insurance Company 37150 INSURERB: INSURER C: INSURER D: REVISED TO INCLUDE San Juan Capistrano, CA 92675 INSURERE: LIQUOR LIABILITY COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATFD. 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. LTR N R TYPE OF INSURANCE POLICY NUMBER FDOAiIYFFECIYVE PdATE?(pp�yYt?N LIMITS A GENERAL LIAMUTY SCP0705086 10129108 90129!09 EACH OCCURRENCE $1040000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO REN'1'Ei3 ATS 'S Ea ec 550 000 MED .EXP (Any One person) $1,000 CLAIMS MADE p OCCUR PERSONAL & ADV INJURY $1,()00,000 X BIIPD Ded:500 . GENERALAGGREGATE $1,000000 GEWL AGGREGATE LIMr.r APPLIES PER: PRODUCTS - COMNOP AGG S P12O- POLICY0 JEC7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO {Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (P-Pem-) $ BODILY INJURY HIREDAUTOS NON -OWNED AUTOS (Peraccident) $ PROPERTY DAMAGE $ {Per accideN) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ � .....W.. ANY AUTO AUTO ONLY: AGG $ EXCESSiUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE . $ ... OCCUR CLAIMS MADE $ DEDUCTIBLE $ RrTE-NTION $ WORKERS COMPENSATION AND 'IATOT SLRM EmpLoYERs, um8LT E.L. EACH ACCIDENT $ ANY PROPRIETOWPARTNER/EXECUTIVE El, DISEASE - EA EMPLOYEE $ OFFICMMEMBFR EXCLUDED? N e5, desuibe under E.L. DISEASE • POLICY LIMIT $ SPECIAL PROVISIONS below a OTHER Liquor SCP0705086 10/29108 10129109 $1,000,000 $500 Ded Liability DESCRIPTION OF OPERAIIDNS f LOCATIONS /VEHICLES I FXCLUSIQNS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Halder is named as Additional Insured for special events per written agreement and. attached Additional Insured Endorsement. San ,Tuan Capistrano Community Redevelopment Agency and The City of San Juan Capistrano 32440 Paseo Adelanto San .Tuan Capistrano, CA 92675 OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 5NDI=AVOR TO MAIL _..30_ DAYS WRCTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DG $0 SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR REPRESE'NTI4TIVE Av,uKu sa t"Ulltm) 1 of 2. #S3211812IM3245265 HLRHO 0 ACORD CORPORATION 7988 nop Western Heritage Insuraflee Cornpat q ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE INSURED AGENT NO. POLICY NUMBER {92:01 A.11$. STANDARD TIME) 32400 PASEC) ADEiANTO SCP0705086 02/20/2009 SART JUAN CAPISTRANO 04040 (The above information is required only when this endorsement is issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Or anization Location(s) Of Covered Operations _ SART JUAN CAPrSTARNO COMM REDEVELOP AGNCY ALL LL?CATLONS UNDER WRITTEN THE CITY OF SAN JUAN CAPISTRANO CONTRACT WITH NAMED !NSTTRED 32400 PASEC) ADEiANTO SAN JUAN CAPISTRANO, CA 92575 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with re- spect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions apply: All other Terms and Conditions of this Policy remain unchanged. This insurance does not apply to bodily injury" or "property damage" occurring after: 1. That portion of "your work" out of which the injury or damage arises has been put to its Intended use by any person or organization other than another contractor or subcontrac- tor ubcontractfor engaged in performing operations for a principal part of the same project. 0 AUTHORIZED REPRESENTATIVE ViHl 21-0479 (02!05) INSURED DATE If the certificate holder is an ADDITIONAL INSURE©, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001/08) 2. of 2 #S3211812IM3205265 Client#. 1251543 305SJCFIESTA A COR CERTIFICATE OF LIABILITY I IV lJ NCEDATE (MMIDDlYYYYj ,. 02125!09 PRODUCER THIS CERTIFICATE IS ISSUED AS A iU€ATTER OF INFORMATION BB&T Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of Orange County HOLDER. THIS CERTIFICATE HOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 880 Langsdorf Drive Suite 100 A Fullerton, CA 92831 INSURERS AFFORDING COVERAGE MAIC # INSURED San Juan Capistrano Fiesta Association F.O. Box 532 INSURERk Western Heritage Insurance Company 37150 INSURER B: X71 COMMERCIAL GENERAL LMILITY fNSURERC: _ INSURER DT REVISED TO INCLUDE DAMAGE TO RrNTED San Juan Capistrano, CA 92675 INSURER E: LIQUOR LIABILITY CLAIMS MADE OCCUR COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTtNITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE. TERMS, EYCLUStONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR SR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MfDDJY POLICY EXPIRATION DATE (MMMOfM LIMITS A GENERAL LIABILITY 9CP0705086 10128108 10/29109 EACH OCCURRENCE $1,000,000 X71 COMMERCIAL GENERAL LMILITY DAMAGE TO RrNTED CLAIMS MADE OCCUR RASO EXP (Any one person) $1 000 PERSONAL &ADV INJURY 31 000 000 X BIIPD Ded:50.0 .'... GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS » COMPIOP AGG S POLICY DPRO.15W El LOC AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT ANY AUTO (Ea awdent) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ BODILY INJURY HIRE -D AUTOS NON-OWNEDAUTOS (Peramident) - 3 PROPERTY DAMAGE $ (Per aceldeni) GARAGE LIABILITY ... AUTO ONLY -EA ACCIDENT $ OTHER THAN EA AGC $ ANY AUTO AUTO ONLY. AGG $ EXCESSIUMBRELLA LlAelLITY EACH OCCURRENCE $ AGGREGATE OCCUR CLAIMS MADE - $ DEDUCTIBLE $ RETENTION $ COMPENSATION AND WC STATU• OTFf- TORYI ER FMPLC YE S' LL0kBILrrY EBAPLOYERS' LIABILITY E.L. EACH ACCIDENT ANY PROPRIETOWPARTNEWEXECUTIVE - E.L. DISEASE . EA EMPLOYEd,% OFFICERIMEMBER EXCLUDED? If yas, desefte under El. DISEASE -POLICY LIMIT I $ SPECIAL PROVIS;ONS below .A OTHER Liquor SCP0705086 10/29108 10129109 $1,000,000 $500 Dad Liability DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES I EXCLUSMS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Certificate Holder Is named as Additional Insured for operations of the Named Insured per written agreement and attached policy form. (See Attached Descriptions) SHOULD ANY OF THE ABOVE DESCRIED POLICIES BE CANCELLED BEFORE THE EXPIRATION .State of California DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30„„„ DAYS WRITTEN Departmentof Transportation NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FA1 LURE TO DO 30 $HALL District 12 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 3337 Michelson Cir, Ste CN380 REPRESENTATIVES. Irvine, CA 92612-8894 A TH R ZrzD REPRESENTAnvE ra�.vleu eu CevU-Iruol 1 013 #532111313/M3205265 HLRHO a ACORD CORPORAT]ON 1988 nop Western Heritage Insurance company ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE INSURED AGENT NO. POLICY NUMBER l 12;01 XM, STANDARD TIME)NAMED 3337 MICHELSCN DRIVE, SUITE CN380 SCP0705086 02/20/2009 SAN JUAN CAPISTRANO 04040 (The above information is required only when this endorsement is issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization Location(s) Of Covered Operations STATE OF CALIFORNIA �* ALL LOCATIONS UNDER WRITTEN DEPT. OR TRANSPORTATION, DISTRICT 12 CONTRACT WITH NAMED INSURED 3337 MICHELSCN DRIVE, SUITE CN380 IRVINE, CA 9261_2-0894 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or or- ganizations) shown in the Schedule, but only with re- spect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of these acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions apply:. All other Terms and Conditions of this Policy remain unchanged. This insurance does not apply to "bodily injury" or "property damage;" occurring after: 9. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal part of the same project. N AUTHORIZED REPRESENTATIVE WHI 21-0479 (Q2/05) INSURED DATE If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 endorsernent(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insuror(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 25-5 (2001108) 2 of 3 #S32118131M3205265