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1996-1002_GOLDEN TRIANGLE LAND SURVEYING_Compliance with Insurance Requirments STATE R0 BOX 42bSOSAN FRAN 0. CA 9141,42-0 8 7 COMPENSATYON CERTIFICATE . ' T 6 ,;INSURANCE --RTIFCATE EXPIRES. " K, u C171 OF SANZ JMCCAPISTRANO TH, SHARON : - i 1 24 E €A`g SAN JUAN ?"'APiSTRAM0 CA 92675 SOB. SAN JUAN SPORTS PARK. CITY OF SANjUA CAPISTRANO This is to certify that we have:issued a:vaird Workers' Cot°r r)e) E„atio 3n uramce poi cy in a iorm approved bytic t�:<l,ft>rs�G Insurance Commissioner e to!-he e apiover"'smm" --'d h" km't0r i � r3n'i.ra1[ ;•; z-�:x't r"a This policy is not subject fc�caance-Hation by th'-Fund except up art t Aays udYJan"'e written nonce to tho e-P- Pft)yer, 30 30 We grill,also give you , ays'advance notice shou�d this pOicy be canceiged prior to 4s norrmK expiration. This certificate of insurance �s not an insurance policy and does, not arnefO, extent or,alter the coverape afforded by rhe policies listed herein. Notwi.thstan aing any requirement, %arm, or condition: of anv contract or otter doc,um(:,A with -respect to which this certificate of insur<anm may. be, 'issue€::oi may oc tas`r�,,t[i' MSUr ncp afte,r zed by the l; li ies described herein is siJ,biact to ak the terrn ,: Suchmm r3CSlIf,E'£'.5, �... . � L . AUTHOF-flZeD RFPRESFN-fANV ��r sst�r�rIr 414 EMPLOYER'S U'ASILITY LHAITMCLibi 4'C,7dt-FiAE-Z COST' 141:0 00,000 PER 043C10:RRE� E . E� � T #24 65 ENT17 LED PTWP--A " -, HOLDER'S NOTICE EF50C TwE 12-0-2-96 IS A TT ACHED TO AND FORMS PART r: THiS POS i> Y.: ENiF>i...OYER 11l`i'C;HNG POST ROAD y� '..... ®®......... ww I€ry� �'. /'14J({'��imot� ��.- CCER TOGA , r i \ �: ',..185UE DATE (MM/DD/Y'!) 11 30 96 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER TIME COVERAGE AFFORDED BY THE ACORDIA OF SOUTHERN POLICIES BELOW. CALIFORNIA INC. COMPANIES AFFORDING COVERAGE P O BOX 19570 IRVINE CA 92713 COMPANY LETTER A COMMERCIAL UNION ..... ............. ......................._,..,..,..,..,..,.., ........,. .....................,.., _ COMPANY INSURED LETTER B COMMERCIAL UNION GOLDEN TRIANGLE LAND COMPANY C SURVEYING LETTER ..... ......... ......... 2679 SEACREST COURT COMPANY VISTA CA 92083-8702LETTER D COMPANY E LETTER CONTINENTAL CASUALTY 'OVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THEa INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co TYPE OF IN$URANCE POLICY NUMBER POLICY EFFECTIWE :POLICY EXPIRATION LIMBS LTR: DATE(MM/DD1YY) - DATE(MMIDDNYI AL GENERAL LIABILITY FALH 7 0 0 7 7 5/05/96 5/05/97 GENERAL AGGREGATE _$2 1,.0 0.0/.�.p.0 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $1 r 000, 000 ........ CLAIMS MADE.,.X.,.,OCCUR.. PERSONAL&ADV.INJURY :$.�./.Pop, 000 OWNER'S&CONTRACTOR'S PROT . EACH OCCURRENCE $1 t.000 I 000 FIRE DAMAGE(Any one fire) $100, 000 MED.EXPENSE IAny one Person) $5 0 0_0 AUTOMOBILE LIABILITY FALH7 0 07 7 - 5/05/96 5/05/97 COMBINED SINGLE S ANY AUTO LIMIT 1, 000, 000 ALL OWNED AUTOS .80 DILY INJURY :$ SCHEDULED AU'T'OS (Per person) X HIREDAUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY ..................................... PROPERTY DAMAGE :$ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS EACH ACCIDENT... _......$. AND DISEASE--POLICY LIMIT $ EMPLOYERS'LIABILITY DISEASE-EACH EMPLOYEE $ OTHER LSN113790696 6/12/96 6/12/97 ',LI 1, 000, 000 PROF LIABILITY DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!SPECIAL ITEMS PROFESSIONAL LIABILITY LIMIT IS PER CLAIM & POLICY AGGREGATE/CERT HOLDER IS NAMED AS ADDITIONAL INSURED ON GL POLICY-SEE ATTACHED ENDORSEMENT/ALL SURVEYING OPERATIONS INCL BUT NOT L'I'D TO SAN JUAN SPORTS PARK CERTIFICATE HOi DER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 0_._DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE CITY OF SAN JUAN CAPISTRANO LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR S. HEIDER-OPEN SPACE PROD MGR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 32400 PAS EO ADE LANTO 5533 AUTHORIZED REPRESENTATIVE SJ CAPISTRANO CA 92675 SHERRY YOUNG FOR ACORDIA Y ACbRD 25-S (7/9Q) EAC(}RD CORPORATION 1900; Producer : ACORDIA Producer Code: 04-67396 This endorsement, effective 11/30/96 forms a part of Policy Number FALH70077 issued to GOLDEN TRIANGLE LAND SURVEYING by Employers , Fire Insurance Company. ADDITIONAL INSURED ENDORSEMENT SECTION II - LIABILITY INSURANCE NAME OF ADDITIONAL DESCRIPTION OF INSURED PREMISES CITY OF SAN JUAN CAPISTRANO All Surveying 32400 PASEO ADELANTO 5533 services performed for SAN JUAN CAPISTRANO, CA 92675 additional insured **SEE ATTACHED FORM CG20091185** Additional premium charged: NONE SRY I Y�OUNG R A�ORD I A (Authorized Representative) AA&C: Y Issued: 11/30/96 POLICY NUMBER: C( JIERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED—OWNERS, LESSEES or CONTRACTORS (Form A) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization (Additional Insured): Location of Covered Operations Premium Basis Rates Advance Premium Bodily Injury and (Per Property Damage Liability Cost $1000 of cost) $ Total Advance Premium $ (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 1. WHO IS AN INSURED (Section 11) is amended to (a) All work on the project (other than include as an insured the person or organization service, maintenance, or repairs) to (called "additional insured")shown in the Sched- be performed by or on behalf of the ule but only with respect to liability arising out of: additional insured(s)at the site of the A. "Your work" for the additional insured(s) at covered operations has been com- the location designated above, or pleted; or B. Acts or omissions of the additional insured(s) (b) That portion of "your work" out of in connection with their general supervision which the injury or damage arises has of "your work" at the location shown in the been put to its intended use by any Schedule. person or organization other than an- other contractor or subcontractor 2. With respect to the insurance afforded these addi- engaged in performing operations for tional insureds,the following additional provisions a principal as a part of the same apply: project. A. None of the exclusions under Coverage A, (3) "Bodily injury„ or "property damage„ except exclusions (a), (d), (e), (f), (h2), (i), arising out of any act or omission of the and (m), apply to this insurance. additional insured(s) or any of their em- B. Additional Exclusions. This insurance does ployees, other than the general supervi- not apply to: sion of work performed for the additional (1) "Bodily injury" or "property damage" insured(s) by you. for which the additional insured(s) are (4) "Property damage" to: obligated to pay damages by reason of (a) Property awned,used or occupied by the assumption of liability in a contract or or rented to the additional insured(s); agreement.This exclusion does not apply (b) property in the care,custody,or can- to liability for damages that the additional insuredover s) would have in the absence of of the additional insured(s) or the contract or agreement. over which the additional insured(s) are for any purpose exercising phys- (2) "Bodily injury" or "property damage" ical control; or occurring after: (c) "Your work" for the additional in- sured(s). CG 20 09 1185 Copyright, Insurance Services Office, Inc., 1984 FROM :CPL I FORK I R RCC 71 RS7770 S`3- 1996, 12-10 13: 10 P.01/03 FOfl IA REGIONAL CommmcsAL c*xmt 7-72-7 E. 1mperfid ifighway Suite #'3()o P. 0. Box 1700 714 577-7000 800 729-3005 /�yy Fax. 714 577-7059 Fax_ 800 297-7843 FAX COVER SHEET To Fte. 1- Date - - _ From: =� � cJ .,,�1 Est_ # Pages (including cover sheet).- Memo: heet):Memo: FROM :C"LIFORNIP RCC 7146777059 1996, 12--10 13: 13 ##461. P.03/03 COMMERCIAL.AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 050 251. 345 AAP ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name and Address of Person or Organization. CITY OF SAN JUAN CAPISTRANO ATTN: SHARON HEIDER, OPEN SPACE PF'OJECT MANAGER 32400 PASEO AUELA'N'TO 5533 SAN JUAN CAPTSTRANO, CA 92675 PROJECT: SAN JUAN SPORTS PARK, CITY OF SAN JUAN CAPIS'T.'RANO A. The person or organization shown in the Schedule is included as an insured bort only if liable far the conduct of an "insmd" and only to the extent of that liability. S. CANCELLATION t. If we cancel the policy, vire will mail or deliver notice to such person or organization in accordance With the Common Policy Conditions. 2. It you cancel the policy, we will mail or deliver notice to such person or organization. 3. Cancellation ends this agreement.. BW 1140-93) FROM :CALIFORNIA RCC 714S777059 1888, 12-10 17:18 #461 P.02/03 E OF INSURANCE' ALLSTATE INSURANCIFF COMPANY ALLSTATE INDEMNITY COMPANY ALLSTATE TEXAS LLOYD'S THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE eFulFfCAT E HOLDER T HIS CERTIFI CATE DOES NOT AMEND,CXT E ND OR ALTER THE COVERAGE AFFORDED BYTHL POLIGIES BF-LOW. - .._.� CERTIFICATE MOLDER NAMED INSURED rNameddress of Part to Vslhorrfhis Certificate is Issu9dName and Address of Insured N JUAN CAPISTRANO GOLDEN TRIANGLE TANTS SURVEYING 'CNC ON HEIDER , OPEN SPACE PRL MGR 811. HITCHING POST ROAD 32400 PASEO ADELANTO 5533 VISTA, CA 92083 SAN JUAN CAPISTRANO, CA 92675 This is to certify that policies of insurance listed galow have been issued to the insured narrred above subject to the expiration data indicated below, notwithstartding 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 dIl the terms,exclusions,and conditions of such policies, TYPE OF INSURANCE AND LIMITS COMMERCIAL GENERAL LIABILITY Policy Effective Expiratlon Number Date Date ...... �._ Limit Amours GENERAL AGGREGAT<" t LIMET{Other than Products�- GarrlpEete�i Operations} ► RODUCTS—COMPLETED OPI RATIONS AGGREGATE LIMIT S PERSONAL.AND ADVERTISING INJURY LIMIT EACH OCCURRENCE LIMIT �- — ---- - -- W PHYSICAL DAMAGE _ _...� _... ..... --._..,._.... ....... $ ANYONE LOSS M EDICAL EXPENSE LIMIT _LO.SS _ S ANY ONE PERSON ERS'COMPENSATION& Pblicy Effective F3rpira2ltyn LIABILITY Number Date, Date .�............. .....�Catera a Limits ER5'CDMI'ENSATION `aTATUTORY applies only in tho f(yliawin s�.tdies_ -- �� BODILY INJURY BY ACCIDEN r $ EACH AeCIDEN T EMPLOYERS` _ �..�_ BODILY INJURY BY DISEASE _._ .... � LIABILITY �.. EACH EMPLOYEE i, BCIDILY ICVJUEY BY DESI`ASE. $ POLICY LIMIT Effective AUTOMOBILE LIABILITY Policy Number 050 2 513 A 5 Data 12/06/96. .2/0 6/9 Date Expiration I-2/ - 01 9 7 �[}Y19r8�e ........._.� m................ ..� _ _ ..._ 8514 LImIt& []ANY AUTO ❑ OWNED A11TOS ❑ HIRED AUTD.5 Combined Sin IIS Limit of Liability BODILY INJURY&PROPERTY DAMAGU 5 2 ,(j 0 OT0(�� IFACI{AC:C:IDEt�IT &SPECIFIED AUTOS NON-OWNUIJ AUTOS 5 Ift Liability Limits RndllWa amaze Each ❑OWNED PWVATE PASSENGER AUTOS Y 1 rY Pre e P BY PERSON DOWNEDAIITO.Si01HIRTHAN PRIVATEPASSFNGEiT $ $ ACCIDENT UMBRELLA LIABILI'T'Y Policy Effective � Expiration Number [Sate Date FACH OCCUHRENCE —� -- EGA �GENERAL AGGREGATE PRODUCTS-_--COMPLETED OPERATIONS AGG_WT'E .. .__. OTHER(Show Policy Effective Expiration type of Policy) __.--- NumberDate Date DESCRIPTION OF OPERAFIONSILOCATIONSIVEHICL.ESIIRE sTRICTIONSf frECIAL 14 EMS PROTECT. SAN JUAN SPORTS PARK, CITY 01�' SAN .JUAN CAPISTRANO CANCELLATION Number of days notice r0 �+a4htxl'zed Rrprnsnnt�tlue ate Should ally of the above described policies be cancelled before the expiration-date,the Issuing company will endeavor to mail wlthin the nurnber©f daysentered above,written notice to the Certificate holder named above_But failuretornailsuch noticeshall impoSE floobligation or liability of any kind upon the company,its agents or representatives. CERTIFICATE OF INSURANCE El ALLSTATE INSURANCE COMPANY ❑ ALLSTATE INDEMNITY COMPANY ❑ ALLSTATE TEXAS LLOYD'S THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFI- CATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CERTIFICATE HOLDER NAMED INSURED Name and Address of Party to Whom this Certificate is Issued Name and Address of Insured CITY OF SAN JUAN CAPISTRANO GOLDEN TRIANGLE LAND SIJPVEYTNG INC ATTN: SHARON HEIDER, OPEN SPACE PRO MGR 811 HITCHING POST ROAD 33400 PASEO ADELANTO 5533 �ITSTA, CA 92083 SAN JUAN CAPISTRANO, CA 92675 This is to certify that policies of insurance listed below have been issued to the insured named above subject to the expiration date indicated below, 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. TYPE OF INSURANCE AND LIMITS COMMERCIAL GENERAL LIABILITY Policy Effective Expiration Number Date Date Limit Amount_._..-____... .___...... .,_ -._ _ W_ GENERAL AGGREGATE LIMIT(Otherthan Products—Completed Operations) $ PRODUCTS_—_COMPLETED OPERATIONS AGGREGATE LIMIT - --- - _--__ __ PERSONAL AND ADVERTISING INJURY LIMIT $ EACH OCCURRENCE LIMIT_-- PHYSICAL DAMAGE_LIMIT $ ANY ONE LOSS MEDICAL EXPENSE LIMIT $ ANY ONE PERSON WORKERS'COMPENSATION& Policy Effective Expiration EMPLOYERS'LIABILITY Number Date Date _.- Coverage Limits WORKERS'COMPENSATION STATUTORY—applies onI in the following states: BODILY INJURY BY ACCIDENT $ EACH ACCIDENT EMPLOYERS' BODILY INJURY BY DISEASE $ EACH EMPLOYEE LIABILITY — BODILY INJURY BY DISEASE $ POLICY LIMIT AUTOMOBILE LIABILITY Policy Effective Expiration Number 0505I345 Date J-x/06/96 Date I7/0J-/� Coverage Basis -- - Limits ❑ANY AUTO ❑ OWNED AUTOS ❑ HIRED AUTOS Combined Single Limit of Liability BODILY INJURY&PROPERTY DAMAGE $ ,00�F_ E EACH ACCIDENT KISPECIFIED AUTOS ❑ NON-OWNED AUTOS Split Liabili y Limits Bodily Injury € Property®amage Each -I DOWNED PRIVATE PASSENGER AUTOS $ I PERSON ❑OWNED AUTOS OTHER THAN PRIVATE PASSENGER $ $ � ACCIDENT UMBRELLA LIABILITY Policy Effective Expiration Number Date Date EACH OCCURRENCE GENERAL AGGREGATE PRODUCTS—COMPLETED OPERATIONS AGGREGATE OTHER(Show Policy Effective Expiration type of Policy) Number Date Date DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLESIRESTRICTIONS!SPECIAL ITEMS PROJECT: SAN JUAN SPORTS PARK, CITY OF SAN JUAN CAPTSTRANO CANCELLATION Number of days notice � Authorized Representative bate Should any of the above described policies be cancelled before the expiration-date,the issuing company will endeavor to mail within the number of days entered above,written notice to the certificate holder named above.But failure to mail such notice shall impose no obligation or liability of any kind upon the company,its agents or representatives. U10523-2 COMMERCIAL.AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 050 251 345 BAP ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name and Address of Person or Organization: CI'T'Y OF SAKI JUAN CAPISTRANO ATTN: SHARON HEIDER, OPEN SPACE PFOJECT MANAGER 32400 PASEO ADELANTO 5533 SAKI JUAN CAPISTRANO, CA 92675 PROJECT: SAN JUAN SPORTS PARK, CITY OF SAN JUAN CAPISTRANO A. The person or organization shown in the Schedule is included as an insured but only if liable for the conduct of an "insured" and only to the extent of that liability. B. CANCELLATION 1. If we cancel the policy, we will mail or deliver notice to such person or organization in accordance with the Common Policy Conditions. 2. If you cancel the policy, we will mail or deliver notice to such person or organization. 3. Cancellation ends this agreement. BU 11140-93) O AIISM CUSTOMER NUMBER: CA050251345 RUN DATE: 12-11-98 A.I.P. (CA) 10 50 251345 04 01 0040 CITY OF SAN JUAN CAPISTRANO SAN JUAN SPORTS PK,CITY OF SJC 32400 P ADELANTO 5533 SAN JUAN CAPIST'RANO, CA 92875 to 1-4M 0` (V Ltl Y r z wa Lu u.: HU114-2 YOU'RE IN GOOD HANDS WITH ALL TATEv AllStMo CERTIFICATE OF INSURANCE EFFECTIVE DATE OF CERTIFICATE 12/06/96 kLLSTATE INSURANCE COMPANY TOME OFFICE - NORTHBROOK, IL 60062 iereby certifies that the following insurance is in force: POLICYHOLDER POLICY NUMBER POLICY PERIOD GOLDEN TRIANGLE LAND 050251345 BAP 12/01/96 TO 12/01/97 SURVEYING INC. AT 12:01 A.M. STANDARD TIME 811 HITCHING POST RD VISTA, CA 92083 -he person or organization designated below is described in the policy as: CITY OF SAN JUAN CAPISTRANO SAN JUAN SPORTS PK,CITY OF SJC 32400 P ADELANTO 5533 SAN JUAN CAPISTRANO, CA 92675 LIENHOLDER (Loss Payable Clause) ADDITIONAL INTERESTED PARTY ADDITIONAL INSURED X CERTIFICATE HOLDER :overages designated are afforded as stated below: LIABILITY: $2,000,000 EACH ACCIDENT o the person or organization stated above: his policy, as respects the interest of the loss payee, additional interested party, additional insured or certificate holder amed herein, may be cancelled by the Company during the policy period by giving such person or organization 10 days fritten notice at its last address known to the Company. roof of such mailing is deemed sufficient proof of such notice. his Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by the policy =ferred to above. U1380-1 PAGE 1 OF 1 it III I I BU114-2 YOU'RE IN GOOD HANDS WITH ALLSTATE(s) CUSTOMER NUMBER: CAu50251345 RUN DATE: 12-11-96 A.I.P. (CA) 10 50 251345 04 01 0040 CITY OF SAN JUAN CAPISTRANO SAN JUAN SPORTS PK,CITY OF SJC 32400 P ADELANTO 5533 SAN JUAN CAPISTRANO, CA 92675 cli er Lu CLr x CL c� E aU,14-2 YOU'RE IN GOOD HANDS WITH ALL T T fl E CERTIFICATE OF INSURANCE EFFECTIVE DATE OF CERTIFICATE 12/06/96 11-STATE INSURANCE COMPANY IOME OFFICE - NORTHBROOK, IL 60062 ereby certifies that the following insurance is in force: POLICYHOLDER POLICY NUMBER POLICY PERIOD GOLDEN TRIANGLE LAND 050251345 BAP 12/01/96 TO 12/01/97 SURVEYING INC. AT 12:01 A.M. STANDARD TIME 811 DITCHING POST RD VISTA, CA 92083 'he person or organization designated below is described in the policy as: CITY OF SAN JUAN CAPISTRANO SAN JUAN SPORTS PK,CITY OF SJC 32400 P ADELANTO 5533 SAN JUAN CAPISTRANO, CA 92675 LIENHOLDER (Loss Payable Clause) ADDITIONAL INTERESTED PARTY X ADDITIONAL INSURED CERTIFICATE HOLDER :overages designated are afforded as stated below: LIABILITY: $2,000,000 EACH ACCIDENT o the person or organization stated above: his policy, as respects the interest of the loss payee, additional interested party, additional insured or certificate holder arced herein, may be cancelled by the Company during the policy period by giving such person or organization 10 days Britten notice at its last address known to the Company. roof of such mailing is deemed sufficient proof of such notice. his Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by the policy Merred to above. U1380-1 PAGE 1 OF 1 1 11 11 1 1 su114-2 YOU'RE IN GOOD HANDS WITH ALLSTATE@ �fr111 7HII 1J1.t,(U n"). Is ,r.C- ATE RO. BOY 420807,SAN FRANCISCO, CA 94142-0807 COMPENSATION ISI rURANC,— U N , CERTIFICATE O!'WORKERS' COMPENSATION INSURANIGE . DECEM515R'2 "11 96 C17nTIFICATEE�Xf'IRFSs 1�01f49 CITY OF N j '1 �+�'f /�0{ RANO � � . r, y • OPEN SPACE I�kOJEGT Iii R, T . S (�IT�I`R � AT N` SHARON �{ E` 32400 PASEO ADEI-ANTt 25633 SAN JUAN CAPISTRANO CA 92675 JOB: SAN,DUAN SPORTS PARK L CITY OF SAN JUAN CAPISTRANO This Is to certify that we have issued a valid Workers' compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy Is not subject to cancellation by the fund except upon t*YJ(ays'advancos written notice to the e€nplaycr. 30 30 We will also give you stays'advaque notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an Insurance policy and doses not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requiremept, term, or cnnditlon of any contract or other document with respect to which M(- `bartificate of,.ini iUrgtnce mgy;h� i4sq�O`Pr may pert*,,' the ins ur�h c�,af't�rded by the policies described herein;ia, w} to all tl� sr I t ,exclu forts�4 ns,of sucY�'Po[i�ie� 7 AUTHORIZED Q>I>=PrEe 'Fl1�v .' r ,I EMPLOYER'S fw1A €.{.:ITY, IMIT INCLUDING DEFEN ,Cf}ST: $1"000;Poo PER'L tRRE�E_ FNDORSEMENT#2065 ENTITLED CrERTIFICATF HOLDER'S NOTICE EFFECTIVE 12.02.98 IS ATTACHED TO AN FORMS A PART OF THIS POLICY. r=€YII"LS)yr-K GOLDEN TRIANGLE L*b SURVEYING"''. 811 HITCHING POST ROAD VISTA GA 92083 NR LLL. G. 1'J7b G•DlYl'1 tA-I? bHI'I Dill ,U I{U. i0li r. 1/C COMP NSATI© N STAT'�� SAN DIEGO D { STRI1 OFFICE PUND • FACSIMILF COVER SHEET THIS TR N5Mf55CN IS FROk4 A RICO FX 60 FACSIaE UNIT, C4#r P kT&E `NIT?-( GAO-UPS II AND III TERMINALS. THIS UNI [S C FtATiC}VJ- 24 HOU�S 0AALY, STkTE FUND TELEFAX WNBE 1 1S : (619) 552.7255 (P CY) (619) 552-7110 (CLAIMS) DELIVER TO: IAT ; p-4t/9 TELEFAX NUMBER ' # 4 °�lt L.*<.A CxXt STATI ccsTEdsaTio-W 1WSflWCE TUxM OEPMNENT ; PONE : (619) 557-7066 C OF -DD" appear nri �A El3 i JERTM.CAT"5. sr-VOI" will NOT appear on ORIGINAL document w.hich will followin the xrzail- THE T0T°Q NUM8ER OF PAGES, THIS COYER SHEET, A,9r7 sIa I ATdY TAxsIssx)N �Is occU , cA�. s,g) ;os C)ATF/TIME SENT _.......... _SIGNATURZ SC� p 7'1 lE 7i i o'irl 5rli°1 tST = 1'L 4--ZYti ; 14�3U A A C; t144.M10b;J;9 1/ 4 ACORDi,_. OF SOUTHERN CALIFORNIA, 3 Park Plaza, Suite 1200 Irvine, California 92714 ( 714) 664-4700 FAX # (714) 757-6635 FAX NUMBER; FROM: SHERRY YOUNG REGARDING L�L* NUMBER OF PAGES (Including Corner Sheet) : ORIGINAL TO FOLLOW BY MAIL: ]MESSAGE/INSTRUCTIONS: 15[Nl 6y lt- 4-Z1t) > 14:;J 3 A A U, /i44ZJ011,)ll'* L/ 4 HAI�I,E ,�{MMIDDlYY) l0 9s rauuucER THIS CERTIFCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, FXTFND OR ALTER THE COVERAGE AFFORDED BY THE ACO.RDIA OF SOUTHERN POLICIES BELOW. CALIFORNIA INC. COMPANIES AFFORDING COVERAGE P O BOX 19570 IRVINE CA 92713 coMPANY A I TTER COMMERCIAL UNION COMPANY e LETTER COMMERCIAL UNION . ......... ......... I........ ......... ......... GOLDEN TRIANGLE LAND COMPANY C SURVEYING LETTER _........ ...... .......... 2679 SEACREST COURT CL)MPANY D VISTA CA 92083-8702 LETTER COMPANY ' LETTERCONTINENTAL CASUALTY FAG1=S ;I THIS 18 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 CONRNTION QF ANY CONTRACTOR OTHER DOCUMCNT WITH RESPECT" TO WHICH THIS CERTIFICATE MAY LTE ISSUI=D OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES bESCRISED HEREIN 1S SUBJECT TO ALL THE TERMS, FXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REouCED BY PAIL) CLAIMS- TYPE Of HNBUIYAwCR: PpLK,Y N1iRIBER Pg1ACY EFFE TWE '.POLICY EXPIRATION. IJNLPTB T}I, DATt(IVIhS71 O YY) _ DATE';MMWIVY) - aEWRALLIABILITY ' FALH70077 5/05/96 5/05/9-1 GE NE.RALAGGREGAT� :S2 QQt} 000 X (.pMMERGIAL GENERAL LIABILITY PROoucTS-COMP1OP AGG 511, 000, 000 CLAIMS MADE X OCCUR- PERWNAL_!4 ADV,INJURY . ....... OWNER'B&CONTRACTOWS PROT, FAll M OCCURA.F.m>< .... 8110.00-000. -_---_ FIREVAMAGEIArrywliIN) 5100A000. .. .. ... MEI.EXPENSE(A+Y ww pw mDr4_X 5�000 u�ro AMO8U..0 LIAMUrY FALH7 0 0 7 7 5/05/96 a 0 5 9 7 GaM[IINED BINS3L ----_-. - / I E .t ANY AUTO _ - IvlMer 11000, 000 .... ALL OWNED AUTOS BODILY IIv UAY _. WAHEDULEI)AUTOS (Por povem) 8 X`HiIRM AUTOS WDILY INJURY XIPiw soci erd;I s :NON-OWNED AUTOS GAAAGF IJARILMY - -......... PROPERTY DAMAGE ! EXCEM LAAIRR.TTY FACk CICCURREWCE $ UMriA&LLA FORM AGGREGATE 6 .. OTHER THAN UMBRELLA FORIA - S'rATUT"ORY LI1s" -. - EA—H ACCIOF7". ...$. AND ............... ----- ------- __..-. .DISEASV-POLY"Mff :E LMBEASE_EACH EMPLOYEE 4 DYNER LSN113790696 6/12/96 '. 6/1„2/97 LI 1,000, 000 PROF LTARTLTT'Y DL°SCRIwnOw*F OPUKA"ONSILOCATWNB)VEtWA.EBBPECIAL IVE.MS PROFESSIONAL LIABILITY LIMIT IS PER CLAIM & POLICY AGGREGATE/CERT HOLIER is NAMED AS ADDITIONAL INSURED ON GL POLICY—SEE ATTACHED ENDORSEMENT/ALL SURVEYING OPERATIONS INCL BUT NOT LTD TO SAN JUAN SPORTS PARK cgllttmAYtlktyLptn:- Clr.+CELILATIOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUINQ COMPANY WILL ENDEAVOR TO MAIL 3 0 BAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDFR NAMED TO THE CITY OF SAN YUAN CAPISTRANO LEFT. BUT PA1LURE TO MAIL SUCH NOTICE SHALL IMPOSE NO 0tsUlGATION OR S. HEIDER^-OPEN SPACE PROJ MGR LIA13ILFTY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR AFPRc9FmNTATIVE6_ 32400 PASEO ADELANTO 5533 SJ CAPISTRANO CA 92675 AUTIIaHLInss nF.PnPsewTArnfE UAW SHERRY YOUNG FOR ACOADIA Y ] Ni DI • 1t- 4-au , I'l•ilu Et n k-_ Producer: ACORDIA Producer Code: 04-67398 This endorsement, effective 11/30/98 forms a part of Policy Number FALH70077 issued to GOLDEN TRIANGLE LAND SURVEYING by Employers ' Fire insurance company. ADDITIONAL INSURED ENDORSEMENT SECTION TI - LTABILITY INSURANCE NAME OF ADDITIONAL DESCRIPTION OF INSURED PHSMISES CITY OF SAN JUAN CAPISTRANO All Surveying 32400 PASEO ADELANTO 5533 services performed for SAN .YUAN CAPISTRANO, CA 92x75 additional insured "SEE ATTACHED FORM CG20091185** Additional premium charged: NONE )C _._.. SHERRY YCIUNG FOR A �ORDIA (Authorized Representative) AA&COY Issued; 11/30/96 3LIN'I DI - li" qI-M) , 14.00 i H A 1.,- 1144A01UDA,4 41 4 POLICY NUMBER: C: MERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED—OWNERS, LESSEES or CONTRACTORS (Form A) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization(Additional Insured). Location of Covered Operations Premium Basis Rates Advance premium Bodily Injury and (Per Property Damage Liability Cost $1000 of cost) � Total Advance Premium (if no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 1. WHO IS AN INSURED (Section 11) is amended to (a) All work on the project (other than include as an inspired the person or organization service, maintenance:, or repairs) to (called"additional insured")shown in the Sched- be performed by or on behalf of the ule but only with respect to liability arising out of: additional insured(s)at the site of the A. '"Your work" for the additional insured(s) at covered operations has been corn- the tocation designated above, or plated; or B_ Acts or omissions of the additional insured(s) (b) That portion of "your work" out of in connection with their general supervision which the Injury or damage arises has of "your worts" at the location shown in the been put to its intended use by any Schedule. person or organization other than an- other contractor or subcontractor 2. With respect to the insurance afforded these addi- engaged in performing operations for tional insureds,the following additional provisions a principal as a part of the same apply: project. A. None of the exclusions under Coverage A. (3) "Bodily injury" or "property damage" except exclusions (a). (d), (e). (f), (1.12), (i). arising out of any act or omission of the and (m), apply to this insurance. additional insured(s) or any of their em- B. Additional Exclusions. This insurance does ployees, other than the general supervi- not apply to: sion of work performed for the additional (1) "Bodily injury" or "property damage" insured(s) by you, for which the additional insured(s) are (4) "Property damage"to: obligated to pay damages by reason of (a) Property owned.used or occupied by the assumption of liability in a contract or or rented to the additional Insured(s); agreement. This exclusion does not apply to liability for damages that the additional (b) Property in the care,custody,or con. insured(s) would Have in the absence of trol of the additional insured(s) or the contract or agreement. over which the additional insured(s) are for any purpose exercising phys- (2) "Bodily injury" or "property damage'" Ical control, or occurring after: (c) "Your work" for the additional in- sured(s). CG 20 09 11 8b Copyright, Insurance Services Office, Inc.. 1984 n