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11-0301_PETERSON-CHASE GEN ENG CONST., INC_Insurance
ACCERTIFICATE OF LIABILITY DATA IhIMl11YYYY) �..,..- ITY INI� AVE 3/92011 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 HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed 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 ileu of such endorsemen s. PRODUCERMEPeggy Coleman _ ................._ _ Brown 6 Brown of California, Inc. PHONEP ,Eit): ('14)221-1800 � uo),I714)221-419e 508 N. State College Blvd. nDoness:pcoloman@bbsoaal.com Suite 400 PRODUCER CUSTCAtERID�n�007003.8 Orange �` 4 92868 )NSURER(S)AFFORDING COVERAGE NAZCA INSURED INSURERA:Travelers. Property Casualty Co 25674- - -_ nmu e:Fireman's Fund Insurance 21873 Peterson Chase INSURER C: ---- General Engineering Construction Inc. r+sura-u: 1792 Kaiser Avenue E tNSUFIER iW Irvine CA 92614-5706 INSURER F: COVERAGES CERTIFICATE NUMBER:CL10122004289 REVISION NUMBER- 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. TERRA 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. .._.............................m..,..... .�.,....... ...PdUCYEFF POLtGYEXP .. iADDL'$USR' �--__.__......., LTR; TYPE OF INSURANCE POLICY NUMBER MMroDlYYYY = MWIym LIMITS GENERAL LIABILITY _... EACH OCCURRENCE S _- 2,000,006 }C COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ��._... PREN)ISES(Ea.ocxw ) ...-s.....- - 50,000 A _. __.CLALMS-MADS �X OCCUR DT€C08303P132TIL10 4/4/2010 4/4/2011 MED EXP(Arry or*Person) S Not CA9@iCA X PW. _$25,OOO PERSONAL 8 ADV INJURY S 2,000,000 GENERAL AGGREGATE S 4,000,000 GEN'LAGGREGATE LIMIT APPLIES PERPROptJCT$•COA1PfOPAGG S 4,000,000 X POLICY x PRO LOC $ AUTOMOBILE LIABILITY E COMBINED SINGLE LIMIT $ 11000,000 `X' lea acsuled) ANY AUTO R ALL OWNED AUTOS CT81093228$OATCTIO 6/15/2010 6/15/2011 ,BODILYINJURY(Per person) $ BODILY INJURY(Per aoPftz11) I SCHEDULED AUTOS PROPERTY DAMAGE XiHIRED AUTOS (Peraecoed) t NON-OWNED AUTOS Urtderosuted mo:otW S MWCO Paymonts a 4 X I UMBRELLA LIAB t OCCUR EACH OCCURRENCE S 10,000,000 EXCESS LA6CLAII<A84AIInE AGGREGATE S 10,000,000 DEDUCTIBLE__ I g - A 1 X RETENTION a 10,000 DTSMCUP8303P132T1L10 a/4/2010 4/4/2011 $ AND9MPLLEYBER EXCLUDED? NlA STATU DTH ANY PROPRIETORIPARTNEItIMCUTIVE YIN x .TORY LIMITS _ ': ER- IN E t.EACH ACCIDENT s l,000,000 (McmdalaryInNH) �! TJUBQ895NB2511 1/1/2011 1/1/2012 'If yes.desa%be Lrdw EL-D15ERSE-C?EMPLOYEE$ _i:000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT.$... 11000,000 B j Rented/Lea;sedM)[2930D7943 ;6/13/2010 6/15/2011 $400,000006 2,5W Policy Limit $250.000 Dee 2.500 Any One Iten DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(A11ach ACORD 101,Addiftnal Ramarka Schedule,If more apace is ro4ulmd) RE. Job 0642 Contract ICIP07107 Project: Del Obispo St. Widening CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of San Juan Capistrano ACCORDANCE%nTH THE POLICY PROVISIONS. Public Works 32400 Paseo Adelant;o AUTHORIZEDREPRESENTATIYE San Juan Capistrano, CA 92675 Roger ElmnOne/PCOLEH ACORD 26(2009/09) 01988-2009 ACORD CORPORATION. All rights reserved. INS025 poll s) The ACORD name and logo are registered,narks of ACORN COMMENTS/REMARKS City of San Juan Capistrano and its elected and appointed officials are named as additional insured as required by written contract as respects general liability regarding the operations of the named insured. Form CG02460805 OFREMARK COPYRIGHT 2000, AMS SERVICES INC. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO is AN INSURED--(Section 11)Is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to 'bodily Injury" or agree In a "written contract requiring Insurance" "property damage" caused by "your work" to Include as an additional insured on this Cover- and Included iin the � �pl � ap- age Part,butns hazaWunless the wt contract a Only with respect to liability for"bodily Injury", requiring Insurance" specifically requires you "p party damage"or"personal Injury";and to provide such coverage for that additional insured, and then the insurance provided to b) if, and only to the extent that, the injury or the additional Insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oo- you or your subcontractor In the performance curs before the end of the period of time for of"your wore to which the `written contract which the "written contrail requiring Insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is Insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional Insured 2. The Insurance provided to the addillonal insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other Insurance", whether primary, a) in the event that the Limits of Insurance of excess, contingent or on any other basis, that Is this Coverage Part shown In the Declarations available to the additional insured for a loss we exceed the limits of requiring insurance", the In-liability required by the cover under this endorsement. However, if the "written contract req *written contract requiring insurance" specifically surance provided to the additional insured circa that this insurance apply an a primary p shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that %vritten contract requiring in- this Insurance is primary to "other insurance" suranc:e". This endorsement shall not in- available to the additional insured which coven crease the limits of insurance described In that person or organization as a named Insured Section III—Limits Of Insurance. for such loss, and we will not share with that "other Insurance". But the insurance provided to b) The insurance provided to the additional In- the additional Insured by this endorsement$till is sured does not apply to"bodily Injury", "prop- excess over any valid and collectible "other in- eriy► damage"or"personal injury" arising out suranre", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that Is available to the addi- professional architectural,engineering or sur- tional insured when Chet person or organization Is veying services,including: an additional Insured under such "other insur- 1. The preparing, approving, or failing to ance". prepare or approve, maps. shop draw- d. As a condition of coverage provided to the Ings, opinions, reports. surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, a) The additional insured must give us written approving, or falling to prepare or ap- notice as soon as practicable of an "occur= prove,drawings and specifications-,and rence" or an offense which may result In a IL Supervisory, inspection, architectural or claim. To the extent possible, such notice engineering activities. should Include: CG D2 46 08 05 0 2005 The SL Paul Travelers Companies,Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY L How, when and where the "occurrance" any provider of"other Insurance"which would or offense took place; cover the additional Insured for a toss we it. The names and addresses of any Injured cover under this endorsement. However,this persons and witnesses;and condition does not affect whether the Insur- ance provided to the additional insured by III. The nature and location: of any Injury or this endorsement is primary to 'other €nsur- damage arising out of the"occurrence"or ance" available to the additional insured offense. which covers that person or organization as a bf If a claim Is made or"suit"is brought against named insured as described in paragraph 3. the additional Insured, the additional Insured above. must; S. The following definition Is added to SECTION V. I. Immediately record the specifics of the —DEFINITIONS: claim or"salt'and the date received;and "Written contract requiring insurance"means it. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit"as person or organization as an additional in- soon as practicable. cured on this Coverage Part, provided that the bodily injury" and property damage"oc- c) The additional Insured must Immediately curs and the"personal InjuW Is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us In the investigation or settlement of contract or agreement by you; the claim or defense against the suit". and otherwise comply with all policy conditions. b. While that part of the contract or d? The additional insured must tender the do- agreement Is In effect;and fense and Indemnity of any claim or"suit"to c. Before the and of the policy period. Page 2 of 2 0 2005 The St.Paul Travelers Companies,Inc. CG D3 46 08 05 Fla AC"R" CERTIFK.ATE OF LIABILITY INS6.,ANCE 4/4/(2011 ,.. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA OLDER. 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 HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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), PRODUCER CONTACT Lauran Graham . NA Michael Ehrenfeld Company PHON n EM), (760}730-2939 (AIX,NoL t�soi7 o-z9ss --- _, .—_.._._._-. EMAIL 2333 ,laur@ ehrenfel.dinsurance,com State Street, Suite 201 ADDRESS: ang --.-............... PRODUCER 00000780 �;--- Carlsbad CA 92008 INSURER(§)AfFORDING COVERAGE NAIC.Of INSURED INSURER,A:Hartford Fire Insurance Co3A ari '19662 _ .._ ___y INSURER B:Hartford Casualty insurance 29424 Green Horizons Landscape & Maintenance, Inc. INSURER C:National Union Eire Insurance 1530 Industrial Avenue INSURERI? ._ ............ _ .. .. ___----.__-- INSURER E! Escondido CA 92029 INSURER F: COVERAGES—— VCERTIFICATE NUMBER:CL1133021171 REVISION NUMBER: THIS fS 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. _ TYPE OF INSURANCE ._. -. INSR ADDL EFF ', POLICY EXP - LTR POLICY NUMBER MMIDDlYYYY MMIDOIYYYY i LIMITS GENERAL LIABILITY P EACH OCCURRENCE $ 1,000,000 � , DAMAGE TO RANTED __.._ COMMERCIAL GENERAL LIABILITY E 300,000 _� 3 E PREMISES(Ea occurrence J-�_- S/1/2011 1/1/2012 A CLAIMS-MADE I OCCUR i X 'i1 72UUNSR5612 MED EXP(Any one person) $ 10,000 .... ...... . ,,- . ? IPERSONALBADVI�$ 1,000,000 [GENERAL AGGREGATE is 2,000,000 [' GENT AGGREGATE LIMIT APPLIES PER: F2R20yCTS-COMP/2P AGG i $ 2,000,000 X POLICY I PR()- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 $ 1,000,000 X. BODILY aenc) N) / $/1/2012 INJURY(Per person) $ A ALL OWNED AUTOS 172UUNSR5612 3/1 2011 BODILY INJURY(Per accident): $ ...._ SCHEDULED AUTOS t i .....-... _...,.._._. i PROPERTY DAMAGE HIRED AUTOS X (Per accident) $ ` X NON-OWNED AUTOS Medical payments _$ 5,000 Uninsured mutorsstcombined i$ 1,000,000 X EUMBRELLA L11 EXCESS LRBAB ' OCCUR EACH OCCURRENCE $ 2'r 000,000 ..._ i _AGGREGATE 2,000,000 CLAIMS-MADE': ...... ..... _I DEDUCTIBLE .............. $ , ._._.._._.—..-------� _........ ... 13 X = R TENTION $ 10 00#7 1' 214HUSR5613 1,/ /2011 :1 1/2)312 $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X - OTH- WC STATU 1 FR ANY PROPMETORIPARTNERIEXE-CUTIVE Y 1 N F.L.EACH ACCIDENT --- --------- - _._...._.0 s 1OOi7OOfl OFFICERJMEMBER EXCLUDED? NIA ---- (MandatorylnNH) WC0999125 4/1/2011 4/3./2012 E.L.DISEASE-EA EMPLOYE $ 110001000 I If yes:describe under - DESCRIPTION OF pPERATfpNS below El DISEASE-POLICY LfMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {Attach ACORD 101,Additional Remarks Schedule,if more space is requlredi Re: Del Obispo Street Widening, Del Obispo from Alipaz to Paseo Adelanto, CIP 07107, Job #642. The City of San Juan Capistrano and Peterson-Chase General. Engineering Construction, Inc are included as Additional Insured as required by written contract, as respects to Comm'1 General Liability, but limited to the operations of the Insured under said contract, and always subject to the policy terms, conditions and exclusions per endorsement HG 0004 0605 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of San Juan Capistrano ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department 32400 Paseo Adelant0 AUTHORIZED REPRESENTATIVE San Juan Capistrano, CA 92675 E Georgeson/GHR ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200908) The ACORD name and logo are registered marks of ACORD have all your rights and duties under this Coverage 5. Nonowned Watercraft Part. With respect to watercraft you do not own that is less e. Unnamed Subsidiary than 51 feet long and Is not being used to carry Any subsidiary, and subsidiary thereof, of yours persons for a charge, any person is an insured while which is a legally incorporated entity of which you operating such watercraft with your. permission. Any own a financial interest of more than 50% of the other person or organization responsible for the voting stock on the effective date of the Coverage conduct of such person is also an insured, but only Part. with respect to liability arising out of the operation of the watercraft, and only if no other insurance of any The insurance afforded herein for any subsidiary kind is available to that person or organization for this not named in this Coverage Part as a named liability. insured does not apply to injury or damage with respect to which an insured under this Coverage However, no person or organization is an insured with Part is also .an insured under another policy or respect to: would be an insured under such policy but for its a. "Bodily injury„ to a co-"employee" of the person termination or the exhaustion of its limits of operating the watercraft; or insurance. b. "Property damage"to property owned by, rented to, 3. Newly Acquired or Formed Organization in the charge of or occupied by you or the employer Any organization you newly acquire or form, other than of any person who is an insured under this a partnership,joint venture or limited liability company, provision. and over which you maintain financial interest of more 6. Additional Insureds When Required By Writtsn than 50% of the voting stock, will quality as a Named Contract, Written Agreement Or Permit Insured if there is no other similar insurance available The following person(s) or organization(s) are an to that organization. However: additional insured when you have agreed, in a written a. Coverage under this provision is afforded only until contract, written agreement or because of a permit the 180th day after you acquire or form the issued by a state or pofitical subdivision, that such organization or the end of the policy period, person or organization be added as an additional whichever is earlier; insured on your policy, provided the injury or damage b. Coverage A does not apply to "bodily injury" or occurs subsequent to the execution of the contract or "property damage" that occurred before you agreement. acquired or farmed the organization;and A person or organization is an additional insured under c. Coverage B does not apply to "personal and this provision only for that period of time required by advertising injury" arising out of an offense the contract or agreement, committed before you acquired or formed the However, no such person or organization is an insured organization. under this provision if such person or organization is 4. Mobile Equipment included as an insured by an endorsement issued by With respect to "mobile equipment" registered in your us and made a part of this Coverage Part, name under any motor vehicle registration law, any a. Vendors person is an insured while driving such equipment Any person(s) or organization(s) (referred to below along a public highway with your permission. Any other as vendor), but only with respect to "bodily injury" person or organization responsible for the conduct of or "property damage" arising out of "your products" such person is also an insured, but only with respect to which are distributed or sold in the regular course liability arising out of the operation of the equipment, of the vendor's business and only if this Coverage and only if no other insurance of any kind is available Part provides coverage, for "bodily injury" or to that person or organization for this liability. However, "property damage" included within the "products- no person or organization is an insured with respect to: completed operations hazard". a. "Bodily injury" to a cc-"employee" of the person (1) The insurance afforded the vendor is subject to driving the equipment; or the following additional exclusions; b. "Property damage" to property owned by, rented to, This insurance does not apply to: in the charge of or occupied by you or the employer "Bodilyu or "property damage" for of an person who is an insured under this (a} inj rp p li dg y p which the v vender is obligated to pay provision. damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; Page 10 of 18 HG 00 01 06 05 (b) Any express warranty unauthorized by you; c. Lessors of Lane[ or Premises. (c) Any physical or chemical change in the Any person or organization from whom you lease product made intentionally by the vendor; land or premises, but only with respect to liability (d) Repackaging, except when unpacked solely"' arising out of the ownership, maintenance or use of for the purpose of inspection, demonstration, that part of the land or premises leased to you. testing, or the substitution of parts under With respect to the insurance afforded these instructions from the manufacturer, and then additional insureds the following additional. repackaged in the original container; exclusions apply: (e) Any failure to make such inspections, This insurance does not apply to: adjustments, tests or servicing as the vendor 1. Any "occurrence" which takes place after you .has agreed to make or normally undertakes cease to lease that land; or to make in the usual course of business, in connection with the distribution or sale of the 2. Structural alterations, new. construction or products; demolition operations performed by or on behalf of such person or organization. . (f) Demonstration, installation, servicing or repair operations, except such operations d. Architects, Engineers or Surinycrs performed at the vendor's premises in Any architect, engineer, or surveyor; but only with connection with the sale of the product; respect to liability for "bodily injury" "property (g) Products which, after distribution or sale by damage" or "personal and advertising injury„ you, have been labeled or relabeled or used caused, in whole or in part, by your acts or as a container, part or ingredient of any omissions or the acts or omissions of those acting other thing or substance by or for the on your behalf; vendor; or (1) In connection with your premises; or (h) "Bodily injury" or "property damage" arising (2) In the performance of your ongoing operations out of the sole negligence of the vendor for performed by you or on your behalf. its own acts or omissions or those of its With respect to the insurance afforded these employees or anyone else acting on its additional insureds, the following additional behalf. However, this exclusion does not exclusion applies: apply to: This insurance does not apply to "bodily injury" (i) The exceptions contained in Sub- "property damage" or "personal and advertising paragraphs (d) or(f);or injury" arising out of the rendering of or the faliure (ii) Such inspections, adjustments, tests or to render any professional services by or for you, servicing as the vendor has agreed to including: make or normally undertakes to make in 1. The preparing, approving, or falling to prepare the usual course of business, in or approve, maps, shop drawings, opinions, connection with the distribution or sale of reports, surveys, field orders, change orders or the products. drawings and specifications; or (2) This insurance does not apply to any insured 2. Supervisory, inspection, architectural or person or organization, from whom you have engineering activities. acquired such products, or any ingredient, part e. Permits Issued By State Or Political or container, entering into, accompanying or containing such products. subdivisions b. Lessors of Equipment Any state or political subdivision, but only with respect to operations performed by you or on your (1) Any person or organization from whom you behalf for which the state or political subdivision lease equipment; but only with respect to their has issued a permit. liability for "bodily injury" "property damage" or "personal and advertising injury" caused, in With respect to the insurance afforded these whole or in part, by your maintenance, operation additional insureds, this insurance does not apply or use of equipment leased to you by such to: person or organization. (1) "Bodily injury" "property damage" or "personal (2) With respect to the insurance afforded to these and advertising injury" arisjng out of operations additional insureds this insurance does not performed for the state or municipality, or . apply to any "occurrence" which takes place (2) "Bodily injury" or "property damage" included after the equipment lease expires, within the "products-completed operations hazard". FIG 00 01 06 05 Page 11 of 18 f. Any Other Party c. Persons or organizations making claims or bringing Any other person or organization who is not an "suits". insured under paragraphs a. through. e. above, but 2. General Aggregate Limit only with respect to [lability for "bodily injury" The General Aggregate Limit is the most we wilf pay "property damage" or "personal and advertising for the sum of: injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting a. Medical expenses under Coverage C; on your behalf: b. Damages under Coverage A, except damages (1) In the performance of your ongoing operations; because of "bodily injury" or "property damage" (2) In connection with your premises owned by or included in the "products-completed operations hazard"; and rented to you; or (3) In connection with "your work" and included c. Damages under Coverage B. within the "prod ucts-compfeted operations 3. Products-Completed Operations Aggregate limit hazard", but only if The Products-Completed Operations Aggregate Limit (a) The written contract or agreement requires is the most we.will pay under Coverage A for damages you to provide such coverage to such because of "bodily injury" and "property damage" additional insured; and included in the "products-completed operations hazard". (b) This Coverage Part provides coverage for "bodily injury" or "property damage" included `� Personal and Advertising In Limit within the "products-completed operations Subject to 2. above, the Personal and Advertising hazard". Injury Limit is the most we will pay under Coverage B With respect to the insurance afforded to {hese for the sum of all damages because of all "personal additional insureds, this.insurance does not apply and advertising injury" sustained by any one person or organization, to: "Bodily injury" "property damage" or "personal and 5• Each Occurrence Limit advertising injury" arising out of the rendering of, or Subject to 2. or 3. above, whichever applies, the Each the failure to render, any professional architectural, Occurrence Limit is the; most we will pay for the sura engineering or surveying services, including: of. (1) The preparing, approving, or failing to prepare a. Damages under Coverage A; and or approve, maps, shop drawings, opinions, b. Medical expenses under Coverage C reports, surveys, Heid orders, change orders or because of all "bodily injury" and "property damage" drawings and specifications; or arising out of any one "occurrence". (2) Supervisory, inspection, architectural or 6. Damage To Premises Rented To You Limit engineering activities. Subject to 5. above, the Damage To Premises Rented The limits of insurance that apply to additional insureds To You Limit is the most we will pay under Coverage A under this provision is described in Section III — Limits for damages because of"property damage"to any one Of Insurance. prer'nises, while rented to you, or In the; case of How this insurance applies when other insurance is damage by fire, lightning or explosion, while rented to available to the additional insured is described in the you or temporarily occupied by you with permission of Other Insurance Condition in Section IV — Commercial the owner. General Liability Conditions. In the case of damage by fire, lightning or explosion, No person or organization is an insured with respect to the the Damage to Premises Rented To You Limit applies conduct of any current or past partnership,joint venture or to all damage proximately caused by the same event, limited liability company that is not shown as a Named whether such damage results from fire, lightning or Insured in the Declarations. explosion or any combination of these. SECTION Ili— LIMITS OF INSURANCE 7. Medical Expense Limit 1. The Most We will Pay Subject to 5. above, the Medical Expense Limit is the The Limits of Insurance shown in the Declarations and most we will pay under Coverage C for all medical the rules below fix the most we will pay regardless of expenses because of "bodily injury" sustained by any the number of: one person. a. Insureds; 8. How Limits Apply To Additional Insureds b. Claims made or"suits" brought; or If you have agreed in a written contract or written agreement that another person or organization be Mage 12 of 18 HG 00 01 06 05 DATE(MWDDNYYYI ---.- CERTIFICATE OF LIABILITY INSlRANCE 7/7/2010 PRODUCER (714)221-1800 FAX: (714)221-4196 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown of California, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 500 N. State College Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 400 Orange CA 92868 INSURERS AFFORDING COVERAGE MAIC# INSURED INSURER A:Travelers Property 25674 Peterson Chase INSURER 6:Travelers Casualty and 19038 General Engineering Construction Inc. INSURER CFireman Is Fund Insurance 21873 1792 Kaiser Avenue INSURER D. Irvine CA 92614--5706 INSURER E: OVERAQES 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 CERTIIMICATIE 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. PAID CLAIMS. (NSR ADD'L POLICY EFFECTIVE TYPE OF INSURANCE POLICY NUMBER DATE(MMfDD/YYDATE M DDIY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 tX . MMERCIAL GENERAL LIABILITY 'ReMI ES( RENTEDn $ 50,000 ACLAIMS MADE �OCCUR DTECO8303PI32TIL10 4/4/2010 4/4/2011 MED EXP An one person) $ Not Covere d: $25,000 $ 2,000,000 Per Occurrence GENERALAGGREGATE S 4,000,000 GEN'L AGGR EGATE LIM IT APPLIES PER: PRODUCTS-COMPIOP AGG $ 4,000,000 POLICY X PRO- LO AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea acc6dsnt) $ 1,000,000 A ALL OWNED AUTOS DT8109322B60ATCT10 6/15/2010 6/15/2011 BODILY INJURY SCHEDULED AUTOS (Per.person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accidert) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS;UMBRELLA LIABILITY EACH QCCURRENCr $ 10,000,000 X OCCUR FICLAIMS MADE A RE ATE $ 10,000,000 S A DEDUCTIBLE DTSIMCUP8303PI32TILIO 4/4/2010 4/4/2011 $ X RETENTI N $10,000 S $ WORKERS COMPENSATION AND X I WG STATU- OTH- ER EMPLOYERV UABOUTY ANY PROPRIETOR/PARTNERIEXECUTIVE E FACH ACCIDENT S 1,000,000 OFFICERIMEMBEREXCLUDED? DTACRUBO895N82510 1/1/2010 1/1/2011 E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE POLICY LIMIT $ 1,000;000 C OTHER Rented/Leased MX193007993 6/15/20117 6/15/2011 $400,000 Policy Limit $250,000 Any One Item Iced: $2,500 DESCRIPTION OF OPERATIONSILOCATIONSlVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTfSPECIAL PROVISIONS Job #614 Contract #07116; Junipero Serra Rd and Rancho Viejo Rd 10 Day Noti.Ce of Cancellation for non-payment of pramium, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City Clerk 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 32400 Paseo Adelanto FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE San Juan Capistrano, CA 92675 INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Roger E-Tmons/PCOLEM ACORD 25(2009108) ©ACORD CORPORATION 9988 INS025(0908)-08a Page I oft IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001108) INS025(oix.08a Page 2 oil COMMENTS/REMARKS City of San Juan Capistrano, its elected and appointed officials are included as additional insured as required by written contract as respects general liability regarding the operations of the named insured. Form CGD2460805 OFREMARK COPYRIGHT 2000, AMS SERVICES INC. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL_LIABILITY COVERAGE PART 1. WHO IS AN INSURED—(Section 11)is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part,but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury" requiring insurance" specifically requires you "property damage"or"personal injury";and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional Insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage fart shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring Insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to "bodily rri u the additional insured by this endorsement still is sured does not apply to 1 ry"� "prop- excess over any valid and collectible other in- erty damage" or "personal injury° arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services,including: an additional insured under such "other insur- 1. The preparing, approving, or failing to ance". prepare or approve, reaps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove,drawings and specifications;and notice as soon as practicable of an "occur- ii. Supervisory, inspection, architectural or rence" or an offense which may result in a engineering activities. claim. To the extent possible, such notice g g should include: CG D2 46 08 05 0 2005 The St. Paul Travelers Companies,Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence° any provider of"other insurance"which would or offense took place; cover the additional insured for a toss we lI. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the Insur- ance provided to the additional insured by ill. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the"occurrence"or ance available to the additional insured offense. which covers that person or organization as a b) If a claim Is made or"suit"is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: S. The following definition is added to SECTION V. 1. Immediately record the specifics of the —DEFINITION : claim or'suit'and the date received; and "Written contract requiring insurance" means Ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claire or"suit"as person or organization as an additional in- soon as practicable.ittenotice sured on this Coverage Part, provided"that the bodily Injury" and property damage oo- cj The additional insured must immediately curs and the 'personal injury"is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement Is in affect;and fense and indemnity of any claim or "suit' to c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 DATE(MMIDI)NM Y) A_........CORD CERTIFICATE OF LIABILITY INSURANCE 7/7/2010 PRODUCER (714)221-1800 FAX: (714}221-4196 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brawn of California Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 500 N. State College Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 400 Orange CA 92868 INSURERS AFFORDING COVERAGE NAIC# INSURED VSURERA:Travelers Property. 25674 Peterson Chase INSURER B Travelers Casualty and 19038 General Engineering Construction Inc. INSURER CFireman Is Fund Insurance 21873 1792 Kaiser Avenue INSURER D: Irvine CA 92614-5706 INSURER E: QVERAGES 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. AQ RFGATP f IMITS SHOWN MAY HAVE BEE q REDUCED BY PAID CLAIMS. !NSR ADD'L INSRDI TYPE OF INSURANCE POLICY NUMBER (MMi0DfYYJ POLICY MM1D1711'Y EXPIRATt N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 21000.000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PR M ccurr n $ 50,000 A CLANS MADE FJX�OCCUR DTECO8303PI32TIL10 4/4/2010 4/4/2011 MED EXP(Any oneperson) $ Not Covere ae Ded: $25,000 PFIRSONAL&AQV[NJURY $ 2,000,000 Per occurrence GENFRALA RE ATI= $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: EBaQQ�'TS-COMP)OP AGG $ 4,000,000 I Y PRO- XjECT E LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea ae6dent) $ 1,000,000 A ALL OWNED AUTOS DT8109322B60ATCT10 6/15/2010 6/15/2011 BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per acddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA AOC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LABILITYEAI�d QQr.QSEEUQE $ 10,000,000 X OCCUR ❑CLAIMS MADE TE 10,{700,000 $ A DEDUCTIBLE DTSMCUP8303P132T1L10 4/4/2010 4/4/2011 $ X RE FNTI N 110,000 $ WORKERS COMPENSATION AND X I WC STATU-WITS OTH- EMPLOYERS'LIABILITY ER.. ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIOEN7 Is 1,000,000 OFFICERIMEMBEREXCLUDED? DTACRUB0895N82510 1/1/2010 1/1/2011 E.L,D[SEASE-nAFMPLOYEE$ 1,000,000 If yes,describe under SPECIAL PR V€ I N below E.L.D[ EASE-POLI Y LIMIT $ 1,000,000 C OTHER Rented/Leased MX193007993 6/15/2010 6/15/2011 $400,000 Policy Limit $250,000 Any One Item Ded: $2,500 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job #614 Contract #07116; Junipero Serra Ad and Rancho Viejo Rd 10 Day Notice of Cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City Clerk 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 32400 Paseo Adelanto FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE San Juan Capistrano, CA 92675 INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Roger Emmons/PCOLEM ACORD 25(2001108) ©ACORD CORPORATION 1988 INS025 pio8).ma Page t of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) INS025 piosyosa Page 2 or 2 COMMENTS/REMARKS City of Sar Juan Capistrano, its elected and appointed officials are included as additional insured as required by written contract as respects general liability regarding the operations of the named insured. Form CGD2460005 0FREIMARK COPYRIGHT 2000, AMS SERVICES INC. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED— (Section ll) is amended c) The insurance provided to the additional in- to include any person or organization that you cured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury" requiring insurance" specifically requires you *property damage"or"personal injury";and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- '"written contract requiring insurance" specifically surance provided to the additional insured requires that this Insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to b) The insurance provided to the additional in- the additional insured by this endorsement still is cured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services,including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove,drawings and specifications,and notice as soon as practicable of an "occur- iI. Supervisory, inspection= architectural or rend" or an offense which may result in a engineering activities. claim. To the extent possible, such notice g g should include: CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" any provider of"other insurance"which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any Injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by Ill. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the°occurrence"or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or"suit"is brought against named insured as described in paragraph 3. the additional insured, the additional Insured above. must: 5. The following definition is added to SECTION V. I. Immediately record the specifics of the —DEFINITIONS: claim or"suit"and the date received; and "Written contract requiring insurance" means II. Notify us as soon as practicable. that part of any written contract or agreement The additional Insured must see to it that we under which you are required to Include a receive written notice of the claim or"suit"as person or organization as an additional in- soon as practicable. sured on this Coverage Part, provided that the bodily Injury" and property damage oc- c) The additional insured must Immediately curs and the"personal injury" is caused by an send us copies of all legal papers received In offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect;and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG 02 46 08 05 DATE(MMrDDIYYYY3 ACORP. CERTIFICATE ®F LIA W g _ ANCE 6/15�2010 PRODUCER (714)221-1800 FAX: (714)221-4196 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown of California, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 500 N. State College Blvd. 2010 JUN LTLWR BEHMERAGEIAFFORDED BY THE AMEND, EXTEND BELOW.OR Suite 400 Orange CA 92868 ;tN I1RRS AFFORDING COVERAGE NAIC# INSURED ;.- I €k� SAN �JUAMIt�SU�E3 AST� � ��ers Proper__y 25674 Peterson Chase INSURER B:Travelers Casualty and 19038 General Engineering Construction Inc. INSURER C:Fireman's Fund Insurance 21873 1792 Kaiser Avenue INSURER D: Irvine CA 92614--5706 INSURER F: OVERAGES 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. AGREGATE LIMIT H WN MAY HAVE B PAID LAIM INSR ADD'L POLICYTYPE OF INSURANCE POLICY NUMBER DATE(IDnrYYEI DATE EXPIRATION LIMITS GENERAL LIABILITY j H N $ 2,000,000 X COMMERCIAL GENERAL LIABILITY I POR]mMISE SO RE FD $ 50,000 A CLAIMS MADE ❑X OCCUR DTECO8303P132TIL10 4/4/2010 4/4/2011 VIED EXP Any one erson) $ Not Covere X Ded: $25,000 PERSONAL&ADV INJURY $ 2,000,000 Per Occurrence QENERALAQQREGATE $ 4,000,000 GEN'L AGGRFGATF LIMIT APPLIES PER: R TS-COMP/ P $ 4,000,000 P Ll Y X :TE LOC AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT (Ea accident} $ 1,000,000 X ANYAUTO A ALL OWNED AUTOS DT8109322B60ATCTIO 6/15/2010 6/15/2011 BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Peer accident} PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY ,LIQ € X OCCUR CLAIMS MADE AGGREGATE $ 10,000,000 A € DEDUCTIBLE DTSMCUP8303PI32TILIO 4/4/2010 { 4/9/2011 $ I X fZETENTION 10,000 1 B I WORKERS COMPENSATION AND E X WC S7ATU- E3TM EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWFXECUTIVF F.L.EACH ACCIDENT $ r_ 00 r 000 {OFF[CERIMEMBEREXCLUDED? DTACRLIB0895N82510 1/1/2010 E 1/1/2011 E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under SPECIAL PROVISIONS below I.L.DISFASIE-MLICY LIMIT 1,000,000 C OTHER Rented/Leased MX193007993 6/1.5/2010 6/15/2011 $400,000 Policy Lima 1$250,000 Any One Stem I fled: $2,500 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES]EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job #526 Contract. #CIP102 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE ]DESCRIBED POLICIES SE CANCELLED BEFORE THE City of ,San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Engineering and Building Dept. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 32400 Paseo, Adelanto FAILURE TO DO So SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE San Juan Capistrano, CA 92675 INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Roger ;morons/PCOLEIS ACORD 25(2001108) d ACORD CORPORATION 1988 IN 5025(oi 0apea Paga.a of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURER, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endarsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001108) page 2 of 2 INS025(01 08).08a COMMENTSIREMARKS City of San jean Capistrano and its elected and appointed officials are named additional. insured as respects general :.Liability Policy Form CGD2460805 as required by written contract regarding operations of the named insured. 10 day notice of cancellation for non-payment of premium. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. A !Ra`� CERTIFICATE OF LIABILITY INSURANCE 4/4/2011YYY, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR N=GATIV LY,ANI ENP, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES TRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE 61_6EFt. ` IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies 2&Nre ffll e p?nc tie ent)€A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 3 PRODUCER CONTACT PeggyColeman NAME_--- _ Brown & Brawn at nc. PHONE (714)221-1.800 FAx 1�1a�zzl azss California,r t €I= (A1C N4 ExEJ _... ....... ..... -... (Alp, No) 500 N. State College Blvd. Aro ssI_ coleman@bbsocal.com Suite 400 PRODUCER 00070018 - - CUST4MER la 1� _ _ Orange.._.._. . CA 92$6$ ...InISURER(s}AFFUR1dwGC.... GE Nwc - - - - - _A INSURED INSURER Travelers Indemnat Company, .0f ,25682 INSURER B:Travelers Property Casualty Ca 25674 - - -- - Peterson Chase INSURER C:Fireman Is Fundw Insurance 21873 _-- General Engineering Construction Inc. INSURERO: 1792 Kaiser Avenue INSURERE ............. ................ -- Trvine CA. 92614-5706 INSURER F. COVERAGES CERTIFICATE NUMBER,CL114405284 REVISION NUMBER: 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. ]NSR ADDL 8088... ........... __. -- -- - POLICY.EF POLICY EXP--- LIMITS _. LTR TYPE OF INSURANCE WD POLICY NUMBER ! MMIDIIlYYYY MMIDDIYYYY ) GENERAL LIABILITY EACH I OCCURRENCE )$ 2,000,000 --- 1 DAMAGE Td X COMMERCIAL GENERAL LIABILITY PREMISES(Eaoccu ranee} $ 300,000 _. A _..I CLAIMS-MACE 1 X OCCUR PTZCO8303P132TIL11 ;4/4/2011 4/4/2012 MEDrXP{Anyone arson $ Not COVere ... P. } X j Ded: $25,000 I PERSONAL INJURY j $ 2,000,000 l ----- --- -- —[ ---- --- .... _....... ...... Per Occurrence ...... . ......:[ i _GENERAL AGGREGATE_. ;$ 4,000,000 GEHL AGGREGATE LIMIT APPLIES PER: PRO PRODUCTS-OOMPfOP AGG $ 4,000,000 ._ _....... POLICY x LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -- (Ea accident) $ 1,000,000 X — — _. ANY AUTO I °_-. T8109322B60ATCT11 &/4/2011 4/4/2012 BODILY iN..URY(Per ----.. on) $ A ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS .. ._ ... .. ....... $._..... ....,..___ --- PROPERTY DAMAGE X HIRED AUTOS (Per ace€dent) .._ - - -- ---- -- X NON-OWNED AUTOS Underinsured motorist $ ............... $ Medical paymenis X i UMBRELLA UAB ',.. x�OCCUR 3 � EACH OCCURRENCE $ 1Q'000,000 EXCESS UAB _ CLAIMS-MARE 3 i, AGGREGATE $ 10,()00,000 _ DEDUCTIBLE __—.- ...... . B x I RETENTION $ 10 000 TSMCUP8303P132TIL11 14/4 /2011 4/4/207.2 $.......�.. WC STATU OTH B WORKERS COMPENSATION i x TORY..LIMITS ......ER.AND ANL]EMPLOYERS'LIABILITY ...... ........ ..._... .._._... ANY PROPRIETORIPARTNEF:fEXECUTIVE� E.L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED? N/A .._. _._ _.. ... T TUB0895NB2511 1/1/2011 1/1/207.2 (Mandatory in NH) � ,E.L. .L DISEASE EA EMPLOYE $.. .. 1,0f30,fl00 If yes,describe under DESCRIPTION OF OPERATIONS below j E.L.DISEASE-POLICYLIMIT $ 1,000,000 C '', Rented/Leased [593030397 ;4/4/2011 4/4/2012 $4Q0,OpOped:2,500 Policy Limit I d:2,500 Any One Ite DESCR,IPTION OF OPERATIONS f LOCATIONS f VEHICLES{Attach ACORD 101,Additional Remarks Schedule,if more space is required) ,lob #614 Contract #07116, Junipero Serra Rd and Rancho Viejo Rd CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of San Juan Capistrano ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk 32400 Paseo Adelanto auTHORlzeo REPRESENTATIVE San Tuan Capistrano, CA 92675 Roger Emmons/PCOLEM r ACORD 25(2009/09) O 1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS City of San Tuan Cap=strano, its elected and appointed officials are included as additional insured as required by written contract as respects general liability regarding the operations of the named insured. orm CGD246 OFREMARK COPYRIGHT 2000, AMS SERVICES INC. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE !READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART f. WHO IS AN INSURED—(Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you cured does not apply to "bodily injury" or agree In a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part,but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage"or"personal injury";and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to sured does nota I to "bodily in u " " the additional insured by this endorsement still is apply u� 1 rri , prop- excess over any valid and collectible "other in- ofdamage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- eying professional architectural, engineering or sur vtional insured when that person or organization is eying services,including: an additional insured under such "other insur 1. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- q. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove,drawings and specifications,and notice as soon as practicable of an "occur- ii. Supervisory, inspection, architectural or rence" or an offense which may result in a engineering activities. claim. To the extent possible, such notice should include: CG 02 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. How, when and where the "occurrence" any provider of"other Insurance"which would or offense took place; cover the additional insured for a loss we ill. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by Iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the"occurrence"or ante" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or"suit"is brought against named insured as described in paragraph 3. the additional insured, the additional Insured above. must: 5. The following definition is added to SECTION V. I. Immediately record the specifics of the --DEFINITIONS: claim or"suit"and the date received, and "Written contract requiring insurance" means II. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit"as person or organization as an additional in- soon as practicable. sured on this Coverage fart, provided that the bodily injury and property damage oc- a) The additional insured must immediately curs and the"personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect;and fense and indemnity of any claim or "suit° to c. Before the end of the policy period. Page 2 of 2 0 2005 The 5t. Paul Travelers Companies, Inc. CG 02 46 08 05