12-1204_TEDDIMAN, WENDY AND DYSINGER, SUSAN_Agenda Report_E12TO:
FROM:
DATE:
SUBJECT:
12/4/201 2
E12
City of San Juan Capistrano
Agenda Report
Honorable Mayor and Cillc~e~bers
Karen P. Brust, City~ , V
Prepared by: Cathy Sale d , Executive Services Manage~
December 4, 2012
Consideration of Renewal of License Agreement for the City-Owned
Pasture Property Located at the Terminus of Oso Road , West of Camino
Capistrano (Susan Dysinger and Wendy Teddiman).
RECOMMENDATION:
By motion, direct staff regarding the continuation of a License Agreement with Susan
Dysinger and Wendy Teddiman in the amount of $100 per month, plus water service,
for use of the City-owned pasture property located at the terminus of Oso Road, west of
Camino Capistrano.
EXECUTIVE SUMMARY:
There is currently a one-year License Agreement (Attachment 1) in place with Susan
Dysinger and Wendy Teddiman for the use of the 23.8 acre Open Space pasture
property located at the terminus of Oso Road, west of Camino Capistrano (Attachment
2, Exhibit A) for the boarding of two horses. The majority of the property is sloped and
the horses utilize a small flat portion.
The monthly lease fee is $100, plus water service. The Agreement expires on
December 4, 2012. The horse owners have kept current with insurance requirements
(Attachment 3), the monthly lease fee , and water service billings. Staff is seeking
direction from the City Council regarding the continuation of the Agreement.
DISCUSSION/ANALYSIS:
In 2008, the property was purchased by the City as Open Space. At that time, there
were five elderly horses stabled on a portion of the property. The horse owners
requested that the City allow the horses to remain on the property for the remainder of
their lives or until the property begins to be utilized for another purpose. The horse
owners were unable to bare the expense of boarding the horses commercially, so the
horses would have been put down or sold. At that time, it was determined that an
Agreement be put in place for the horse owners to pay a $100 per month rent and water
service fee, due to their inability to pay for commercial boarding and the mature state of
City Council Staff Report
December 4, 2012
Page2of2
the horses. This Agreement has been renewed annually. Originally, there were five
horses on the property, three of which have expired. Two horses (Attachment 2, Exhibit
B) remain on a portion of the property abutting the hillside, located at the terminus of
Oso Road, west of Camino Capistrano. At this time, there is no plan in place by the City
to utilize the pasture area for another purpose.
FISCAL IMPACT:
The City currently receives $100 per month in rent from Ms. Teddiman and Ms.
Dysinger, plus water service to property. The average water service bill is approximately
$26.00 per month. The new Agreement does stipulate the same requirement. Ms.
Teddiman and Ms. Dysinger each have general liability coverage insurance in the
amount of $500,000 in place, as required by the Agreement.
ENVIRONMENTAL IMPACT:
On November 26, 2012, the City's Senior Civil Engineer visited the property and found it
to be in compliance with environmental requirements.
PRIOR CITY COUNCIL REVIEW:
Not applicable.
COMMISSION/COMMITTEE/BOARD REVIEW AND RECOMMENDATIONS:
Not applicable.
NOTIFICATION:
Susan Dysinger
Wendy Teddiman
A TTACHMENTCSl:
Attachment 1 -License Agreement dated December 5, 2011
Attachment 2 -Draft License Agreement
Attachment 3 -Insurance documents
LICENSE AGREEMENT
This License Agreement ("Ag.reement") is made this S ~ay of December, 2011,
by and between the City of San Juan Capistrano, a municipal corporation,
("LICENSOR"), and Wendy Teddiman and Susan Dysinger ("LICENSEE").
RECITALS
WHEREAS, LICENSOR is the owner of 23.8 acres of open space la'nd In the City
of San Juan Capistrano, California, generally located at the terminus of Oso Road, west
of Camino Capistrano, which property was acquired to be maintained as open-space
within the City; and
WHEREAS, LICENSEE desires to conduct equestrian pasture operations on 23.8
acres of the property; and
WHEREAS, LICENSEE has equestrian pasture expertise and experience and
desires to manage the maintenance and operations of all equestrian activities on the
property.
LICENSE
NOW, THEREFORE, LICENSOR and LICENSEE do hereby mutually agree as
follows:
Section 1. Grant of License/Term.
(a) Grant of License. LICENSOR hereby grants to LICENSEE a License to manage,
maintain, and operate an equestrian pasture operation on the property, as
depicted on the site plan attached hereto as Exhibit "A" and incorporated herein by
reference (hereinafter referred to as the "Premises"). LICENSEE shall provide the
expertise, supervision and management over the equestrian activities, and
LICENSEE shall own and/or be responsible for the two equines as identified in
Exhibit B stabled at the Premises. The Premises shall not be used for any other
purpose.
(b) Term. The term of this Agreement with regard to the Premises, shall be for a
period of one year, commencing upon the date first above written, unless sooner
terminated.
Section 2. License Fee.
(a) LICENSOR shall receive from LICENSEE a license fee of one hundred dollars
($100) monthly, to be paid on a monthly basis, based on a twelve month calendar
year.
Page 1 of 6
607214.1
ATTACHMENT 1
Section 3. Nature of Uses Permitted Under the License and Maintenance of Premises.
(a) Operation of Equestrian Pasture Operation. LICENSEE shall be responsible for
the supervision and management of every aspect of running an equestrian pasture
operation on the Premises for the four horses as described in Exhibit B.
LICENSEE shall perform all operations in a competent manner, consistent with the
standards of the industry and in accordance with all applicable Federal, State and
local regulations, including the City's Municipal Code. LICENSEE shall obtain, at
its sole cost and expense, all governmental permits and. authorizations of whatever
nature required by any g'overnmental agencies having jurisdiction over
LICENSEE's use of the Premises.
(b) Condition of Premises. LICENSEE accepts the Premises in its present condition,
"as is", upon execution of this License. LICENSOR makes no warranty of the
suitability of the Premises for equestrian pasture operations and expressly
disclaims any warranty or representation with regard to the condition, safety,
security or suitability for LICENSEE's intended use of the Premises. The duly
authorized representative of LICENSOR may enter upon the Premises and all
structures and buildings thereon, or any portion thereof, at any time, and from time
to time.
(c) Maintenance of Premises. LICENSEE may use the existing structures on the
Premises for LICENSEE's use in equestrian pasture operations. LICENSEE shall
maintain, at LICENSEE's expense, the Premises, including all existing structures
and all equipment owned and furnished by LICENSEE, in a reasonable state of
repair and working order.
Section 4. No Assignments.
LICENSEE may not assign, sublet or otherwise transfer its interest under this
Agreement without the prior written consent of the LICENSOR. Any attempted
assignment, sublet or transfer made in violation of this provision shall be null and
void.
Section 5. Water.
Water is available to the LICENSEE at the Premises. LICENSEE is required to
pay for water at the current agricultural rate for water and any costs required In
keeping the water system operational. LICENSEE is required to remain current in
payment of water billings.
Section 6. Utilities.
607214.1
Subject to Section 5 above, LICENSEE is fully and solely responsible for providing
any utility service required for LICENSEE's use of the Premises.
Page 2 of 6
Section 7. Time of the Essence.
Time is of the essence of each and every provision, covenant, and condition
herein contained and on the part of LICENSEE to be done and performed.
Section 8. Default.
(a) If LICENSEE defaults in the payment of the license fee, or any additional
applicable license payments, or defaults in the performance of any of the other
covenants or conditions hereof, LICENSOR may give LICENSEE notice of
such default and if LICENSEE does not cure any such default within three (3)
days, or such other time period as specified in the notice of default, after the
giving of such notice, then LICENSOR may terminate this license on not less
than ten (1 0) days' notice to LICENSEE. On the date specified in such notice
the term of this license shall terminate, and LICENSEE shall then quit and
surrender the Premises to LICENSOR, but LICENSEE shall remain liable as
hereinafter provided. If this license shall have been so terminated by
LICENSOR, LICENSOR may at any time thereafter resume possession of the
Premises by any lawful means and remove LICENSEE or other occupants and
their effects.
(b) In addition, if LICENSEE breaches any covenant or condition of this license,
LICENSOR may, on reasonable notice to LICENSEE (except that no notice
need be given In case of emergency), cure such breach at the expense of
LICENSEE. The reasonable amount of all expenses, including attorney's
fees, incurred by LICENSOR in so doing shall be deemed additional fees
payable on demand.
Section 9. Termination Due to Bankruptcy or Insolvency.
In the event proceedings in bankruptcy are commenced by LICENSEE, or
LICENSEE is found to be in a state of insolvency, then in such event, LICENSOR
shall· have the right to terminate this Agreement and all further rights and
obligations thereunder, by ten (1 0) days' notice in writing to LICENSEE, in which
event, on the expiration of the ten (1 0) days from mailing of the notice, this License
shall automatically terminate.
Section 10. Termination for Convenience.
607214.1
This Agreement may be terminated for any reasons by the LICENSOR following
thirty (30) days written notice. LICENSOR incurs no liability whatsoever for
termination of this Agreement at any time.
Page 3 of 6
Section 11. Notices.
Any notice required to be given under this Agreement shall be in writing and shall
be deemed to have been duly given and received if and when personally served,
or forty-eight (48) hours after being deposited in the United States mail, first class,
postage prepaid, addressed to the intended party at:
LICENSOR:
City of San Juan Capistrano
City Manager
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
LICENSEES:
Wendy Teddiman
31103 Rancho Viejo Rd. #2315
San Juan Capistrano, CA 92675
And
Susan Dysinger
1356 Dunning Dr.
Laguna Beach, CA 92651
Section 12. Attorneys' Fees.
If either party commences action against the other party arising out of or in
connection with this License, the prevailing party shall be entitled to have and
recover from the other party reasonable attorney's fees and costs of suit.
Section 13. Surrender of Premises.
LICENSEE shall, at the termination of this License, vacate the Premises in as
good condition as they are in at the time of entry thereon by LICENSEE. Upon
vacating, LICENSEE shall leave Premises free and clear of all rubbish and debris.
Section 14. Insurance.
607214.1
LICENSEE shall pay for and maintain insurance throughout the life of this License
with general liability coverage of five hundred thousand Dollars ($500,000)
minimum coverage per occurrence, and fire and all risk property damage
insurance, insuring all of LICENSEE's equipment and trade fixtures located on the
Premises for full replacement cost. Said policy shall name LICENSOR as
additional insured by endorsement to the policy and shall be in a form satisfactory
to LICENSOR. LICENSEE will furnish LICENSOR with proof of insurance issued
Page 4 of 6
by an insurer approved by LICENSOR showing the coverage to be in force.
LICENSEE's insurance coverage shall be primary coverage. LICENSOR and
LICENSEE each waive the rights of subrogation that may arise against the other
because of any act covered by insurance. The policy shall provide that
modification or cancellation of the pollcy'shall not occur without thirty (30) days
advance written notice provided by the insurer. to LICENSOR.
Section 15. lndemnitv.
LICENSEE shall defend, indemnify, and hold harmless LICENSOR, and their
respective elected officials, officers, employees, and agents, from and against any
and all actions, claims, demands, losses, costs, expenses, including legal costs ·
and attorney's fees, for death or injury to persons or damage to property or the
Premises, or for the pollution thereof and cleanup costs, arising out of or related to
LICENSEE's use of the Premises, except to the extent of such loss as may be
caused by LICENSOR's own negligence, including that of their respective officials,
officers, employees and agents.
Section 16. Taxes.
Pursuant to Revenue & Taxation Code §107.7, the property interest created herein
may be subject to property taxation and LICENSEE may be subject to property
taxes levied on such interest. In no event shall LICENSOR be liable for any taxes
owed as a result of this License or LICENSEE's use of the Premises.
Section 17. No Relocation Benefits.
This Agreement is not intended to convey a property interest but to permit
LICENSEE to use the Premises as provided for herein. LICENSEE acknowledges
the .rights granted by State and/or Federal Relocation Assistance Laws and
regulations and, notwithstanding any other provision of this Agreement, expressly
waives all such past, present and future rights, if any, to which LICENSEE might
otherwise be entitled from LICENSOR with regard to this License Agreement and
the business operated on the Premises. LICENSEE shall not be entitled to
relocation assistance, relocation benefits, or compensation for loss of goodwill
.upon the termination of this Agreement.
Section 18. Entire Agreement.
607214 I
The terms in this Agreement constitutes the entire understanding and agreement
be~een the Parties and supersedes all previous negotiations between them
pertaining to the subject matter thereof.
[SIGNATURE PAGE FOLLOWS]
Page 5 of 6
IN WITNESS WHEREOF, LICENSOR and LICENSEE have caused this License
Agreement to be executed on the date and year first written above.
LICENSEES:
By:&~~>'.-??~
Susan Dysinger tf
-)~ .
By: " '1-ddJ~ endy Teddiman .
Maria
APPROVED AS TO FORM:
~A,~
607214.1'
LICENSOR:
CITY OF SAN JUAN CAPISTRANO,
A California municipal corporation
By:~~
/amAlievatOJMayor
Page 6 of 6
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EXHIBIT A
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EXfHBiT B
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LICENSE AGREEMENT
This License Agreement ("Agreement") is made this 4th day of December, 2012, by
and between the City of San Juan Capistrano, a municipal corporation, ("LICENSOR"),
and Wendy Teddiman and Susan Dysinger (11LICENSEE").
RECITALS
WHEREAS, LICENSOR is the owner of 23.8 acres of open space land in the City
of San Juan Capistrano, California, generally located at the terminus of Oso Road, west
of Camino Capistrano; this property was acquired to be maintained as open-space within
the City; and
WHEREAS, LICENSEE desires to conduct equestrian pasture operations on 23.8
acres of the property; and
WHEREAS, LICENSEE has equestrian pasture expertise and experience and
desires to manage the maintenance and operations of all equestrian activities on the
property.
LICENSE
NOW, THEREFORE, LICENSOR and LICENSEE do hereby mutually agree as
follows:
Section 1. Grant of Licensefferm.
(a) Grant of License. LICENSOR hereby grants to LICENSEE a License to manage,
maintain, and operate an equestrian pasture operation on the property, as
depicted on the site plan attached hereto as Exhibit "A" and incorporated herein by
reference {hereinafter referred to as the "Premises"). LICENSEE shall provide the
expertise, supervision and management over the equestrian activities, and
LICENSEE shall own and/or be responsible for the two equines as identified in
Exhibit "B" stabled at the Premises. The Premises shall not be used for any other
purpose.
{b) Term. The term of this Agreement with regard to the Premises, shall be for a
period of one year, commencing upon the date first above written, unless sooner
terminated.
Section 2. License Fee.
(a) LICENSOR shall receive from LICENSEE a license fee of one hundred dollars
($1 00) monthly, to be paid on a monthly basis, based on a twelve month calendar
year.
Page 1 of 6
ATTACHMENT 2 607214.1
Section 3. Nature of Uses Permitted Under the License and Maintenance of Premises.
(a) Operation of Equestrian Pasture Operation. LICENSEE shall be responsible for
the supervision and management of every aspect of running an equestrian pasture
operation on the Premises for the two horses as described in Exhibit B.
LICENSEE shall perform all operations in a competent manner, consistent with the
standards of the industry and in accordance with all applicable Federal, State and
local regulations, including the City's Municipal Code. LICENSEE shall obtain, at
its sole cost and expense, all governmental permits and authorizations of whatever
nature required by any governmental agencies having jurisdiction over
LICENSEE's use of the Premises.
(b) Condition of Premises. LICENSEE accepts the Premises in its present condition,
"as is", upon execution of this License. LICENSOR makes no warranty of the
suitability of the Premises for equestrian pasture operations and expressly
disclaims any warranty or representation with regard to the condition, safety,
security or suitability for LICENSEE's intended use of the Premises. The duly
authorized representative of LICENSOR may enter upon the Premises and all
structures and buildings thereon, or any portion thereof, at any time, and from time
to time.
(c) Maintenance of Premises. LICENSEE may use the existing structures on the
Premises for LICENSEE's use in equestrian pasture operations. LICENSEE shall
maintain, at LICENSEE's expense, the Premises, including all existing structures
and all equipment owned and furnished by LICENSEE, in a reasonable state of
repair and working order.
Section 4. No Assignments.
LICENSEE may not assign, sublet or otherwise transfer its interest under this
Agreement without the prior written consent of the LICENSOR. Any attempted
assignment, sublet or transfer made in violation of this provision shall be null and
void.
Section 5. Water.
Water is available to the LICENSEE at the Premises. LICENSEE is required to
pay for water at the current standard rate for water and any costs required in
keeping the water system operational. LICENSEE is required to remain current in
payment of water billings.
Section 6. Utilities.
607214.1
Subject to Section 5 above, LICENSEE is fully and solely responsible for providing
any utility service required for LICENSEE's use of the Premises.
Page 2 of 6
Section 7. Time of the Essence.
Time is of the essence of each and every provision, covenant, and condition
herein contained and on the part of LICENSEE to be done and performed.
Section 8. Default.
(a) lfLICENSEE defaults in the payment of the license fee, or any additional
applicable license payments, or defaults in the performance of any of the other
covenants or conditions hereof, LICENSOR may give LICENSEE notice of
such default and if LICENSEE does not cure any such default within three (3)
days, or such other time period as specified in the notice of default, after the
giving of such notice, then LICENSOR may terminate this license on not less
than ten (10) days' notice to LICENSEE. On the date specified in such notice
the term of this license shall terminate, and LICENSEE shall then quit and
surrender the Premises to LICENSOR, but LICENSEE shall remain liable as
hereinafter provided. If this license shall have been so terminated by
LICENSOR, LICENSOR may at any time thereafter resume possession of the
Premises by any lawful means and remove LICENSEE or other occupants and
their effects. ·
(b) In addition, if LICENSEE breaches any covenant or condition of this license,
LICENSOR may, on reasonable notice to LICENSEE (except that no notice
need be given in case of emergency), cure such breach at the expense of
LICENSEE. The reasonable amount of all expenses, including attorney's
fees, incurred by LICENSOR in so doing shall be deemed additional fees
payable on demand.
Section 9. Termination Due to Bankruptcy or Insolvency.
In the event proceedings in bankruptcy are commenced by LICENSEE, or
LICENSEE is found to be in a state of insolvency, then in such event, LICENSOR
shall have the right to terminate this Agreement and all further rights and
obligations thereunder, by ten (1 0) days' notice in writing to LICENSEE, in which
event, on the expiration of the ten (1 0) days from mailing of the notice, this License
shall automatically terminate.
Section 10. Termination for Convenience.
607214.1
This Agreement may be terminated for any reasons by the LICENSOR following
thirty (30) days written notice. LICENSOR incurs no liability whatsoever for
termination of this Agreement at any time.
Page 3 of 6
Section 11. Notices.
Any notice required to be given under this Agreement shall be in writing and shall
be deemed to have been duly given and received if and when personally served,
or forty-eight (48) hours after being deposited in the United States mail, first class,
postage prepaid, addressed to the intended party at:
LICENSOR:
City of San Juan Capistrano
City Manager
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
LICENSEES:
Wendy Teddiman
31103 Rancho Viejo Rd. #2315
San Juan Capistrano, CA 92675
And
Susan Dysinger
1356 Dunning Dr.
Laguna Beach, CA 92651
Section 12. Attorneys' Fees.
If either party commences action against the other party arising out of or in
connection with this License, the prevailing party shall be entitled to have and
recover from the other party reasonable attorney's fees and costs of suit.
Section 13. Surrender of Premises.
LICENSEE shall, at the termination of this License, vacate the Premises in as
good condition as they are in at the time of entry thereon by LICENSEE. Upon
vacating, LICENSEE shall leave Premises free and clear of all rubbish and debris.
Section 14. Insurance.
607214.1
LICENSEE shall pay for and maintain insurance throughout the life of this License
with general liability coverage of five hundred thousand Dollars ($500,000)
minimum coverage per occurrence, and fire and all risk property damage
insurance, insuring all of LICENSEE's equipment and trade fixtures located on the
Premises for full replacement cost. Said policy shall name LICENSOR as
additional insured by endorsement to the policy and shall be in a form satisfactory
to LICENSOR. LICENSEE will furnish LICENSOR with proof of insurance issued
Page 4 of 6
by an insurer approved by LICENSOR showing the coverage to be in force.
LICENSEE's insurance coverage shall be primary coverage. LICENSOR and
LICENSEE each waive the rights of subrogation that may arise against the other
because of any act covered by insurance. The policy shall provide that
modification or cancellation of the policy shall not occur without thirty (30) days
advance written notice provided by the insurer to LICENSOR.
Section 15. lndemnitv.
LICENSEE shall defend, indemnify, and hold harmless LICENSOR, and their
respective elected officials, officers, employees, and agents, from and against any
and all actions, claims, demands, losses, costs, expenses, including legal costs
and attorney's fees, for death or injury to persons or damage to property or the
Premises, or for the pollution thereof and cleanup costs, arising out of or related to
LICENSEE's use of the Premises, except to the extent of such loss as may be
caused by LICENSOR's own negligence, including that of their respective officials,
officers, employees and agents.
Section 16. Taxes.
Pursuant to Revenue & Taxation Code §107.7, the property interest created herein
may be subject to property taxation and LICENSEE may be subject to property
taxes levied on such interest. In no event shall LICENSOR be liable for any taxes
owed as a result of this License or LICENSEE's use of the Premises.
Section 17. No Relocation Benefits.
This Agreement is not intended to convey a property interest but to permit
LICENSEE to use the Premises as provided for herein. LICENSEE acknowledges
the rights granted by State and/or Federal Relocation Assistance Laws and
regulations and, notwithstanding any other provision of this Agreement, expressly
waives all such past, present and future rights, if any, to which LICENSEE might
otherwise be entitled from LICENSOR with regard to this License Agreement and
the business operated on the Premises. LICENSEE shall not be entitled to
relocation assistance, relocation benefits, or compensation for loss of goodwill
upon the termination of this Agreement.
Section 18. Entire Agreement.
607214.1
The terms in this Agreement constitutes the entire understanding and agreement
between the Parties and supersedes all previous negotiations between them
pertaining to the subject matter thereof.
[SIGNATURE PAGE FOLLOWS]
Page 5 of 6
IN WITNESS WHEREOF, LICENSOR and LICENSEE have caused this License
Agreement to be executed on the date and year first written above.
LICENSEES:
'
By: ". ) Ct 4 <r ,~ i), ·1~-;_,._l l~
Susan Dysinger _} cJ ·~ By: JltUAt} ~etldyed(funan
ATTEST:
Maria Morris, City Clerk
APPROVED AS TO FORM:
60721·1 I
LICENSOR :
CITY OF SAN JUAN CAPISTRANO,
A California municipal corporation
By: ____________________ __
Mayor
Page 6 of 6
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Catherine Salcedo
From:
Sent:
To:
Subject:
Susan Dysinger
Thursday, November 08, 2012 6:02 PM
Catherine Salcedo
Fwd:
Here is a current foto of my horse Cisco.
~---
Cordially,
S«4a.4 'Df14bt9etr.
1 EXHIBIT 8
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ATTACHMENT 3
American Bankers RENEWAL OF SL-1032107-93
Insurance Company of Florida * 12:01 AM AT INSUREDS ADDRESS
A Stock Insurance Company NAMED BELOW
8655 E. Via de Ventura
Scottsdale, AZ 85258-3321
POLICY NUMBER POLICY PERIOD POLICY TYPE AGENCY l"~nu TO
SL 1032107 11117/2012111117/2013 COMMERCIAL LIABILITY COVERAGE 3469001-0001
YOU AS NAMED INSURED AND ADDRESS AGENT
SUSAN DYSINGER PARKER GENERAL INSURANCE
122 S 1ST AVE
PO BOX 661030
ARCADIA, CA 91006-3605
,~~ "'"""' .,. __ ,, ..
A2083-0886
The Insured Is: IJl An Individual D A Joint Venture
D A Partnership D An Organization (other than a partnership or joint venture)
D A Limited Liability Company
All known exposures at the beginning of the policy period have been identified below.
Location of all premises owned, rented occupied or controlled by the insured:
1356 DUNNING DRNE
ORANGE COUNTY
LAGUNA BEACH, CA 92651
In return for your payment of the required premium, we provide the Commercial Liability Coverage during the policy period.
Limits of Llabll~
Each Occurrence Limit $120002000
Medical Payments Limit $5z000 /per person
General Aggregate Limit $ 2,000,000
Other than Products/Completed Work $ 2,000,000
Aggregate Limit Products/Completed Work $ 2,000,000
Fire Legal Liability $50z000 /per occurrence
If this Is checked --we do not provide coverage for Products/Completed Work, and the Each Occurrence Limit does not
apply to Coverage N.
Charge for Non-Owned Auto Liability Coverage $NOT COVERED
Charge for Hired Auto Liability Coverage $NOT COVERED
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Classification
Saddle Animals, Prvt.
Code
16401
Rating Basis
VARIOUS
Rate
INCLUDED
Premium
63
CONTINUED ON NEXT PAGE
member llf Assurantcroup.
2
American Bankers RENEWAL OF SL-1032107-93
Insurance Company of Florida * 12:01 AM AT INSUREDS ADDRESS
A Stock Insurance Company NAMED BELOW
8655 E. Via de Ventura
Scottsdale, AZ 85258-3321
POLICY NUMBER POLICY PERIOD POLICY TYPE AGENCY p
I'Rnu TO
SL 1032107 11117/2012111/17/2013 COMMERCIAL LIABILITY COVERAGE 3469001-0001 2
YOU AS NAMED INSURED AND ADDRESS AGENT
SUSAN DYSINGER PARKER GENERAL INSURANCE
122 S 1ST AVE
PO BOX 661030
ARCADIA, CA 91006-3605 ·-V' ~V ..,__ U ~· ,_,
A2083-0886
Classification Code Rating Basis Rate Premium
Endorsements:
A2083 (0886), B8033G0809 (), CL-100 (1.0), CL-162 (1098), CL-300 (1.0), CP13000A-R0310 (), GL-100 (1.0), GL-
102 (2.0), GL-202 (1.0), GL-841 (1.0), GL-899 (1.0}, M8005G-0505 (), M8010G0705 (), M8027M0409-SIG ()
Comments:
SCHEDULE OF HORSES:
CISCO-TENN. WALKER X PAINT -PLEASURE -100% OWNERSHIP
MINIMUMPREMIUMADJ = $ 212
Total Premium: $ 275
COUNTERSIGNED:--------BY-------------------
AUTHORIZED AGENT
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