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Home My WebLink AboutC-1423(A) - Basic compensation liability insuranceCOARAGE PART OOMPREHENSIYE AUTOMOBILE LIABILITY INSU� (Ed. l� -yak) For attachment to Policy No. to complete said policy. SCHEDULE The insurance afforded is only with respect to such of the following Coverages as are indicated by specific premium charge or charges. The limit of the company's liability against each such Coverage shall be as stated herein, subject to all the terms of this policy having reference thereto. Coverages Limits of Liability 1. Owned Automobiles — Premium Basis — Per Automobile Advance Premiums C —BadBy Injury Liability 10Q thousand dollars each person QQ thousand dollars each occurrence E D— Properly Damage Liability 1 100 thousand dollars each occurrence Purposes of Use S 200 Form numbers of endorsements aMached at issue C1099, FORM 00 AL 644 S Total AdvancePremum E 6oQ. Description of Haards Advance Premiums 1. Owned Automobiles — Premium Basis — Per Automobile BI PD Town or City and State In Which the Automobile Will Be Principauy Caraaetl Year of Model Trade Name Body Type and Model; Truck Size; Tank Gallonage Capac- Ity; or Bus Seating Capacity Identification Number Serial Number Motor Number Purposes of Use 400. 200. AS PER SCHEDULE 2. HiredAutoaabks — Premium Basis —Cost of Hire TYPes Hiretl Locations Where Automobiles WIII Be Principally Used Purposes of Use Estimated Cost of Hire Rates Per $100 Cost of Hire BI PD EXCLUDED 3. Non-Owned Aulomobbs — Premium Basis — Class 1 Persons and Class 2 Employees Class 1 Persons —Name of Each Location of Headquarters of Persons Named Herein EXCLUDED Class 2 Employees — Estimated Average Number Location of Headquarters of Class 2 Employees Rates Per Employee BI PD EXCLUDED Total Advance B.I. and P.D. Premiums ; 0 is 200. When used as a premium basis: A. "cost of hire" means the amount incurred for (a) the hire of automobiles, including the entire remuneration of each employee of the named insured engaged in the operation of such automobiles subject to an average weekly maximum remuneration of;1DD, and for (b) pick -up, transportation or delivery service of property or passengers, other than such services performed by motor carriers which are subject to the security requirements of any motor carrier law or ordinance. The rates for each EIDD of "cost of hire" shall be 5% of the applicable hired automobile rates, provided the owner of such hired automobile has purchased automobile Bodily Injury Liability and Property Damage Liability insurance covering the interest of the named insured on a direct primary basis as respects such automobile and submits evidence of such insurance to the named insured; B. "Class I persons" means the following persons, provided their usual duties in the business of the named insured include the use of min-awoed automobiles: (a) all employees, including officers, of the named insured compensated for the use of such automobiles by salary, commission, terms of employment, or specific operating allowance of any sort; (b) all direct agents and representatives of the named insured; C. "Class 2 employees" means all employees, including officers, of the eaared insured, riot included in Class 1 persons. 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'asn io aaueualu!ew 'd!yvaumm aql 10 lno 8u!sue pue aauannaao ue Aq pasne3 'saildde aauemsu! s!ql 40!4m of a8ewep Apadwd 'a io Arnfui Appoq '3 10 asneaaq se8ewep se AM of pale8ggo Apagal awrwq Ileys pamsw ay1 yoigm swns lie pamsui aql jo l!eyaq uo Aed p!m Auedwm ay1 A11118VI7 33VWVO A183dO8d —a 39tlE= unie811 AanfNI A111108-3 HYMAN 'I COVERAGE PART DMOBILE PHYSICAL DAMAGE INSURANCE (Fie tolnatic) A 4396 For attachment to Policy No. , to complete said policy. (Ed. 1 -73) SCHEDULE - - -- PHF Item 1. The insurance afforded is only with respect to such of the following Coverages as are indicated by specific premium charge or charges and, under each such Coverage, applies only to such covered automobiles as are indicated, by entry herein, of one or more of the designating numerals for that purpose appearing in PHF Item 4. The limit of the company's liability against each such Coverage shall be as stated or designated herein, subject to all the terms of this insurance having reference thereto. Maximum Limit of Liability Any one covered automobile All covered amemobnes $ 15,0110. $ 75,000. PHE Item Covered Automobiles as of Effective Date of this Insurance: (a) Description; Purposes of Use IF & B = Pleasure and Business; C = Commercial) All covered automobiles at an one location $ 7,000.. Records to be submitted: Semi- ❑ Monthly ❑ Quarterly ❑ Annually Rota Year Trade Name LIMIT OF LIABILITY —Each covered automobile Coverage 0 Model COVERAGES COVERED ADVANCE IF ACTUAL CASH VALUE (AM IF STATED AMOUNT OTHERWISE, Enter: "S", 2 AUTOMOBILES Enter: Enter: meaning "as separately PREMIUM AS PER SCHEDULE P — Collision land DEDUCTIBLE AMOUNT and DEDUCTIBLE stated in PHF Item 2(c)' R — Theft 5 1 &_ 7 ACV $ $ $ $ $ 0— COMPREHENSIVE _ — -- $ - -__ $ — — — $ - - _ $ — — — — __ $ 200. to 1 & Price cast $_ 25Q. appear to the moved insured and the Loss Payee named below: 1 $ P— COLLISION -7 _ _ _ _ACV $ $ 3 $ — $ — — — 8 5 — — — — — — $ 4o . Q —FIRE, LIGHTNING OR — — — — — ta+.n @A�s. x ,":'$ 8 4'�� $ TRANSPORTATION $ E g -$ ..... —THEFT R — — — — — — . . $ $ S— WINDSTORM, HAIL, :.. '`' ,;.: $ Z;; EARTHQUAKE OR EXPLOSION _ _ _ _ _ _ _ _ _ _ _ ��°"' $ W T— COMBINED ADDITIONAL — — — $ V— TOWING (Notavailabie _ _ _ _ _ J $25 for each disablement in California) $ Form numbers of endorsements attached at issue $ Total Advance Premium $ Maximum Limit of Liability Any one covered automobile All covered amemobnes $ 15,0110. $ 75,000. PHE Item Covered Automobiles as of Effective Date of this Insurance: (a) Description; Purposes of Use IF & B = Pleasure and Business; C = Commercial) All covered automobiles at an one location $ 7,000.. Records to be submitted: Semi- ❑ Monthly ❑ Quarterly ❑ Annually Rota Year Trade Name Body Type — Capacity (Truck Load, Gallonage, Bus Seating); Identification (t), PrFniproally Swaged to Per use classi. Coverage 0 Model Serial (S), Motor (M) Ile.; cylinder, (No.); Model (TQlm, State) -. or Use ficitM 1 nter. Amount or "ACV" and Deductible nteo "ACV" I and Deductible I 2 3 4 5 6 7$ 2 $ $ $ $ $ $ is ACV ACV ACV ACV ACV ACV ACV $ $ $ $ $ $ $ 3 0— Comprehensive AS PER SCHEDULE P — Collision 4 Q— Fire. Lightning or Transportation $ R — Theft 5 S — Windstorm, Hail, Earthquake or Ez Sion $ T — Combined Additional 6 V— Towing $ $ 7 $ $ 4 (b) Facts Respecting Purchase List Acgal Purchased Rating Any lug under Coverages other than Towing is payable as interest may to $ Price cast Me. a Tr. --New (14); used (u) synaal appear to the moved insured and the Loss Payee named below: 1 $ $ 2 $ 6 $ 3 $ 4 7 8 5 $ S 6 E Totals 8 7 $ $ (c) Limit of Liability (if not stated in PHF Item 1); Net Rates; Advance Premium Rota LIMIT OF LIABILITY —Each covered described in (a) above and automobile covered for: Coverage 0 Net Rates Coverages Covera es other than Collision Collision nter. Amount or "ACV" and Deductible nteo "ACV" I and Deductible I 2 3 4 5 6 7$ $ $ $ $ $ $ $ $ $ $ $ $ is ACV ACV ACV ACV ACV ACV ACV $ $ $ $ $ $ $ 0— Comprehensive X X X P — Collision $ Q— Fire. Lightning or Transportation $ R — Theft $ S — Windstorm, Hail, Earthquake or Ez Sion $ T — Combined Additional X X X V— Towing "ACV" = ACTUAL CASH VALUE PHF Item 3. Except with respect to bailment lease, conditional sale, purchase agreement, mortgage or other encumbrance, the named insured is the sole owner of every covered automobile designated in PHF Item 1 as covered under this insurance, unless otherwise stated herein: PHF Item 4. Explanation of entries in PHF Item 1 for designating the covered automobiles to which this insurance applies, under each Coverage afforded: 1 = all covered automobiles 2 = aH registered covered automobiles 3 = all covered automobiles of the private passenger type 4 = all covered automobiles of the commercial type 5 = the covered automobiles described in PHF Item 2 (including newly acquired vehicles, subject to the provisions of paragraph (b) of the "covered au inuala7e" definition) When so entered in addition to numerals 1, 2, 3 or 4: 6 = excluding vehicles leased to the named insured 7 = excluding, under Collision Coverage, any vehicle not having an actual rash value of at least $ ,'5100.00 lover) ADVANCE PREMIUM ' Auto Coverage 0 Coverage P Coverage 0 Coverage R Coverage S Coverage T Coverage V 1 $ $ $ $ 2 $ $ $ $ $ $ $ 3 E $ $ $ $ $ $ 4 $ 8 $ $ $ $ 5 $ $ $ $ $ $ 6 $ $ $ 7 8 8 $ S 8 E Totals 8 $ $ $ E PHF Item 3. Except with respect to bailment lease, conditional sale, purchase agreement, mortgage or other encumbrance, the named insured is the sole owner of every covered automobile designated in PHF Item 1 as covered under this insurance, unless otherwise stated herein: PHF Item 4. Explanation of entries in PHF Item 1 for designating the covered automobiles to which this insurance applies, under each Coverage afforded: 1 = all covered automobiles 2 = aH registered covered automobiles 3 = all covered automobiles of the private passenger type 4 = all covered automobiles of the commercial type 5 = the covered automobiles described in PHF Item 2 (including newly acquired vehicles, subject to the provisions of paragraph (b) of the "covered au inuala7e" definition) When so entered in addition to numerals 1, 2, 3 or 4: 6 = excluding vehicles leased to the named insured 7 = excluding, under Collision Coverage, any vehicle not having an actual rash value of at least $ ,'5100.00 lover) �uNaminr -salnlels Uans a) wo;uoo of papuawe Agaza4 ail ponssi si a3ueznsui sigl 'ue1Je3ol auo Aue (p) PUB aNgam0lee PRJRA03 quo Aug (p Hugaadsaz 39oISIA u!azagm Blois aql ;o salnlels 941 41!m la!guoa u! ale 4314M aaueznsu! 5!41 10 swlai -ozd anoge all of 13afgns ' olazaUl altimidde ,,Mil!geil to liwy Pentium, aql nldltiS 01 Pawlape3 MEIRSal Io smzal '1 Se elupag3s ayI u! palels `Aue ;! 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Alladmd Bill to pled os s! &Sol Bill azo;aq awg hue IS ' olaza4l a8ewep 1ue4lnsal Aue -sap Iou pue sllgemspt p1aAn a 4I!m asn 10; 11998!5911 Apaq zadse3 a o; ssq of g) zo; luawAed ql!m 'pausi pames aql of Alzadozd ualols Aue asuadxa s3l le uznlaz (q) 'punos ;O zo'Alzadozd ualols 10 paHewep a4l ageldal zo it al (e) uw13npad&z pue Huiploaaz 10 'mimpoldaz 'Hu!P1o3az Bql 10; pauH!gap Juaw �Aepi zo 'Aadoar d! Ssel -nJJSU1 10 aoimp Aue_gl!N asn 10; wn!paw za4Jo to 3s!P P1o3ad " jyA: q kue (n) pies zo; Aed Am Auedwoa ayI 'aaueznsu! Sig Aq pazano3 ssal Aug o4 13odsaz 9l !M - 114"Unee paJUI3 aql u! papelsin 5521 zo; luauzled g Alluaueuuad s! luawnzlsu! 10 amap Plans ssalun punos ;o umimpozdaz pue •aaueznsw s! u! a uwd A e3 !Bads se pe 1a o asuadxa Aue lunplooez 10 'uog3opotdal 'gu jo3az all 1o; pau0rs9P JpawluJS 110 03IABp Aug (!) 41 P P II 9 U3 4! of $sq oI (a) znaw 10 Alzadozd ualols ;o AiMie.1 101 Pzemal Aug Aed 10 )ago UP eBilgo Aug awnsse amlemweluo3 an113eoipel i!!) 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'ainpay3s ayl ui paquasap al!goUnlne zo lo!z 'uoisoldxa 'agenbglzea `Neil 'wzolspuiA 'Auawel zo I;aUI 'azg 'sl3algo POJQA03 a ;! `pue ;oazayl shod uaaMlaq palzodsuezl hiaq si zo 'epeueo zo 'suo!s Huglej 'soliss!w Aq pasne3 ssol pue sselli ;o a8e4eazq 'aHezano3 siyl ;o asod - sassod to sauoluzal sp 'eouawy ;o salelS,,paliu0. Bill uiUlim st aligowolne panm3 zzdd all zo; 'Inq :uoisnlo3 )dam asne3 Aue wozl- 3AISN3113HdW03 -0 3BV83AOD 941 al!ym 'pouad 4311od ayI Huunp 51 11332 43t4w sssf-o1 Aluo sapdde a3uelnsui s141 - :zapun'saNgowelne pazam3 of ssol zol Aed 0!m Auedwo3 a4l 'I 3S0 30 MUM 491111111111 °00183d A3110d 'ill S1N3W3380tl MUM 'I C � COVERAGE PART UNINSURED MOTORISTS INSURANCE For attachment to Policy No. , to complete said policy. SCHEDULE AL 9590 (Ed. 1.73) The insurance afforded is only with respect to the following Coverage as indicated by specific premium charge. The limit of the company's liability against such Coverage shall be as stated herein, subject to all the terms of this policy having reference thereto. cove Limits of Liability Advance Premium U— Uninsured Motorist thousand dollars each person Q - thousand dollars each accident is Form numbers of endorsements attached at issue s AL 626A Total Advance Premium S 60. Designated Insured . Description of Insured Highway Vehicles (Check appropriate box) - ❑ Any automobile owned by the named insured ❑ Any pr -ovate passenger automobile owned by the named insured ❑ Any highway vehicle to which are attached dealer's license plates issued to the main" insured - - ® Any highway vehicle designated in the declarations of the policy by the letters "UM" and a highway vehicle ownership of which is acquired during the policy period by the named insured as a replacement therefor ❑ Any mobile equipment owned or leased by and registered in the name of the named insured - - - - - I. COVERAGE U— UNINSURED MOTORISTS (Damages for Bodily Injury) The company will pay all sums which the insured or his legal representative sMU be legally entitled to recover as damages from the owner or operator of an uninsured highway vehicle because of bodily injury sustained by the insured, caused by accident and arising out of the ownership, maintenance or use of such uninsured firdrway vehicle; provided, for the purposes of this coverage, determination as to whether the insured or such'representatfve is legally entitled to recover such damages, and if so the amountthereof, shall be made by agreement between the insured or such representative and the company or, if they fail to agree, by arbitration. No judgment against any person or organization alleged to be legally responsible for the bodily inryry shall be conclusive, as between the insured and the company, of the issues of liability of such person or organization or of the amount of damages to which the insured is legally entitled unless such judgment is entered pursuant to an action prosecuted by the insured with the written consent of the company. Exclusions. This insurance does not apply: (a) to bodily injury to an insured with respect to which such insured, his legal representative or any person entitled to payment under this insurance shall, without written consent of the company, make any settlement with any person or organization who may be legally liable therefor; (b) to bodily injury to an insured while occupying a highway vehicle (other than an insured highway vehicle) owned by the named insured, any designated in- sured or any relative resident in the same household as the named or desig- nated insured, or through being struck by such a vehicle, but this exclusion does not apply to the named insured or his relatives while occupying or If struck by a highway vehicle owned by a designated insured or his relatives; (c) so as to inure directly or indirectly to the benefit of any workmen's compensa- tion or disability benefits carrier or any person or organization qualifying as a self- insurer under any workmen's compensation or disability benefits law or any similar law. H. PERSONS INSURED Each of the following is an insured under this insurance to the extent set forth below: (a) the named insured and any designated insured and, while residents of the same household, the spouse and relatives of either; (b) any other person while occupying an insured highway vehicle; and (c) any person, with respect to damages he is entitled to recover because of 1 injury to which this insurance applies sustained by an insured under (a) or (b above. The insurance applies separately with respect to each insured, except with respect to the limits of the company's liability. 111. LIMITS OF LIABILITY Regardless of the number of insureds under this policy, the company's liability is limited as follows: (a) The limit of liability stated in the schedule as applicable to "each person" is the limit of the company's kability, for all damages because of bodily, injury sustained by one person as the result of any one accident and, subject to the above provision respecting "each person ", the limit of liability stated in the schedule as applicable to "each accident" is the total limit of the company's liability for all damages because of bodily injury sustained by two or more persons as the result of any one accident. (b) Any amount payable under the terms of this insurance because of bodily injury sustained in an accident by a person who is an insured under this coverage shall be reduced by (1) all sums paid on account of such bodily injury by or on behalf of (i) the owner or operator of the uninsured highway vehicle and (ill any other person or organization jointly or severally liable together with such owner or operator for such bodily injury, including all sums paid under the bodily injury liability coverage of the policy, and (2) the amount paid and the present value of all amounts yayable on account of such bodily injury under any workmen's compensation law, disability benefits law or any similar law. (c) Any payment made under this insurance to or for any insured shall be applied- in reduction of the amount of damages which he may be entitled to recover from any person or organization who is an insured under the badly injury liability coverage of the policy. (d) The company shag not be obligated to pay under this insurance that part of the damages which the insured may be entitled to recover from the owner or operator of an uninsured highway vehicle which represents expenses for medical services paid or payable under the medical payments coverage of the policy. IV. POLICY PERIOD; TERRITORY This insurance applies only to accidents which occur during the policy period and within the United States of America, its territories or possessions, or Canada. V. ADDITIONAL DEFINITIONS When used in reference to this insurance (including endorsements forming a part of the policy): "designated insured" means an individual named in the schedule under Desig- nated Insured; (over) "highway vehicle" means a land motor vehicle or trailer other than (a) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads, (b) a vehicle operated on rails or crawler- treads, or (c) a vehicle while located for use as a residence or premises; "bit- and-run vehicle" means a highway vehicle which causes bodily injury to an insured arising out of physical contact of such vehicle with the insured or with a vehicle which the insured is occupying at the time of the accident, provided: (a) there cannot be ascertained the identity of either the operator or owner of such highway vehicle; (b) the insured or someone on his behalf shall have reported the accident within 24 hours to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall have filed with the company within 30 days r 0 unala 1a u! 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AUTOMOBILE AL 9644 A 979a (Ed. 6.73) OUT- OF-STATE INSURANCE ENDORSEMENT This endorsement, effective , forms a part of policy No. 112:01 A. M., standard time) issued to by Avihanzed ftepresenfative It is agreed that, subject to all the provisions of the policy except where modified herein, the following provision is added If, under the provisions of the motor vehicle financial responsibility law or the motor vehicle compulsory insurance law or any similar law of any slate or province, a non-resident is required to maintain insurance with respect to the operation or use of a motor vehicle in such state or province and such insurance requirements are greater than the insurance provided by the policy, the limits or the company's liability and the kinds of coverage afforded by the policy shall be as set forth in such law, in lieu of the insurance otherwise provided by the policy, but only to the extent required by such law and only with respect to the operation or use of a motor vehicle in such state or province, provided that the insurance under this provision shall be (educed to the extent that there is other valid and collectible insurance under this or any other motor vehicle insurance policy. In no event shall any person be entitled to receive duplicate pay- ments for the same elements of loss. END. # 3 AUTOMOBILE (The Attaching Clause need be complet* when these endorsements are Issued subsequent to prep of the policy.) These endorsements modify such insurance as is afforded by the provisions of the policy relating to the following: UNINSURED MOTORISTS INSURANCE These endorsements, effective , form a part of policy No. (12:01 A. M., standard time) issued to AL HIM (Ed. S -73) by Auth iiiZed sentatlre �1+- -- 1111001 CALIFORNIA AMENDMENT It is agreed that: 1. Subsections (b), (c) and (d) of the provision entitled "Limits of Weili- ty" are replaced by the following: (b) Any loss payable under the terms of this insurance to or for any person shall be reduced by: (1) the amount paid and the present value of all amounts payable to him under any workmen's compensation law, exclusive of non - occupational disability benefits; (2) the amount the insured is entitled to recover from any other person insured under the bodily injury liability coverage of the policy; and (3) all sums paid by or on behalf of the owner or operator of the uninsured highway vehicle and any other person or organization jointly or severally liable together with such owner or operator for bodiy injury to an insured. (c) The company shall not be obligated to pay under this insurance that part of the damages including damages for care and loss of services because of bodily injury which the insured may be entitled to recover from the owner or operator of an uninsured highway vehicle which represents expenses for medical services paid or payable under the Automobile Medical Payments Coverage of the policy. 2. Paragraph (a) of the definition of "uninsured highway vehicle" is amended to read as follows: (a) a highway vehicle with respect to the ownership, maintenance or use of which there is, in at least the amounts specified by the financial responsibility law of the state in which the insured highway vehicle is principally garaged, no bodily injury liability bond or insurance policy applicable at the time of the accident with respect to any person or organization legally responsible for the use of such vehicle, or with respect to which there is a bodily injury liability bond or insurance policy applicable at the time of the accident but the company writing the same denies coverage thereunder or refuses to admit coverage thereunder except conditionally or with reservation or such company is or becomes insolvent; or 3. The Condition entitled "Other Insurance" is replaced by the following: Othor Insurance With respect to bodily injury to any insured occupying a highway vehicle (other than a highway vehicle which is owned by the named insured) to which the bodily injury liability coverage of the policy applies, the insur- ance hereunder shall not apply if the owner of such vehicle has insurance similar to that provided for herein. Subject to the preceding paragraph, if the insured has other similar insur- ance available to him, any damages including damages for care and loss of services because of bodily injury shall be deemed not to exceed the higher of the applicable limits of the respective coverages and such damages including damages for care and loss of services because of bodily injury shall be pro -rated between such coverages in such proportion as each coverage bears to the total of such limits. A. The Condition entitled "Arbitration" is amended to read as follows: Arbitration If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages including damages for care and loss of services because of bodily injury from the owner or opera- tor of an uninsured highway vehicle because of bodily injury to the insured, or do not agree as to the amount of payment which may be owing under this insurance, then, upon written demand of either, the matter or matters upon which such person and the company do not agree shall be settled by a single neutral arbitrator, and judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction thereof. Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrator pursuant to this insurance. 5. The Condition entitled "Action Against Company" is amended to read as follows: Action Against Company No action shall lie against the company unless, as a Condition precedent thereto, the insured or his legal representative has fully cdmplied with all the terms of this policy nor unless within one year from the date of the accident: (a) suit fm bodily injury has been filed against the uninsured motorists in a court of competent jurisdiction, or (b) agreement as to the amount due under this insurance has been concluded, or (c) the insured or his legal representative has formally instituted arbi- tration proceedings. A 907 UNINSURED MOTORISTS INSURANCE AMENDMENT (California) It is agreed that with respect to Uninsured Motorists Insurance, Exclusion (cl is amended to read as follows: (c) so as to inure directly or indirectly to the benefit of any workmen's compensation or disability benefits carrier or any person or organization qualifying as a self - insurer under any workmen's compensation, disability benefits law or any similar law or directly to the benefit of the United States or any state or political subdivision thereof. END: #- tF -y-- CASUALTY i C -1099 ENDORSEMENT This endorsement, effective forms o Dort of policy No. (T2.01 A. M., ,ta,dcrd times issued to by P11LICY PERIOD, TERRITORY AMENDED APPLICABLE ONLY TO COMPREHENSIVE AUTOMOBILE LIABILITY - COVERAGE AGREEMENT IV AUTOMOBILE PHYSICAL DAMAGE - COVERAGE AGREEMENT III GARAGE INSURANCE COVERAGE - COVERAGE AGREEMENT VI IN CONSIDERATION OF THE PREMIUM PROVIDED, IT IS AGREED THAT THE APPLICABLE COVERAGE AGREEMENT OF THE POLICY I5 DELETED IN ITS ENTIRETY AND THE FOLLOWI14G SUBSTITUTED THEREFOR: CONDITION 1. POLICY PERIOD, TERRITORY: THIS POLICY APPLIES ONLY TO ACCIDENTS, OCCURRENCES AND LOSS DURING THE POLICY PERIOD WHILE THE AUTOMOBILE IS WITHIN NORTH AMERICA, HAWAII OR ANY TERRITORY OR POSSESSION OF THE UNITED STATES OF AMERICA, OR IS BEING TRANSPORTED BETWEEN PORTS THEREOF, IT IS AGREED THAT ANY CLAIM PAYABLE UNDER THE COVERAGES OF COMPREHENSIVE, COLLISION, FIRE, THEFT AND COMBINED ADDITIONAL COVERAGE OF THE POLICY ARISING OR RESULTING FROM ANY LOSS OR DAMAGE OCCURRING WITHI14 THE REPUBLIC OF MEXICO SHALL BE PAYABLE IN THE UNITED STATES OF AMERICA, AND THAT IN THE EVENT OF LOSS OR DAMAGE WHICH MAY MAKE NECESSARY THE REPAIR OF THE AUTOMOBILE OR REPLACEMENT OF ANY PART OR PARTS THEREOF, WHILE SAID AUTO- MOBILE IS WITHIN THE REPUBLIC OF MEXICO, THE BASIS OF ADJUSTMENT OF CLAIM FOR SUCH REPAIRS AND /OR REPLACEMENT SHALL NOT EXCEED THE COST OF SUCH REPAIRS AND /OR REPLACEMENT AT THE NEAREST POINT IN THE UNITED STATES WHERE SUCH REPAIRS AND /OR REPLACEMENT CAN BE MADE. WARNING UNLESS YOU HAVE AUTOMOBILE INSURANCE WRITTEN BY A MEXICAN INSURANCE COMPANY, YOU MAY SPEND MANY HOURS OR DAYS IN JAIL, IF YOU HAVE AN ACCIDENT IN MEXICO. INSURANCE COVERAGE SHOULD BE SECURED FROM A COMPANY LICENSED UNDER THE LAWS OF MEXICO TO WRITE SUCH INSURANCE IIJ ORDER TO AVOID COMPLICATIONS AIJD SOME OTHER PENALITES POSSIBLE UNDER THE LAWS OF MEXICO, INCLUDING THE POSSIBLE IMPOUNDMENT OF YOUR AUTOMOBILE. All other terms and conditions of this policy remain unchanged. .. .116, .. �.. ..... �........ Authonced Rcpreschta ivc END. # 1 GENERAL -AUTOMOBILE LIABILITY POLICY N0. CA 572 73 50 INSURANCE COMPANY MGM OF THE PACIFIC COAST NEWPORT BEACH, CALFORfM1A 92660 DECLARATIONS (A STOCK INSURANCE COMPANY) Item 1. Named Insured and Address: (No., street. Town or City, county, state) CITY OF NEWPORT BEACH 3300 NEWPORT BOULEVARD NEWPORT BEACH, CALIFORNIA Item 2. Policy Period: (Mo. Day Yr.) From 6-17-74 to 9-6 -74 12:01 A.M., standard time at the address of the named insured as stated herein. The named Insured is: ❑ Individual ❑ Partnership ❑ Corporation Business of the named Insured Is: (ENTER BELOW) ❑ Joint Venture ® Other: CITY Audit Period: Annual, unless otherwise stated. (ENTEa BELOW) Item 3. The insurance afforded is only with respect to the fnllnwino Cnvera Ba P2rt1e1 indirafod by snerifir nrnmium rharaetsl General Liability Coverage Part(s) Coverage Part Nola). Advance Premiums Automobile Coverage Part(s) Coverage Part No(s). Advance Premiums Completed Operations and Products Liability Insurance E Automobile Medical Payments Insurance E Automobile Physical Damage Insurance (Dealers) E Comprehensive General Liability Insurance E Comprehensive Personal Insurance E Automobile Physical Damage Insurance (Fleet Automatic) A4396 E 54o. Contractual Liability Insurance E Druggists' Liability Insurance E Automobile Physical Damage Insurance (Nan - Fleet) E Elevator Collision Insurance E Farm Employers' Liability and Farm Employees' Medical Payments Insurance E Basic Automobile Liability Insurance E Comprehensive Automobile Liability Insurance A E Farmer's Comprehensive Personal Insurance E Garage Insurance E Farmer's Medical Payments Insurance E Uninsured Motorists Insurance AL9590 E Manufacturers' and Contractors' Liability Insurance $ $ Owner's and Contractor's Protective Liability Insurance E E Owners', Landlords' and Tenants' Liability Insurance E E Personal Injury Liability Insurance E E Premises Medical Payments Insurance E Special Pmtectiveand Highway Liability Insurance New York Department of Transportation E E Storekeeper's Insurance E E E Sub Total— General Liability Premium E Sub Total — Automob(le Premium E 1200. Form numbers of endorsements, other than those entered on Coverage Perils), attached at Issue E Total Advance Premium for this policy. E 1200.00 Bit the Policy Period is more than one year and the premium is to be paid in installments, premium is payable on: Effective Date 1st Anniversary 2nd Anniversary E E E than 4. During the past three years no insurer has cancelled insurance, issued to the named Insured, similar to that afforded hereunder, unless otherwise stated herein: Countersigned: NEWPORT BEACH, CALIFORNIA 7 >> -74 *Not applicable in Tetas Y Aut ortzed Representative Form No. 5555 P (1.1.73) • 0 THE COMPANY DESIGNATED ON THE DECLARATIONS PAGE (A stock insurance company, herein called the company) In consideration of the payment of the premium, in reliance upon the statements in the declarations made a part hereof and subject to all of the terms of this policy, agrees with the named insured as follows: DEFINITIONS plated operations hazard or the underground property damage hazard, or (4) for which liability is assumed by the insured under an incidental contract; When used in this policy (including endorsements forming a part hereo0: "autonuhile" means a land motor vehicle, trailer or semi - trailer designed for travel on public roads (including any machinery or apparatus attached thereto), but does not include mobile equipment; "bodily tejory" means bodily injury, sickness or disease sustained by any person which occurs during the policy period, including death at any time resulting therefrom;. "collapm haard" includes "structural property damage" as defined herein and property damage to any other property at any time resulting therefrom. "Structural property damage" means the collapse of or structural injury to any building or structure due to (1) grading of land, excavating, borrowing, filling, back - filling, tunnelling, pile driving, cofferdam work or caisson work or (2) moving, shoring, underpinning, raising or demolition of any building or structure or removal or rebuilding of any structural support thereof. The collapse hazard does not include property damage (1) arising out of operations performed for the named insured by independent contractors, or (2) included within the completed operations hazard or the underground property damage hazard, or (3) for which liability is assumed by the insured under an incidental contract; "completed operations hazard" includes bodily injury and property damage arising out of operations or reliance upon a representation or warranty made at any time with respect thereto, but only if the bodily injury or property damage occurs after such operations have been completed or abandoned and occurs away from premises owned by or rented to the named insured. "Operations" include materials, parts or equipment furnished in connection therewith. Operations shall be deemed com- pleted at the earliest of the following'times: (1) when all operations to be performed by or on behalf of the named insured under the contract have been completed, (2) when all operations to be performed by or on behalf of the named insured at the site of the operations have been completed, or (3) where the portion of the work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Operations which may require further service or maintenance work, or correc- tion, repair or replacement because of any defect or deficiency, but which are otherwise complete, shall be deemed completed. The completed operations hazard does not include bodily injury or property damage arising out of (a) operations in connection with the transportation of property, unless the bodily injury or property damage arises out of a condition in or on a vehicle created by the loading or unloading thereof, (b) the existence of tools, uninstalled equipment or abandoned or unused ma- terials, or (c) operations for which the classification stated in the policy or in the company's manual specifies "including completed operations "; "elevator" means any hoisting or lowering device to connect floors or landings, whether or not in service, and all appliances thereof including any car, platform, shaft, hoistway, stairway, runway, power equipment and machinery; but does not include On automobile servicing hoist, or a hoist without a platform outside a building if without mechanical power or if not attached to building walls, or a hod or material hoist used in alteration, construction or demolition operations, or an inclined conveyor used exclusively for carrying property or a dumbwaiter used exclusively for carrying property and having a compartment height not exceeding four feet; "explosion hazard" includes property damage arising out of blasting or explosion. The explosion hazard does not include property damage (1) arising out of the ex- plosion of air or steam vessels, piping under pressure, prime movers, machinery or power transmitting equipment, or (2) arising out of operations performed for the named insured by independent contractors, or (3) included within the com- SUPPLEMENTA The company will pay, in addition to the applicable limit of liability: (a) all expenses incurred by the company, all costs taxed against the insured in any suit defended by the company and all interest on the entire amount of any judgment therein which accrues after entry of the judgment and before the company has paid or tendered or deposited in court that part of the judgment which does not exceed the limit of the company's liability thereon; (b) premiums on appeal bonds required in any suc suit, premiums on bonds to release attachments in any such suit for an nt not in excess of the applicable limit of liability of this policy, and Wost of bail bonds required "incidental contract" means any'written (1) lease of premises, (2) easement agreement, except in connection with- construction or demolition operations on or adjacent to a railroad, (3) undertaking to indemnify a municipality required by municipal ordinance, except in connection with work for the municipality, (4) side- track agreement, or (5) elevator maintenance agreement; "insured" means any person or organization qualifying as an insured in the "Per- sons Insured" provision of the applicable insurance coverage. The insurance afforded applies separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the company's liability; "mobile equipment" means a land vehicle (including any machinery or apparatus attached thereto), whether or not self - propelled, (1) not subject to motor vehicle registration, or (2) maintained for use exclusively on premises owned by or rented to the named insured, including the ways immediately adjoining, or (3) designed for use principally off public roads, or (4) designed or maintained for the sole purpose of affording mobility to equipment of the following types forming an in- tegral part of or permanently attached to such vehicle: power cranes, shovels, loaders, diggers and drills; concrete mixers (other than the mix -in- transit type); graders, scrapers, rollers and other road construction or repair equipment; air - compressors, pumps and generators, including spraying, welding and building cleaning equipment; and geophysical exploration and well servicing equipment; "named insured" means the person or organization named in Item 1. of the decla- rations of this policy; "named insured's products" means goods or products manufactured, sold, handled or distributed by the named insured or by others trading under his name, including any container thereof (other than a vehicle), but "named insured's products" shall not include a vending machine or any property other than such container, rented to or located for use of others but not sold; "occurrence" means an accident, including continuous or repeated exposure to conditions, which results in bodily injury or property damage neither expected nor intended from the standpoint of the insured; "policy territory" means: (1) the United States of America, its territories or possessions, or Canada, or (2) international waters or air space, provided the bodily injury or property dam- age does not occur in the course of travel or transportation to or from any other country, state or nation, or (3) anywhere in the world with respect to damages because of bodily injury or property damage arising out of a product which was sold for use or consump- tion within the territory described in paragraph (1) above, provided the original suit for such damages is brought within such territory; "products hazard" includes bodily injury and property damage arising out of the named insured's products or reliance upon a representation or warranty made at any time with respect thereto, but only if the bodily injury or property damage occurs away from premises owned by or rented to the named insured and after physical possession of such products has been relinquished to others; "property damage" means (1) physical injury to or destruction of tangible prop- erty which occurs during the policyy period, including the loss of use thereof at any time resulting therefrom, or (2) loss of use of tangible property which has not been physically injured or destroyed provided such loss of use is caused by an occurrence during the policy period; "underground property damage hazard" includes underground property damage as defined herein and property damage to any other property at any time resulting therefrom. "Underground property damage" means property damage to wires, conduits, pipes, mains, sewers, tanks, tunnels, any similar property, and any apparatus in connection therewith, beneath the surface of the ground or water, caused by and occurring during the use of mechanical equipment for the purpose of grading land, paving, excavating, drilling, borrowing, filling, back - filling or pile driving. The underground property damage hazard does not include property dam- age (1) arising out of operations performed for the named insured by independent contractors, or (2) included within the completed operations hazard, or (3) for which liability is assumed by the insured under an incidental contract. RY PAYMENTS of the insured because of accident or traffic law violation arising out of the use of any vehicle to which this policy applies, not to exceed $250 per bail bond, but the company shall have no obligation to apply fonor furnish any such bonds; (c) expenses incurred by the insured for first aid to others at the time of an acci- dent, for bodily injury to which this policy applies; (d) reasonable expenses incurred by the insured at the company's request in assisting the compan the investigation or defense of any claim or suit, including actual lass nings not to exceed $25 per day. Attach Coverage Part(s) and Endorsements) (If Any) Here CONDITIONS 1. Premium: All premiums for this policy shall be computed in accordance with the company's rules, rates, rating plans, premiums and minimum premiums appli cable to the insurance afforded herein. Premium designated in this policy as "advance premium" is a deposit premium only which shall be credited to the amount of the earned premium due at the end of the policy period. At the close of each period (or part thereof terminating with the end of the policy period) designated in the declarations as the audit period the earned premium shall be computed for such period and, upon notice thereof to the named insured, shall become due and payable. If the total earned premium for the policy period is less than the premium previously paid, the company shall return to the named insured the unearned portion paid by the named insured. The named insured shall maintain records of such information as is necessary for premium computation, and shall send copies of such records to the company at the end of the policy period and at such times during the policy period as the company may direct. 2. Inspection and Audit: The company shall be permitted but not obligated to inspect the named insured's property and operations at any time. Neither the company's right to make inspections nor the making thereof nor any report there- on shall constitute an undertaking, on behalf of or for the benefit of the named insured or others, to determine or warrant that such property or operations are safe or healthful, or are in compliance with any law, rule or regulation. The company may examine and audit the named insured's books and records at any time during the policy period and extensions thereof and within three years after the final termination of this policy, as far as they relate to the subject matter of this insurance. 3. Financial Responsibility Laws: When this policy is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, such insurance as is afforded by this policy for bodily injury liability or for property damage liability shall comply with the provisions of such law to the extent of the coverage and limits of liability required by such law. The insured agrees to reimburse the company for any payment made by the com- pany which it would not have been obligated to make under the terms of this policy except for the agreement contained in this paragraph. 4. Insured's Duties in the Event of Occurrence, Claim or Suit: (a) In the event of an occurrence, written notice containing particulars sufficient to identify the insured and also reasonably obtainable information with respect to the time, place and circumstances thereof, and the names and addresses of the injured and of available witnesses, shall be given by or for the insured to the company or any of its authorized agents as soon as practicable. (b) If claim is made or suit is brought against the insured, the insured shall im- mediately forward to the company every demand, notice, summons or other process received by him or his representative. (c) The insured shall cooperate with the company and, upon the company's request, assist in making settlements, in the conduct of suits and in enforcing any right of contribution or indemnity against any person or organization who may be liable to the insured because of injury or damage with respect to which insurance is afforded under this policy; and the insured shall attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses. The insured shall not, except at his own cost, voluntarily make any payment, assume any obligation or incur any expense other than for first aid to others at the time of accident. 5. Action Against Company: No action shall lie against the company unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, nor until the amount of the insured's obligation to pay shall have been finally determined either by judgment against the insured after actual trial or by written agreement of the insured, the claimant and the company. Any person or organization or the legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this policy to the extent of the insurance afforded by this policy. No person or organization shall have any right under this policy to join the company as a party to any action against the insured to determine the insured's liability, nor shall the company be impleaded by the insured or his legal representative. Bankruptcy or insolvency of the insured or of the insured's estate shall not relieve the com- pany of any of its obligations hereunder. 6. Other Insurance: The insurance afforded by this policy is primary insurance, except when stated to apply in excess of or contingent upon the absence of other insurance. When this insurance is primary and the insured has other insurance which is stated to be applicable to the loss on an excess or contingent basis the amount of the company's liability under this policy shall not be reduced by the existence of such other insurance. When both this insurance and other insurance apply to the loss on the same basis, whether primary, excess or contingent, the company shall not be liable under this policy for a greater proportion of the loss than that stated in the applicable contribution provision below: (a) Contribution by Equal Shares. If all of such other valid and collectible insur- ance provides for contribution by equal shares, the company shall not be liable for a greater proportion of such loss than would be payable if each insurer contributes an equal share until the share of each insurer equals the lowest applicable limit of liability under any one policy or the full amount of the loss is paid, and with respect to any amount of loss not so paid the remaining insurers then continue to contribute equal shares of the remaining amount of the loss until each such insurer has paid its limit in full or the full amount of the loss is paid. (b) Contribution by Limits. If any of such other insurance does not provide for contribution by equal shares, the company shall not be liable for a greater proportion of such loss than the applicable limit of liability under this policy for such loss bears to the total applicable limit of liability of all valid and collectible insurance against such loss. 7. Subrogation: In the event of any payment under this policy, the company shall be subrogated to all the insured's rights of recovery therefor against any person or organization and the insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The insured shall do nothing after loss to prejudice such rights. 8. Changes: Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this policy or estop the company from asserting any right under the terms of this policy; nor shall the terms of this policy be waived or changed, except by endorsement issued to form a part of this policy. 9. Assignment: Assignment of interest under this policy shall not bind the com- pany until its consent is endorsed hereon; if, however, the named insured shall die, such insurance as is afforded by this policy shall apply tt) to the named insured's legal representative, as the named insured, but only while acting within the scope of his duties as such, and (2) with respect to the property of the named insured, to the person having proper temporary custody thereof, as insured, but only until the appointment and qualification of the legal representative. 10. Three Year Policy: If this policy is issued for a period of three years any limit of the companys liability stated in this policy as "aggregate" shall apply separately to each consecutive annual period thereof. 11. Cancellation: This policy may be cancelled by the named insured by sur- render thereof to the company or any of its authorized agents or by mailing to the company written notice stating when thereafter the cancellation shall be effective. This policy may be cancelled by the company by mailing to the named insured at the address shown in this policy, written notice stating when not less than ten days thereafter such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice. The time of surrender or the ef- fective date and hour of cancellation stated in the notice shall become the end of the policy period. Delivery of such written notice either by the named insured or by the company shall be equivalent to mailing. It the named insured cancels, earned premium shall be computed in accordance with the customary short rate table and procedure. If the company cancels, earned premium shall be computed pro rata. Premium adjustment may be made either at the time cancellation is effected or as soon as practicable after cancel- lation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. 12. Declarations: By acceptance of this policy, the named insured agrees that the statements in the declarations are his agreements and representations, that this policy is issued in reliance upon the truth of such representations and that this policy embodies all agreements existing between himself and the company or any of its agents relating to this insurance. 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I!gel l 10 pwil sit ;o uonsnegxa uodn uoueulwal sll ao; Inq Aonod 4ons Aue iapun pamsul up aq pinom io 'epeueo ;o uolleloossV aouemsul aealonN ao sialumiapun AlNlgell A2a8113 olwolV Ien1nW 'uoilmoossV aouemsul Appq ul ABaau3 aealonN Aq panssi Aonod A1!I!gell ABaaua aealanu a aapun peznsul up osle si Aonod sl4l oapun pamsul ue 4olgm of loadsaa 4llm (I) aHewep Alzadaad io Arnful Allpoq of '98e1an00 Al!I!ge!1 Aue aapun 'y :Aldde lou saop Aonod slgl 'I 1041 paai8e sl 11 33NV80SNI 1VNOSH3d 3AISN31,13MIDO S,H3WHVd ONV 1VNOSH3d 3AISN3H3HdWOO '31190W01nV 30VNOVd MONS '31190WOlnV A11WVd NVHl H3H10 33NVHIISNI S1NMAV 1VOW 0NV A11119VI1 MIND 'A11119VI1 31190WOnV 11V al Bunea Aonod 5141 10 suolslAOJ Q41 sanlpow luawasaopua 5141 (WH01 OVOH9) iMMS1690NLN01SIRIM A1111GV11 ASHM annnN PACIFIC INDEMNRY COMPANY (A stock insurance company, herein called the company) In consideration of the payment of the premium, in reliance upon the statements in the declaftRions made a part hereof and subject to all of the terms of this policy, agrees with the named insured as follows: INSURING AGREEMENTS Coverage A— Bodily and Personal Injury thhiNty `. To pay on behalf of the insured all sums which the Insured alaR� li- gated to pay by reason of liability imposed by 4uhrding A1,. State of California Statutes of 1963, or Iwb111tyr asmdlled by the named insured may legally do so, for duilieges::- (1) becaute of bodily injury, sickness or disease; Including. death at any time resulting therefrom and also including cue act foss of services, sustained by any person or persons, or (2) because of any other injury a person may suffer to his person, re"Idon, character or feelings, including but not limited to malpractice, false arrest, detention or imprisonment, malicious prosecution, libel, slander, defamation of character, invasion of privacy, wrongful eviction or wrongful entry. Coverage B — Property Damage Liability — Automobile .j To pay on behalf of the insured all sums which the insured shall become obli- gated to pay by reason of liability imposed by law, including Chapter 1681 of the State of California Statutes of 1963, or liability assumed by contract, insofar as the named insured may legally do so, for damages because of injury to or destruc- tion of property, including the loss of use thereof arising out o the ouiership, maintenance or use of any automobile. Coverage C — Property Damage Liability — Except Automobile To pay on behalf of the insured all sums which the insured shall become obil- gated to pay by reason of liability imposed by law, including Chapter 16BI of the State of California Statutes of 1963, or liability assumed by contract, insofar as the named insured may legally do so, for damages because of injury to or destruc- tion of property, including the loss of use thereof. Coverage D —Errors or Omissions Liability To pay on behalf of the insured all sums which the insured shall become legally obligated to pay, insofar as such coverage is not afforded under Coverages A or C, on account of any claim for breach of duty made against the insured by reason of any negligent act, error or omission of the insured if such negligent act, error or omission is committed during the policy period and discovered during the policy period or within twenty -four months after termination of the policy. II. Defense, Settlement, Supplementary Payments As respects such insurance as is afforded by this policy, the company shall (a) defend in his name and behalf any suit against the insured claiming such damages, even if such suit is groundless, false or fraudulent; but the company shall have the right to make such investigation, negotiation and settlement of any claim or suit as it deems expedient; (b) defend any claim against the named insured or its employee for damages under Section 33294 of the Civil Code or otherwise for the sake of example or by way of punishment, where such claim arises from an act or omission in the scope of employment; (c)(1) pay all premiums and furnish bonds to release attachments for an amount not in excess of the applicable limit of liability of this policy, all premiums on appeal bonds required in any such defended suit, the cost of bail bonds required of the insured in the event of automobile occurrence or automobile traffic law violation during the policy period, not to exceed $250 per bail bond; (2) pay all expenses incurred by the company, all costs taxed against the in- sured in any such suit and all interest accruing after entry of judgment until the company has paid or tendered or deposited with the court such part of such judgment as does not exceed the limit of the company's liability thereon; (3) pay expenses incurred by the insured for such immediate medical and sur- gical relief to others as shall be necessary at the time of the injury; (4) reimburse the insured for all reasonable expenses, other than loss of earn- ings, incurred at the company's request. The company agrees to pay the amounts incurred under this insuring agreement, except settlements of claims and suits, in addition to the applicable limit of liabflity of this policy. III. Penney Imred Each of the follmring is an insured to the extent set forth below; (a) the named hisixed: (b) while,lcting within the scope of his employment as such: (1) sell officer, servant or empPb�yeC� of the named insured, except that the mauranee sa provided aAy ru les,, aervent or employee does not apply to bodily Injury to or death of another officer, servant or employee of the named insured marred fn the course of and arising out of his employment; (2) any member of the govefnieg body of the named insured; (3) any member of boards or commissions of the named insured; (c) under coverages A and 8, anyparsaa while using an owned automobile or a hired automobile and Wilem a organ iahon legally responsible for the use thereof, provided the actoat use of the automobile is by or with the permission of the named insured. The insurance with respect to any person or organization other than the named insured does not apply under division (c) of this insuring agreement: Form Iw001b (570 _. .... ... . - -:... _.....� _. .__..... -� ' air,.' 'aauawn000 auo Aue 10 l!nsa) ay] se' oaiayl asn 10 ssol aql 8w - pnl0u! 'SUwJeLU92JO Jo suosiad ajow Jo sun 10 Aljadwd uo!tonjlsap )o at Amfu! 10 Jno 8u!sije sa8ewep Ile Jul Aplicio!I s,AUedwoa a4l ) . total apt S1 ,a3U8JJn33o gaea„ of algeo!idde se � pue e a owe 9 eaaMADD -Janos Japan suo!lweloap aq] u! pa;e;s A1!I!ga!I 10 1! . 341 A1!I!92!7 1a sl!w!7 'g aouwmo0o auo Aug 10 ilnsaJ aql se suosjad slow Jo omJ Aq pau!elsns 'wOjJaJagi 8wllnsaJ ow!l Aug Is q;eap 8u!pnlaw 'uosjad s!q of jallns Aew uosiod a AJnfu! jayla Aue 10 ;no 8wsue jo aseas!p 10 ssou4a!s 'AJnfu! 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'leg; pap!Awd :smel Al!llq!suodsaa le!oueu!j algeo!ldde aye to suuaw - awnboi aql of lenba )seal Is s1!w!l gl!m Aogod a japun pa)nsu! paweu 0;o aaAoldwa jo lua8e us se jo pamsui paweu a se uos)ad pans 01 algel!ene aauwnsu1 0l411001103 pue p119A J9410 s! 01041 11 'uogednoao gans Aug 10 )no 8u!sue aauannaao hue of taadsaj gl!m 'sa!!gowolne Suuols jo 8u!4jed 8u!lsal pool '8u!lsal '8wmn!lap '8a131AMS %uu!edaJ 'Huglas u! p@W -110 yoajayl aaAoldwa jo jua8e Aue of io 'uopei!ueAjo In uosjad Aue of (1) PART B —This Declatvtions page, with "POLICY PROVISIONS —PART A," and endorsements, if any, issued to form a part thereof, comS the below numbered CALIFORNIA PUBLIC ENTITY SPECIAL isRENENSIVE LIABILITY POLICY ' PACIFIC INDEMNITY COMPANY HOME OFFICE: LOS ANGELES, CALIFORNIA PoNeyme. LP 11624 Item T. Named Insured and Mailing Address: (No., Street, city, county, state, zip code) • CITY OF NEWPORT BEACH • 3300 NEWPORT BLQD.d • NEW PORT BEACHV CALIFORNIA 92660 previous Policy NEW uodeFIFF10eg Office ORANGE COUNTY PFmh= ANDERSON & MILUM Item 2. Policy Period: From FEBRUARY It 1972 to FEBRUARY It 1975 12:01 A.M., Pacific Standard Time Item 3. The named insured is: [—] County ® City F1 Other Item 4. The insurance afforded is only with respect to such and so many of the following coverages as are indicated by specific limits of liability. The limit of the company's liability against each such coverage shall be as stated herein, subject to all of the terms of this policy having reference thereto. COVERACES LIMITS OF LIABILITY $ 100t OOO. each person A. Bodily and Personal Injury Liability $ 300d OOO. each occurrence $ 30011 aggregate products B. Property Damage Liability — Automobile $ 1 000000. each occurrence $ 1002000. each occurrence C. Property Damage Liability —bmept Automobile $ 1 00 000. aggregate products $ 50, 000. each person D. Errors and Omissions Liability $ 150 000. aggregate Form Numbers of forms and endorsements forming a part of this policy at inception: Estimated first year premium is payable $ $2 d 2$0. in advance. Countersigned at LOS ANGELESd CALIFORNIA kk on FEBRUARY 10P 1972 — RB /SEG/LIL Form 1We02a (568) ,� J s i •14jadad to uogeulweluo3 8ell3eolpeJ 10 swio; lie sapnl3ul ,okomp IUadaid„ :leualew algeu0lss1; 10 ssew 1¢311113 a u1elu03 01 Jo U01;3604 U1043 Hullmddns -;1as a ul uolssll Jealm ulelsm 01 pasn J0 pau8lsap snletedde- Aueiivaaw ,,Xlaml aalam„ 'suollelado 43ns J0; pasn saslwald ue pue alts 43ns uo polonpuoo suallelada lie 'pale3ol sl HuloHaia; aql ;a Auq .4a1gM 1o' 41 ay; sapnpul pea 'egeM ;o lesodslp Jo aHeiols agl Jot pasn J0 paledald weld Jo saslwald 'uogm3xa 'ulseq 'aml3mis Aug (p) 'q£Z wnlueln ;o sweill OSZ ueyl BJOw 10 ';oalagl uollewgwao Aug Jo j(£Z wnlueln J9. wmuolnld ;o sweill 6Z uegj Blow swelu03 io 10 slsl = pale"I sl a3mBp JO luaw -dmba gins 81041A saspuaJd 041 le Palosry 041 10 Apalsm 841 w leualew 4ons to lunowe lelol 041 awll Aug le 11 joggles. 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Jo paJmsml ue 'la 11egaq ue io Aq paleiodo Ja 'Aq paumo Al!I!3ey ualxn Aug le sl (e) legalem Jealmo 041 (1) ill 'lmlalem salsas jo salgodeud sampleze j aql wog Hul nsaJ ¢teem 31 P Allada Jo AXfa1 Appoq 01 '820AA00 Al!I!ge13 Aug Japan -0 vogenue8lo Jo umad Lae Aq (1111x; salsm a 10 u011e10de 041 10 Ino 8ulsue pue legasm X81311 ;o salgadold sleplezeq 343 woJ; Huillnsai AJOfni Allpoq of 13odsoi gllM paJmoul sasuadxo of 'pie lsig 01 Hullelai uolslAM sueaw -Aed Aeluawaldg Aue Japn 10 'a81aa0n sluawhed 1e01pay hue lopun •g vollezlueHJo Jo uoslad Aug g11M '10a1a43 (oualle Aue Jo 'emouiV ;o salelS PBBun o4l Aq olul palalua luawaaJHe Aug Japun ';oalagl (3ualfe Aug JO 'e3llawy 11 salelS pl!un aql wm; Aliuwapw of pan11ua 'aq pinoM panssl uaaq IOU 43110d X111 1181 10 'sl Posts 841 (q) 10 '10a1ay1 fdolepuawe Mel Aug Jo '11561 1a 43Y AHJau3 3lwoli aq of luenslnd ualloolald Ieloueul; ulelulew of pannbal sl uollenueHJo Jo uosJad Aue (e) yaigm of laadsdi RM pue ltgalem xalma to salllgdoJd mo;=1 aql iLwj HuillnsaJ (Z) 10 :1!lige!l to llwll sll to uollsneyxo uodn uolleulwlal sll J0l Inq A31lod Ons Aue Japan paJnsul us aq pinoM Jo 'epeuoo 10 uolleimsy aminsul Je8131111 Jo s1allJMJaOn Al!I!go!1 (813113 3lwo1V IenlnW 'uoilmossy meJnsul Lllliquil 481803 Jeaj3nll Aq panssl 43110d 111114¢11 AHJaua lealm a Japan pwnsry ue 1X18 sl Am 1od slgl Japan palmsul ue gol4M al 13odsal gl1M (1) 98emep wadold Jo 6ofal Allpoq 01 'aHelaeo0 AJIIIge!1 Aug Japan •y :Aldde you soop 13llod s!gf 'I :Iegl pagae s! 11 (weal agotm 1N3w3S800N3 Nms11113)(3 01118YI7 A11103 FM3RN ENDLEMENT NO. 6 (The Attaching Clause need be completed only when this endorsement is Issued subsequent to preparation of use policy.) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following coverage part(s): PREMIUM INSTALLMENT ENDORSEMENT This endorsement, effective Febrl%fy,_ .1 4tan12a,& , forms a part of policy No. LP 11624 issued to CITY OF NEWPORT BEACH by PACIFIC INDEMNITY INSURANCE COMPANY Authorized Representative ANDERSON AND MILUM It is hereby understood and agreed that the advance policy premium of $82,280.00 is payable in installments as follows: Due Date: February 1, 1972 (408) Due Date: May 1, 1972 Due Date: August 1, 1972 FORM 21039 (ED, 10.661 45 MRTI (308) (308) $32,912.00 1.00 Installment Fee s32,3TT.-016 Total Installment $24,684.00 "1.00 Installment Fee 24,685.00 Total Installment $24,684.00 1.00 Installment Fee $24,685.00 Total Installment 1 rage I PACIFIC INDEMNITY COMPANY Policy No. jMtx L-P 11624 PR 11UM ANALYSIS FOR COMPREHENSIVE LIABP TY POLICY } ' (Long Form) Named Insured CITY OF NEWPORT BEACH A. ELEVATORS IY °e °I . Class Elevator Inter- Car Gate PREMIUMS Eleraio Location of Building on Which Elevators are Located P.', Fu Code Number lock Contact B. 1, P.D. I. 2. INCLUDED 3. 4. B. OWNER'S, LANDLORD'S AND TENANTS' Class Location of Premises Code NEW PORT BEACH , CALIFORNIA 996 etermining Premium B. 1. P FLAT TO TO 36,463. 139469. . 32,224. 12,428. 3: 4,239 19041. L.omprehenswe Personal Liability phow location of residence) b each occurrence g each person Med. g each accident Pay C. CONTRACTUAL INCLUDED D. MANUFACTURERS' AND CONTRACTORS' Class Code imatedla Annual or Receipts (b) Rates per $100 Classification of Operations B. 1. P.D. INCLUDED E. OWNERS' OR CONTRACTORS' PROTECTIVE Class Code Estimoted l C ost of Work let or Sublet Rules per $100 Description and Locator, of of Work INCLUDED F. PRODUCT— COMPLETED OPERATIONS Class Code Units: (a) Sales (b) Receipts (c) Gallonage Rates INCLUDED Form M1001b Page 1 age 2 PACIFIC INDEMNITY COMPANY Policy No. LP 11624 PREMIUM ANALYSLS.FOR COMPREHENSIVE LIABILITY POLICY fLOWG FORM- CONTINLTED) - vt.vor.ceanrr 68. v,a Name or Number Location County B.I. P.D. B. 1. P.D. C A (86) JL Mo-i : latre e 2 Ot .be: r C.�C I 3 r C1 t 'SO.TiTy Y Oj}e.fy agTatp�4 Da'"Lg ;� 169. 5 5 NEWPORT BEACH, CALIF. ORANGE 15.3 7.013 77. 35. A 580 (86) NOT SUBJ. S W/58% DISC. NEWPORT BEACH, CALIF. ORANGE 1.05 .421 609. 244. H. AUTOMOBILE - HIRED CARS 686. 279. Class or Type Location County Cost of Hire Commercial yy Passenger Ind. Contractor Broad Form J. GARAG 1.70 68. 41. 6 (L f1 Vy�.1R�VD e ✓ i✓ M1J tl V OLVI4l e1 VRt VV [ i• 80A 70. 49. '7t,Y 18. 12. JL Mo-i : latre e 2 Ot .be: r C.�C I 3 r C1 t 'SO.TiTy Y Oj}e.fy agTatp�4 Da'"Lg ;� 169. 120. ry y --e _- -'_ -f' .. 338. 240. i t i 66. RETROS, PREMS. NOT SUBJ. TO RETRO. j 4540 RATES TOTAL PREM. TOTAL PREM. j #OF YEH. CLASS BI PD BI PD BI PD 1.70 68. 41. 6 52. 37. 80A 70. 49. 25% 8CA 18. 12. 5CA 87. 61. 3CA 169. 120. C L.1 C L.2 4,896. 21952. 792. 144. 3,692. 2,627. 639. 142. 59040. 39521. 864. 144. 234. 156. 39. 13. 870. 610. 150. 30. 338. 240. 58. 10. 66. 34. 11. 11 4540 234. 155. 10. $159590. $10,381. $2,708. $4940 RETRO. PREMS. NOT SUBJ. TO RETRO. ABI $15,590.00 $2,708.00 APD 109381.00 494.00 UM 19135.00 PHYS. DAM. 29040.00 $27,106.00 $51242.00 TOTAi -AUTO, i $32- ,348.00 { s yy M i .cTT3-7-11 C?`P:J__ I t T I t INSURED: CIT F NEWPORT BEACI4 i EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE AtITnun RILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Policy No. LP 11624 PAGE 1 OF 21 Item No. Year Model Trade Nams s °errs., r.,1 L-1yn. u.e o °mc °,. s:: "i o.". . c;p. Identification Number Serial Number Motor Number Lo cafi on of Principal Garaging (City, County, $tote) e,e. i "i. r.°n.o °... Cl... Premium Bodily Inlury Property Damage Medical Payments 1. 71 WAYNE SWEEPER T -86 8 C 82. 51. 2. 71 WE LDR TRLR 25 %8CA 21. 13. 3. 71 JOHN LOADER DEERE INCLI INCLUDED 4. 72 WILLYS JEEP 6 S. 72 WILLYS JEEP 6 61 39. 6. 71 FORD LOADER TRACTOR 82- Si- 7. 71 DODGE 4 DR 2 ;r 9. 69 CHEV 2 D 10. 70 CHEV P 11. 70 �AERC 4 DR 546 .70 79. 43. 12, 71 DODGE 4 DR 222 POLICE. .70 79, 43. 13. 1 71 IDODGE . 701 79. j 43. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Some as Above Pu,0..ed New or S.H. Cortil Cc, Cost Pri v. Pa sa. $ym. i o w-o Collision Amount of In su ranee Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rote Premium Rate premium 1. 3353 18 261. 28. 2. 9283 1,536. 2. 3. 9282 1 5,606. 8. 4. 2807 3.350. 7. S. 2809 6. 7711 8.014. 13. 7. 301 4 -2 3.000. .22 7, 8. 0602 4 -6 1,500. .22 3. 9. 0603 4 -4 2 200, @ .22 S. 10. 0702 2,400. 3. 11. 1402 4 -3 2 400. .22 S. 12. 2003 4 -2 3.500. 1.22 8. 13 2 Form M1020c 1571) ccINSURED: .CITwF NEWPORT BEACH EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE iPolicy No. LP 11624 PAGE 2 OF 21 A"TM.^ett ee ♦CIO TPAN cRc AWMED !! Nt Y to URY Gun PROPERTY DAMAGE Item No. Year Model Trade Name Be°''rP' r.'I'L -d.n, r.,,.l�.=e < °.. e:: ^i e,.o cs. Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) ^. . o... cl Premium Bodily Injury Property Damage Medical Payments 14. 71 DODGE 224 POLICE 1.70 79. 43. 15. 71 DODGE 875 POLICE 1.70 79. 43. 16. 71 DODGE 876 POLICE 1.701 79. 43. 17. 71 DODGE 877 POLICE 1.70 79. 43. 18. 71 DODGE 878 POLICE 1.70 79 43. 19. 70 1,1ERC 4 DR 990 POLICE 1.70 79. 43. 20. 70 HERC 4 DR 073 POLICE 1.70 79. 43. 21. 70 iIERC 4 DR 070 POLICE 1.701 79. 43. 22. 70 MERC 4 DR 069 POLICE 1.70 79. 43. 23. 70 -MERC 4 DR 068 POLICE 1.70 79. 43. 24. 70 MERC 4 DR 071 POLICE 1.70 79. 43. li, 71 DODGE 4 DR R79 POLICE 26. 71 DOD U 0 9 3 AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Sam. Above PMo. '. New or S.H. Com'I Car Cost Priv. Pass. Sym. E - ws Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 14. 2005 4 -2 3,500 .22 8. 15. 2006 4 -2 3,500 @ .22 S. 16. 2007 4 -2 3,500 .22 8. 17. 2007 4 -2 3 500 .22 8. 18. 2010 4 -2 3,500 .22 8. 19. 2016 4 -3 3,000 20. 2021 -3 3,000 .22 21 2022 - 2024 4 -3 3,000 @ .22 7. 24. 2025 4 -3 3,000 22 7. 26. 2028 4 -2 3,500 .22 8. Form M1020c (571) luINSURED: •CIT F NEI'•1PORT BEACH Policy No. LP 11624 crouss AUTOMOBILE SCHEDULE EFFECTIVE DATE: 2 -1 -72 PAGE 3 OF 21 111CAU hilt O[ AHm TRAtI eRS OWNED SOD! Y IA1111RY AHD PROPERTY DAMAGE Ite m No. Year Model Trade Nome e °er TVe•� n°s w.•.n� 1..,a L°.e a °. e.:s ....o �:c. Identification Number, Serial Number Motor Number Location of Prince .. Garaging (City, County, $iota) a v,.•.o °., a °" Premium Bodily Injury Property Damage Medical Payments 27. 69 FORD 4 DR 197 POLICE 1.70 79 43 28. 69 FORD 199 POLICE 1.70 79 29. 69 FORD 196 POLICE 1.701 79 30. 69 FORD 198 POLICE 1.70 79 31. 69 FORD 148 POLICE 1.70 79 43 32. 69 HARLEY MOTORCY 547 POLICE 1 70 79 41; 33. 69 HARLEY _tIOTORCY 560 POLICE 1.70 79 1 4S 34. 69 FORD SEDAN 35. 70 MOTOGUZ I 804 POLICE 36. 70 ".,IOTOGUZ2 1 828 POLIC 37. 70 MOTOGUZ2 I 38. 65 HARLEY INIOTO , Y 1 337 170 70 39. 70 HARLEY NIOTORCY AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE tem Some Above Purchased Mo. Yr. New or S.H. Com'I Car Cost Pri v. Po ss. Sy m. E� u c uia Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 27. 2032 4 -4 1 @ Z8. 2033 4 -4 1,750. 4. 29. 2034 4 -4 1.750. 4 30. 2035 4 -4 31. 2039 4 -4 1 7S0. 4. 32. 2041 33• 2042 1,0 34. 2045 4 -4 1 750. 4. 35. 2046 1.0 0. .60 6. 1.40 36. 2047 1 000. 60 37. 2048 38. 2050 59. Form M1020c (571) K] INSURED: - CI0 OF NEWPORT BEACH • Policy No. LP 11624 CHUBS EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE PAGE 4 OF 21 AIITnUAMII Fc AM TO At CDC _ nWNFn - Rnntl YIN IIIRY AND PROPFRTY DAMAGF Item No. Year Model Trade Name "'z r'v. *..n w.;ve� r...0 �..e C.P. e - .ip.'. ..'n. Identification Number Serial Number Motor Number Location of Princi peI Garaging (City, County, State) e., i,„. P.o.. o. -. ° "" Premium Bodily Injury Property Damage Medical Payments 40. 70 WILLYS 1z T 839 POLICE 6 61 39 41. 70 WILLYS -z T 557 POLICE 6 61 39 42. 70 CHEV TRK. 132 POLICE 6 61 39 43. 67 INT'L VA14 027 POLICE 6 61 39 44. 71 DODGE 4 DR 219 POLICE 1.70 79 43 45. 68 FORD z T 801 POLICE 6 61 39 46. 70 : +iERC SED 072 POLICE 1.701 79 47. 71 DODGE SED 220 POLTC 1701 79 4� 8 49. 71 DODGE SED 221 POLICE 1.70 79 50. 70 it4ERC SED 547 51. 64 FORD SED 2 692 1 FIRE 11.70 79. 1 43 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Same Above Pu,ochYsed New or S.H. Com'I Car Cont Priv. Pass. Sym. E c Iua Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rote Premium Rate Premium Rate Premium 40. 2059 -2,000. 41. 2060 2-100-0— 3. 42. 2071 2,400 3. 43. 2073 1 0 0 44. 2074 4 -2 3,500. .22 S. 45. 2075 1,500 46. 2076 4 -3 3 0 47. 2077 4 -2 48. 2078 49. 2079 51. 2301 3-6 Soo Z Form M1020c (571) INSURED: ,CIT�OF NEKPORT BEACH Policy No. LP 11624 KIEFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE cH.rss PAGE 5 OF 21 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name e,ar Tn. o.ne., C. u..u. °e c. °. s. :1s:`:.: up. Identificotion Number Serial Number Mot., Number Location of Prindyol Gero ginq (City, County, State) eea. iii. P•°..o.m, 41a" Premium Bodily Iniu ry, Property Do mega Medical Poym ants 53. 65 CHEV ?_ T 768 FIRE 6 61 39 53. 54. 56 FORD li T 824 FIRE 6 61 39 55. 50 CROWN FIRE 412 FIRE SCAI 102 64 56. 65 SEAGRAV1 FIRE 900 FIRE SCA 102 64 35. 57. 52 LA FRANCE FIRE 107 FIRE SCA 102 64 58. 56 ivlACK FIRE 0S2 FIRE SCA 102 6 59. 57 3EAGRAVE FIRE 094 FIRE SCA 102 64 1 i7. 60. 50 MACK FIRE 425 FIRE SCA 102 rill 61. 66 FORD SEB i8. 2311 62. 61 SEAGRAVE FIRE LADDER IRK 947 FIRE SCA 102 i9. 63. 51 CHEV TRK 084 FIRE SCA 1PA 12s 64. 61 CHEV 3/4 T. 08c.1A FIRE ISCA 1.9 2.5 65. 1 67 1 PLY i ISTA.IVAG 1 7 ^ 51. tam Some Above Purchased Mo. Yr. New or S.H. Com'I Car Cosi Pri v. Pass. Sym. �u c w� Collision t of Amount Insurance fire Theft Comprehensive CAC Form Premium Re to Premium Rate Premium Rote Premium Rote Premium 53. 2305 Soo i4. 2306 600 35. 2308 10.000 @ is 36. 2309 20.000 .1S 30 i7. 2310 @ i8. 2311 100000 -1-9 1S i9. 2312 10.000 @ .15 50. 2313 SI,000 .15 R. 51. 2314 3 -6 80 i2. 2315 53. 2316 i4 . 2317 l'onn i5. 2318 4 -6 12,000 Form M1020c (571) INSURED: CITY • NEWPORT BEACH ` Policy No. LP 11624 C S HUB AUTOMOBILE SCHEDULE EFFECTIVE DATE: 2 -1 -72 PAGE 6 OF 21 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name e.e. r... r. `.L Srau i:a L -1cs' e.a tm%C.a Identification Number Serial Number Motor Number Location of Princippe l Garaging (City, Counry, State) eva. i. P -oa... Premium Bodily Injury Property Damage Medical Payments 66. 67 PLYRi 2 DR 292 FIRE 1.70 79 43 67. 69 P:IACK FIRE 062 FIRE SCA 102 64 68. 70 MACK FIRE 172 FIRE SCA 102 64 69. 70 CROWN FIRE 638 FIRE SCA 102 64 70. 69 CHEV STA.WAG 274 1.70 79 43 71. 70 WILLYS 'z T 884 6 61 3 72. 70 WILLYS 12 T 8SS 6 61 39 73. 71 WILLYS 7S. 71 WILLYS ?- T 371 78.1 67 CHEV % T 473 6 61 39 AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above Pu... h..od New or S.H. Corel Car Cost Priv. Pass. Sym, E u. w.6 Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rote Premium Rate Premium Rate Premium Rate Premium 66. 2319 4 -6 1 200 .22 3. 67. 2320 45,000 .15 68. .27 68. 2321 50,000 @ .15 75. .27 69. 2322 80,000 .15 120. .27 70. 2801 4 -4 I 00 2 71. 2802 72. 2803 73. 2804 7 75. 2806 1P500 2 78. 2818 1 000 1. Form M1020c 45711 CINSURED: -CI TOP F NEWPORT BEACH • policy No. LP 11624. �+�+BB EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE PAGE 7 OF 21 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name ?:n v:°cn� r..n L-d C.P. ar.:°s eu,o ,p Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) a °e. °�_ P. °.. o.m. " Premium Bodily Injury Property Damage Medical Poym cots 79. 66 PLYz1 SED 884 1.70 79 43 30. 70 FORD SED 610 1.70 79 43 31. 6S PLYi''1 SED 804 1.70 79 43 32. 69 FORD i T. 744 6 61 39 63. 69 CHEV !- T. 562 6 61 39 84. 66 PLYI SED S03 1 .701 79 43 85. 67 PLY ?1 SED 29S 1.70 79 43 36. 67 PLYH SED 296 I�U 79 43 38. 69 CHEV SED 538 1.701 79 43 89. 69 CHEV SED S63 1.70 79 43 90. 67 PLYM SED 297 1.70 608 1 1.70 79 1 43 AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE I torn Same A6ova PMo he r. New or S.H. Com'I Car Cost Priv. Pass. Sym. E.0 ws Collision Am aunt of Insurance Fire Theft Comprehensive CAC Form Premium Rote Premium Rate Premium Rate Premium Rate Premium 79. 2901 3 -6 700 .23 2. 80. 2902 4 -3 1 200 .22 3. 81. 2903 3 -6 300 .23 1. 82. 2904 1's 0 2 84. 2907 3 -6 400 .23 1. 85. 2908 3 -6 S00 .23 1. 86. 2909 3 -6 500 .23 1. 87. 2910 3 -6 400 .23 1. 88. 2911 4 -4 1,500 .22 3. 89. 2912 4 -4 1,500 .22 3. 9 2913 000 .22 7. Form M1020c 1571) CINSURED,:. CITY 0 NEWPORT BEACH • Policy No. LP 11624 criusE; EFFECTIVE: 2 -1 -72 AUTOMOBILE SCHEDULE PAGE 8 OF 21 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name °ed''r'•' r..n r.... L°.e C.n e. ^y :°..occ`:n Identification Number Serial Number Motor Number Location of Pr,ncepal Garaging (City, County, State) s.e. ^. o.m. °ei Premium Bodil Injury Property Damage Medical Poymerrts 92. 65 PLYIN SED 566 1.70 79 43 93. 69 CHEV SED 303 1.70 79 43 94. 70 CHEV z T. 778 6 61 39 95. 69 FORD 1 T. VAN 983 8CA 82 51 96. 67 FORD 'z T. 366 6 61 39 97. 67 PLYM SED 293 1.701 79 43 98. 69 CHEV SED 242 1 °70 79 43 99° 70 FORD SED 496 79 43, 100 71 t 101 66 FORD TRK 987 8CA 82 51 102 67 FORD AERIAL 711 8CA 82 51 103 69 FORD SED 144 67 IFORD ' T. 369 6 61 39 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE tem Same Above Purchased Mo. Yr. New or S.H. Com'I Car Cost Priv, Pass. Sym. E °u c c Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rata Premium Rate Premium Rate Premium Rate Premium 92. 3001 3 -6 400 .23 1. 93. 3003 4 -4 1,500 .22 3. 94. 3004 1 500 2. 95. 3005 2,000 2 97- S009 6 600 1 98. 3010 4 -4 2,000 .22 4. 99. 3011 4 -3 3,000 .22 7. 100 3201 2,500 4. 101 3203 4 500 5. 102 3204 15 686 17. 103 3101 4 -4 104 31 Form M1010c 157 1) CINSURED,: CITF NEWPORT BEACII • policy No. LP 11624 EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE cHuss PAGE 9 OF 21 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item Na. Year Model Trade Name e.e. TVn T=. =. w.;en u.e L..e c.v. T ° =1 c•�. c °v s., s...,,w ..v_ Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) sm. + °i. P. =v. mm. °vi Premium Bodily Inbr 1 T Property Damage 9 Medical Payments Y 105 67 FORD !i T. 367 6 61 39 106 65 WILLYS ' -2 T. 2S2 6 61 39 107 65 INT'L 1 T. DU`'i O1B -S 8CA1 82 51 108 65 CHEV '- -z T. 566 6 61 39 109 64 WILLYS 1 T. DUMP 119 8CA 32 51 110 65 INT'L 1 T. DU1:'d 10OB -5 8CA 82 S1 111 67 INT'L 2? T. 617 8CA 82 51 112 64 DODGE ^ PCA ^ 113 65 INT'L 2% T. 76FS SCA P17 51 114 70 INT'L , T. 580 6 61 39 115 67 GALION GRADER 121 1171 59 JOHN ARE TRACT 4R 053 82 S1 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE tem Saame Above Purchased Mo. Yr. New or S.H. Com•I Car Cost Priv. Pass. Sym. u u c wa Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 105 3104 1 SOO 2 106 3301 500 1. 107 3303 1,000 1 103 3305 Soo 1- 109 3306 Soo I 110 3307 1 000 1. 111 3311 18,650 20. 112 3312 4 709 5. 113 3313 2,000 2 114 3314 2. 500 4 115 3315 13, 759 15 117 1 3318 5 810 6. Form M1020c (571) U INSURED:. CIT )fF NEWPORT BEACH • policy No. LP 11624 EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE CHU0 ; PAGE 10 OF 21 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Nome s.'r r :.. r,.a w. ,r n.a ...a c.v. r..k ca. ov e.. Idencation Number Serial Number Motor Number Location of Principal Garaging (City, County, State) s.a. i,i. v�.v. o... °ao Premium Bodily Injury Property Damage Medical Payments 118 48 HUBER GRADER 431 INCI IN ELUDED 119 68 MOBIL SWEEPER 371 8CA 82. 51 120 65 CASE LOADER 987 8CA 82 51 121 70 INT'L LOADED. 1371 8CAJ 82 1 51 122 67 IESSICK ROLLED. 920 INC INCLUDED 123 67 INT'L BACKHOE 1056 INC -MCLUDED 124 62 ESSICK VIB. 385 INCI L' LUD 125 69 GAL 126 66 ALLIS TRACTOR 8207 8CAl 82 S1 127 66 FORD 2 T. 986 8CA 128 66 ALLIS TRACTOR 9970 129 66 ?JOBIL SWEEPER 850 8CA 82 S1 1301 67 FORD 13/4 T. 1 629 6 61 39 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE tem Same Above Purc Faced Mo. Yr. New or S.H. Com'I Car Cost Priv. Pass. Sym. E� c C.5 Collision Amount of Insuronco Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rata Premium 118 3319 2,200 2. 119 3320 14,250 15. 120 3321 13,312 15. 121 3322 17,025 24. 122 3323 4,848 123 3324 SPSSO 9. 124 3325 2,240 2. 125 3326 11 025 11. 126 3328 10,450 11. 127 3329 3,190 3. 128 3330 10,450 11. 129 33 1 Form M1020c (571) INSURED: . C 4 OF NE1PO':T BEACH KI EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE QHUaB • Policy No. LP 11624 PAGE 11 OF 21 AUTOMOBILES AND TRAILERS —OWNED — BODILY INJURY AND YKUYEKI T OAMAUE Item No. Year Model Trade Namn mer rrw r,.n w.,en, u-1 c.n a : "s`.:. ::�or Identification Number Serial Number Motor Number Location of Princippal Garaging (City, County, State) n°e. )re. v „v. o.m. a °" Premium Bodily Injury Property Domoge Medical Payments 131 67 TENNAiNT SWEEPER 743 INCI INCLUDED 132 67 TENNANT SWEEPER 744 INCI INCLUDED 133 68 CHEV 2 T. 890 6 61 39 134 63 DODGE 12 T. 869 8CA 82 51 135 69 CHEV i T. 645 6 1 61 39 136 69 FORD 1'-i T. 367 8CA 82 51 137 69 INT'L 21i T. 569 8CA 82 51 138 68 ALLIS TRACTOR 140 8CA 82 51 139 69 DODGE 2% T. 431 SCA 92 Si 140 69 INT'L 2 T. 879 8CA 82 51 141 69 MOBIL SWEEP , 69-S RCA 82 S 1 142 70 CHEV z T. 769 6 61 39 1431 70 INT'L z T. 170 1 1 6 1 61 1 39 AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE tem Sale Above Purchased Mo. Yr. New or S.H. Com'I Car Cost Pei w. Pass. Sym. u u e i,_l Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rote Premium Rare Premium Rote Premium 131 3333 "s 720 4. 132 3334 3,720 4. 133 3335 1 000 1. 134 3337 3,380 4. 135 3339 1.500 2 136 3340 3,000 3 137 3341 138 3342 139 3343 7,831� 140 3344 14,001) 15 141 3345 16.635 1 7, rno a �. 143 3347 2,500 4. Form M1020c 1571) IcINSURED: amussEFFECTIVE CIT`*F NEWPORT BEACH DATE: 2-1-72 AUTOMOBILE SCHEDULE • Policy No. LP 11624 re rr r me nwucn nnnu v win ev •un PROPSRTV DAMAGE PAGE 12 OF 21 Item No. Year Model Tra do Nama 1•.n w•e�• ldentificotion Number n.A Serial Number r ° °v c.i. c °° Motor Number Br. Sm,iny C°I Location of Principal Garaging (City, County, State) a °a.� ^i r.°.. o °m. °O1• Premium godi ly Injury Propmry Damage Medical Payments 144 70 DODGE 3/4 T. 362 6 61 39 145 70 FORD 1 T. 745 8CA 146 70 INT'L 3/4 T. 740 6 61 Sq 147 70 F.W.D. PACKER 036 SCAI 82 Si 148 71 INT'L 2 T. - 8CA 82 51 149 61 HUv1E 1AD CLEANER - I 150 66 ALLIS CLEANER 163 32 -gi 151 66 ALLIS CLEANER 166 87 51 152 67 LAYTON PAVER 2230B TNCT T r 153 68 ALLIS CLEANER 192 154 63 FORD 3 4 T. 640 fil 39 155 63 DODGE 1 T. 090 SCA 82 Si 156 1 63 III.B. I STRIPER - AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE It-- Same Above Purchased Mo. Yr, New or S.H. Com'1 Car Cost Priv, Pass. Sym. u c tua Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rote Premium Rote Premium Rate Premium Rate Premium 144 3348 L500 145 3349 4 500 7. 146 3350 6,125 1 0 147 3351 0 da— 666 148 3352 149 3378 3 300 150 3383 11.800 151 3384 111.700 152 3387 153 3391 R,350 9 154 3600 500 LSS 3601 L56 3603 Form M1020c 1571) INSURED: , CIb OF NE11•1PORT BEACH • C EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE cmuee Policy No. LP 11624 PAGE 13 OF 21 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name s °er ryr• T..n w.�sF. °°ec°r e:: "i::....er Identification Number Serial Number Motor Number Location of Princiyal Garaging (City, County, State) s =a. °i. v. °c. o °m. c' °•' Premium godi ly Injury Property Damage Medical Payments 157 68 CHEV i T. 611 6 61 39 158 70 MARK -RI E STPIPER 107 25% 3 C 21 13 159 67 GLG. STRIPER - INCL I CL. 160 64 FORD lz T. 862 SCA 82 51 161 70 INT'L 16 YD PACKER 020 SCA 82 51 162 70 INT'L ?z T. 820 6 61 39 163 70 INT'L 16 YD PACKER 260 8CA 82 51 164 71 INT'L 16 YD PA KER 373 8CA 82 51 165 68 GIIC % T. 793 6 61 39 166 70 FORD 1% T. 746 8CA 82 51 1-69 71 IXT-'L- 169 66 INT'L IPACKER I 37G -6 8CA 82 51 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Item Same Above Pu,ochYsed r. New or S.H. Com'I Car Cost Priv. Pass. Sym, E c a Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rote Premium Rote Premium 157 3604 1,000 1. 158 3605 1,000 2. 159 3673 1,000 1. 160 5001 1,000 1. 161 5002 15,830 24. 162 5003 4,290 7. 163 5004 18,125 28. 164 5005 17 750 28. 1 2 17 7rn 169 5022 12 090. 13. Form M1020c 1571) CI'idS "U RED: CITY4F NEi`aPORT BEACH EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE CMUBS Policy No. LP 11624 PAGE 14 OF 21 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name sear r.!. r,.a r•yxm n.a �..a c• °. u..•am. a.r s s„ .c.. Identification Number Serial Number Motor Number Location of Princi al Garaging Cit ount State (City, Y, ) e.e. i.i. v....... a °" remium Bodily Injury Property Damage Medical Payments 170 66 INT'L PACKER 86G -6 SCA 32. 51. 171 66 INT'L PACKER 27G -6 8CA 82 51 172 66 INT'L PACKER 11G -6 SCA 82 51 173 66 INT'L PACKER 876 3CA 82 51 174 67 INT'L PACKED. 087 8CAI 82 51 175 67 INT'L PACKER 997 SCA 82 51 176 67 INT'L PACKER 297 8CA 82 51 177 68 INT'L PACKER 208 8CA 32 51 178 69 INT'L PACKER 699 SCAI 927 51 179 65 CHEV j -4 T. 112 6 61 39 180 64 FORD 3/4 T. 142 6 61 39 181 70 DODGE T 1821 68 ICHEV % T sop 1 6 61 39 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE tem Same Above pure ho sed Mo. Yr. New or S.H. C. Car Cost Priv. Pass. Sym. u a C,� Celli sion Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 170 5023 12,090 13. 171 5024 12,090 13. 172 5025 12,090 13. 173 5026 17,285 17. 174 5027 12,270 175 5028 Z70 13. 176 5029 177 5030 178 5031 15,020 17. 179 5201 700 1. 180 5203 500 1. 181 5205 3,500 5. 182 1001 -1,000 1. Form M1020c (571) icINSURED: C.I1OF NEWPORT BEACH EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Pohc'y No. LP 11624 PAGE 15 OF 21 Item No. Yeor Model Trade Name e.eT T.w T..a w.;01 T..a i°.e c°,. eu: ^s`..'i c:°. Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) e,a. m,. rap. o.- °" Premium Bodily Injury Property Damage Medical Payments 183 69 FORD 1 T. 372 8CA 82 51 184 70 INT'L 68 CHEV 1 T. 496 8CA 82 -gi 186 68 CHEV SEI'MR CL 142 8CA 82 187 71 INT'L ' -- T. 826 6 61 188 60 FORD 1 T. 110 SCA 82 S1 189 67 CHEV 15 T. 53 190- 6g �I 191 71 INT'L 3/4 753 6 61 39 192 59 FLEXIBL SEWEROV R 073 INCL INC L 193 68 INT'L LOADER 1781 8CA 82 5 194 68 ESSCO- ESSICK PUT-'1P 256 INCL IN (L 195 1 68 INT'L AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE tem Same Agave Puro hosed Mo. Yr. New or S.H. Com'I Car Cost Pri v. Pass. Sym. E � a w�-° Collision Amount of In su rants Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rote Premium Rate Premium 183 1002 1 500 2. 184 1003 3,000 4. 185 5502 1,000 1. 186 5503 15 275 187 5504 188 U-9- S506 190 5508 -2-9,240 .30 88. .666 191 5509 4 0 192 5571 193 5572 194 5573 2,020 2. 195 5574 R-475 9. Form M1020c 1571) INSURED: CI OF NEWPORT BEACH • EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE Policy No. LP 11624 CHUBS PAGE 16 OF 21 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name e.dr Trrn *',. =wv°mF, rr.«G..e c.r. eaw , .o c;, Identification Number Serial Number Motor Number Location of Principal Garo gang (City, County, State) e.a_i ^+ r..r. o.m. °o" Premium Bodily Injury Property Damage Medical Payments L96 69 I<IELROE BOBCAT 145 INCL I CL 197 66 FORD z T. 116 6 61. 39. L98 67 PLYM STA.WAG. 291 1.70 79. 43. 199 69 FORD z T. 743 6 61 39 200 66 FORD WAGON 726 1.70 79 43 201 68 FORD S/W 344 1.70 79 43 202 69 CHEV S W 883 1.70 79 43 2 CHEV VAN 830 6 61 39 t ZD-i- 71 TNT I 206 65 CHEV z T. 403 6 61 39 207 69 FORD 2 T 796 SCA 82 51 208 1 68 ICHEV 3/4 T. 1 618 6 1 61 1 39 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Some Above Purochased New or S.H. Co.,[ Car Cost Priv. Pass. Sym. g c Wa Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rota Premium Rote Premium Rate Premium 196 5575 4,925 S. 197 5602 800 1. 193 5603 4 -4 1 000 .22 2. 199 5604 2,000 2. 200 5605 3 -6 2 2 204 7700 6,000 6. 20S 7701 3,000 4. 206 7702 600 1. 207 7704 6,580 7. 208 7705 1,000 1. Form M1020c 1571) INSURED: QLTYioF NEWPORT BEACH • Policy No. LP 11624 KI EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE PAGE 17 OF 21 cwuae AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name a °er r.r u.«w.;q,. n.a °.d c.v. e:: ^�a:�;a cev Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) am.i ^;. 1- ,.oam. Premium godi ly injury Property Da moge Medical Payments 209 66 PLY: =I SED S02 1.70 79. 43. 210 71 INT'L 1z T. 127 8CA 82. 51 211 70 INT'L 2 T. 650 8CA 82 51 212 64 INT'L 2 T. 3F4 8CA 82 51 213 62 G! 1C 12 T. 22A 6 61 39 214 68 CHEV '- -z T. 714 215 66 IFORD 1 T. 115 8CA 8Z 51 216 70 INT'L I T. 890 217 66 FORD TRUCK 572 8CA 82 S1 218 67 FORD ' -3 T 3618 6 61 39 219 67 INT'L z T 550 -7 6 61 39 220 64 FORD z T 291 6 61 39 221 1 69 CHEV 1 T AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Same Above PMo. Y'. New or S.H. Com'I Car Cost Priv. Pass. Sym. uis Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 209 7706 3 -6 S00 .23 1. 210 7707 8,275 13. 211 7709 3,440 S. 212 7710 4,030 S. 213 7712 50 214 7713 son 2- 215 7714 3,635 4 216 7715 4,800 7 217 7716 6,65S 218 7717 1 500 2 219 7718 800 1 220 7719 300 1 221 7721 4.555 5 Form M1020c (571) KIINSURED: -CI *OF NEWPORT BEACH Policy No. LP 11624 or�u EFFECTIVE DATE: 2_1_72 AUTOMOBILE SCHEDULE PAGE 18 OF 21 AUTnunnO Fc ANn TRAILERS _ OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Yeor Model Trade Name r.,,.0 w.:en� r, °.0 i °m c. >. e:: "iau;o c:e. Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, Stote) a °a.i "i. v „v. o °m. °a'• Pr mium Bodily Injury Property Damage Medical Payments 222 63 DODGE 12 T. 416 Rote 8CA 82. 5 !22 223 63 CHEV ' -- T. 781 500 fil- 39 224 70 DODGE ?- T. 257 7723 (11 KQ 225 70 CHEV % T. 027 6 61 sg !24 226 70 DODGE 1-'i T. 503 2,800 8CA 82 51 227 66 ASPLUND CHIPPER 309 7725 228 68 BEAN SPRAYER 81040 '26 229 65 PLYIH SED 710 1 70 79 43 230 71 INT'L 3/4 T. 720 6 61 39 231 71 INT'L T. 835 6 61 39 128 232 64 FORD %Z T. 293 1 105 6 1. 233 60 FORD 1 T. 647 9200 8CA 82 SI 234 1 61 I '30 It-- Some Above PwO sad Mo. Yr. New or S.H. Com'I Car Cost Priv. Pass. Sym. c w� Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rote Premium Rate Premium !22 7722 500 1. ' °23 7723 1 500 2. !24 7724 2,800 4. '25 7725 2 500 4. '26 7726 '2 128 7778 1 105 1. !29 9200 3 -6 500 .23 '30 9202 M 9203 U-2— 9 Soo Form M1020c (571) CINSURED: CIT *F NEWPORT BEACH criuse EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE • Policy No. LP 11624 PAGE 19 OF 21 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name B.dy T.p. T- 1-. ;01 4, ^t �°.e c° °. T ° ^sn °i. c °� B., s.m•. c. °. Identification Number Serial Number Motor Num bar Location of Printi pal Garaging (Cit Count State y• y• ) B.e °i P.°°.o °.. c,... Premium Bodily Injury Property Damage Medical Payments Z35 60 CASE TRACTOR 179 INCL INCL 236 65 INT'L 2z T. 98FS SCA 82. 51. Z37 70 INT'L 2 T. 780 6 1 61 39 238 63 INT'L TRACTOR 16830 NCL INCL 239 62 INT'L 2 T. 900A2 6 61 39 240 69 CHEV 3/4 T. 547 6 61 39 241 68 FORD % T. 1 593 6 61 39 242 70 INT'L 1 T. 740 3CA 82 51 243 70 INT'L 1 T. 580 LGA- 82 51 244 70 INT'L 1 T. 810 SCA 82 24S 70 FORD SED 246 65 INT'L ILOADFR 247 1 S7 STATE IGOLDEN RLR WiOUSE 36165 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE tem Some Ague. Purchased Mo. Yr. New or S.H. Cam., Car Cost Priv. Pass. Sy.. u o WJ; Collision Amount of Insurance Fir. Theft Comprehensive CAC Form Premium Rote Premium Rate Premium Rate Premium Rot. Premium 235 9208 5.365 6 236 9209 1,500 2. 237 9210 1.800 2 238 9211 240 9213 2 800 3. 241 9214 1,000 1. 242 9215 4,000 S. 243 9216 41000 5. 244 9217 4,000 5. 245 9218 4 -3 1 1 1,930 22 4. Z46 9271 6.950. 7. Z47 9971 3,530 L45 1 16 63 Form M1020c (571( K1 IiNSUREll;, Y OF NEWPORT BEACH • Policy No. LP 11624, ct+uss EFFECTIVE DATE: 2-1-72 PAGE SCHEDULE PAGE 20 OF 21 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name ,ar Tr.. * +.a..c u..a ., e:� ^s ;,, °.o c.°v. Identification Number Serial Number Motor Nom bar Location of Princiyal Garaging (City, County, State) a °d. m., v,ov.o °., a °" Premium Bodily Injury Property Damage Medical Payments 248 57 GOLDEN STATE HOUSE- TRL 995 INCL I CL 249 64 CUSHMAN 3W SCOOTER 245 POLICE 1.70 79 43 250 64 CUSH &IAN 3W SCOOTER 800 POLICE 1.70 79 43 251 64 FORD 2 TPU 238 POLICE 6 61 1 39 252 62 NIERC COMET 198 FIRE 1.70 79 43 253 62 INT'L 3/4 TPU 9B2 FIRE 254 43 HMIEMADH TRL I 83T % RCA 21 13 255 59 HOIIEIIAD °256 65 PLYM SEDAN 794 1.70 79 43 257 40 TONY BUM TRL 192 25% SCA 21 3 258 67 HAWKE ITRAILER 165 1 25% 8CA 2S91 67 ESSICK TRAILER 71 % SCA 1 21 11 260 1 64 HARLEY 140TORCYC E 098 6 61 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE tom Same Abevo Fur. ho sed Mo. Y, Now or S.H. Co.,I Car Cost Priv. Pass. Sym,.1 E o Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rote Premium 248 9972 4 745 .4S 21. 249 2053 NOT COV 250 2052 INOT COV 251 2081 N 252 2302 2 U— 2304 jn C.D11 254 2871 NOT COV 255 2872 NOT CO 256 2906 NOT COV 257 3371 NOT COV 258 259 3388 260 5 Form M1020c (571) INSURED: . CI � OF NEIVPORT BEACH • policy No. LP 11624 ac EFFECTIVE DATE: 2 -1 -72 AUTOMOBILE SCHEDULE PAGE 21 OF 21 Item No. Year Model Trade Name e.d. +rr.� n.a wM' Hens L-d cp.. e.. s..n.. o.. Identification Number Serial Number Motor Number Location on of f. 9 Princiyal Gara n {City, County, State) ma. �.I. oev o... Premium godi ly Injury Property Domage Medical I Payments 261 70 :,AOHANK TRL 6213 2S% SCA 21 13 :61 262 64 MOHAWK TRL 67A 25% SCA 21 13 263 67 HMIEMAD TRL 620T 25o BCA 21 13 264 58 HOIMEPiAD TRL 322T 250 °CA 21 13 :63 265 63 ELECTRIC 1VHL TRL 472 25% CA 21 13 266 61 INT'L 2 TPU 81SA 7779 6 61 32 267 67 HAIVKEYE TRL 0141 25% 3CA 21 :SiS L8,747. 10,596. :67 9275 MnT COV 2 040 tern Same Above Purcho sed Mo. Yr. New or S.H. Com'I Car Cost Priv, pass. 5ym. E ° w� Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium :61 7771 140T COV '62 7773 NOT COV :63 7777 NOT COV :64 7779 :SiS :67 9275 MnT COV 2 040 Form M1020c (571) Page 3 PACIFIC INDEMNITY COMPAQ Policy Nogg U 11624 PREMIUM ANALYSIS FOR COMPREHENSIVE LIABILITY POLICY )LONG FORM — CONTINUED) CREDITS FOR EXISTING INSURANCE CASUALTY PREMIUM Sec- lion Company Number Limits Expires Ile No Ist Year 2nd Year 3rd Year B.I. P D B I P D. B.I. P.D. B.I. P.D.. - Total B 36,463. 13p469. 36,463. 131,469 TOTALS TO BE DET. B.I. C B.I. AUTOMOBILE — B.1., P.D. AND M.P. Sec- lion Company Number Limits Expires Item No. Premium B.I. PD. M.P. B.I. P.D. M.P. E TOTALS F AUTOMOBILE PHYSICAL DAMAGE Sec- tion Compony Number Expires Item No. Premium Fire Theft Compr. Coll. CAC Less Cr. TOTALS SUMMARY OF PREMIUM CHARGES AND CREDITS PREMIUM RECAPITULATION Annual Premium Ist Year Premium 2nd Year Premium 3rd Year Premium Section B.I. P.D. Med. B.I. P.D. Med. B.I. P.D. B.I. P.D. A Net Automobile - Total B 36,463. 13p469. 36,463. 131,469 TO BE DET. B.I. C B.I. P.D. Net Casualty TO 1 BE DET, TO D E F Total Less Cr. C-0, 36,463t 13.469. G 686. 279. 686. 279 H I K 10 596 18.747._10,,596. Tarsal Less Cr. N, Au1. B.I.A P.D, Fire Theft Compr. Collision CAC L Less Cr. Pl A.I. h , Dam 2,040. PREMIUM RECAPITULATION Form M1001b Page 3 - ANNUAL PREMIUM - Ist YEAR PREMIUM B.I. including Med. Pay. P.D. Phys. Damage B.I. including Med. Pay. P.D. Phys. Dam. Net Casualty Net Automobile - Total 4P4 "IUM 2nd YEAR PREMIUM 3rd YEAR B.I. 1 P.D. B.I. P.D. Net Casualty TO 1 BE DET, TO Form M1001b Page 3 - -. _...._ 1" "_" s . 1� . ,._ .:.. t .' � . 1�'.- I � ;i � t � r t ` n -, - ��• s t a _� dWACIFIC INDEMNITY C0M$NY COVERAGE PART PROTECTION AGAINST UNINSURED MOTORISTS INSURANCE LP 11624 (California) For attachment to Policy No. , to complete said policy. SCHEDULE END. ' #1 The insurance afforded is only with respect to the following Coverage as indicated by specific premium charge. The limit of the company's liability against such Coverage shall be as stated herein, subject to all the terms of this policy having reference thereto. Advance Premium Limits of Liability Coverage INC LO 1 thousand dollars 30 thousand dollars U— Uninsured Motorists each rson each accident $ Form numbers of endorsements attached at issue L: Total Advance Premium Designated Insured Description of Insured Highway Vehicles (Check appropriate box) $] Any automobile owned by the named insured ❑ Any private passenger automobile owned by the named insured ❑ Any highway vehicle to which are attached dealer's license plates issued to the named insured :E] Any highway vehicle designated in the declarations of the policy by the letters "UM" and a highway vehicle ownership of which is acquired during the policy period by the named insured as a replacement therefor ❑ Any mobile equipment owned or leased by and registered in the name of the named insured El 1. COVERAGE U— UNINSURED M07DRISTS (Damages for Bodily Injury) The company will pay all sums which the insured or his legal representative shall be legally entitled to recover as damages from the owner or operator of an uninsured highway vehicle because of bodily injury sustained by the insured, caused by accident and arising out of the ownership, maintenance or use of such uninsured highway vehicle; provided, for the purposes of this coverage, determina. tion as to whether the insured or such representative is legally entitled to recover such damages, and if so the amount thereof, shall be made by agreement between the insured or such representative and the company or, if they fail to agree, by arbitration. No judgment against any person or organization alleged to be legally respon- sible for the bodily injury shall be conclusive, as between the insured and the company, of the Issues of liability of such person or organization or of the amount of damages to which the insured is legally entitled unless such judgment is entered pursuant to an action prosecuted by the insured with the written consent of the company. Exclusions This insurance does not apply (a) to bodily injury to an insured with respect to which such insured, his legal representative or any person entitled to payment under this insurance shall, without written consent of the company, make any settlement with any person or organization who may be legally liable therefor; (b), to bodily in1'ury to an insured while occupying a highway vehicle (other than an insured highway vehicle) owned by the named insured, any designated in- sured or any relative resident in the same household as the named or desig- nated insured, or through being struck by such a vehicle, but this exclusion does not apply to the named insured or his relatives while occupying or if struck by a highway vehicle owned by a designated insured or his relatives; (c) so as to inure directly or indirectly to the benefit of any workmen's campensa- tion or disability benefits carrier or any person or organization qualifying as a self- insurer under any workmen's compensation or disability benefits law or any similar law. 11. PERSONS INSURED Each of the following is an insured under this insurance to the extent set forth below: (a) the named insured and any designated insured and, while residents of the same household, the spouse and relatives of either; (b) any other person while occupying an insured highway vehicle; and (c) any person, with respect to damages he is entitled to recover because of bodily injury to which this insurance applies sustained by an insured under ia) or (1,f above. The insurance applies separately with respect to each insured, except with respect to the limits of the company's liability. III. LIMITS OF LIABILITY Regardless of the number of insureds under this policy, the company's liability is limited as follows: (a) The limit of liability stated in the schedule as applicable to "each person' is the limit of the company's liability for all damages because of bodily injury sustained by one person as the result of any one accident and, subject to the above provision respecting "each person ", the limit of liability stated in the schedule as applicable to "each accident" is the total limit of the company's liability for all damages because of bodily Injury sustained by two or more persons as the result of any one accident. (b) Any loss payable under the terms of this coverage to or for any person shall be reduced by: (1) the amount paid and the present value of all amounts payable to him under any workmen's compensation law, exclusive of non - occupational disability benefits; l21 amounts paid or payable to or for such person under any valid and collec- tible automobile insurance available to the insured to afford benefits for medical expenses; (3) the amount the insured is entitled to recover from any other person insured under the bodily injury liability coverage of this policy; and (4) all sums paid by or on behalf of the owner or operator of the uninsured high. way vehicle and any other person or organization jointly or severally liable together with such owner or operator for bodily injury to an insured. IV. POLICY PERIOD; TERRITORY This insurance applies only to accidents which occur during the policy period and within the United States of America, its territories or possessions, or Canada. V. ADDITIONAL DEFINITIONS When used in reference to this insurance (including endorsements forming a part of the policy): "designated insured" means an individual named in the schedule under Desig- nated Insured; "highway vehicle" means a land motor vehicle or trailer other than Form 181211, (470)\ (over) (a) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads, lb) a vehicle operated on rails of crawler- treads, or (c) a vehicle while located for use as a residence or premises; "hit- and -run vehicle" means a highway vehicle which causes bodily injury to an insured arising out of physical contact of such vehicle with the insured or with a vehicle which the insured is occupying at the time of the accident, provided: (a) there cannot be ascertained the identity of either the operator or owner of such highway vehicle; (b) the insured or someone on his behalf shall have reported the accident within 24 hours to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall have filed with the company within 30 days thereafter a statement under oath that the insured or his legal representa- tive has a cause or causes of action arising out of such accident for damages against a person or persons whose identity is unascertainable, and setting forth the facts in support thereof; and 41.0u!paaowd uo!jejj!gje palnl!1su! 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'si ajagl ya!gm jo asn jo a7ueualmew 'd!ysjaumo aqj 01 jaadsai gl!m ala!4an ABm4El4 a (u) ;sueaw „ alo!49A AeMg8I4 pamsu!un„ 'epeuea 10 aau!nad a pug'sajelS pal!un ayj to uo!ssassod jo Ajojujaj a 'emwnloo jo ja!jjs!a aql sapnlaw „ jels„ 'woj; BuilgVile jo olu! 8uuajua jo uodn jo w sueaw ,lutAdnon, 'ployasnaq awes ayj 10 juap!saj Aug jo pamsw paweu ayj to asn jeln8aj aqj jol pa4s!ujnl OID14DA a 'anoge {o) pue (q) sydez8eiedgns iapun (A!) jo'pajnsu! pa{euE!sap jo paweu 941 se ployasnoy awes aq ja wap!sai Aue jo pajnsu! paleuE!sap Aue 'pamsu! paweu 941 Aq paumo 013149A a 'anoge (0) pue (q) sgd6Rujedgns japun (pN !jaumo aqj 10 uo!ss!wjad ayl;noyj!m pasn au!aq al!gm ala!yae a (n) 'Aagod s!4j up paquasap pue pajeloap Ane04!aads si asn yans ssalun 'nU9A8nuo3 AjaA!1 m oilgnd a se pasn anyM a171yan a (!) :apniau! 1ou peys „113149A ACM4314 pamsul„ wjal ayj MCI !ployasnoy awes ayj 10 juap!sgj e;! j941!a 0 asnods ayj Aq jo pamsw pajeu3isap jo Pawn aqj Aq palejado au!aq ap4m (a) 'uo!jamjsap jo ssol '8u!71njas `j!edaj 'uMOPjewq sj! 10 asneaaq asn lewjou wojl umejp4l!M u04m 'anoge (e) 4dej8ejedgns w paquosap se 812148A Aglip pamsw ue jol ajnj!lsgns a se pasn ANjejodwaj a0gm (q) 'saildde bilod 04j JD 080Jan03 A11l!gen Amfu! A1!poq aqj ya!4m of 013149A AMOK pamsui ue se alnpayas ayj w paq!usap (e) +313143A ARM4114 a sueaw „31:;40A AM4814 pamsul„ 'luap!73e ata jo-awg 041 le linAdnaOo sum pamsw ayj 4014M 01714RA aql uop7adsup jol ajgelme saryew an!;eluasajdaj 1eEal siq jo pamsu! ayj 'jsanbaj s,Auedwo7 ayj IS (o) RETROSPECTIVE RATING ENDORSEM* NO 2 AUTOMOBILE — GENERAL LIABILITY In consideration of the issuance of the policy or policies stated below and the payment of the premium provided for in such policy or policies and as hereinafter provided for, it is agreed as follows: SECTION 1. This Retrospective Rating Endorsement applies to the following listed policies: LP 11624 Wherever the term "the policy" appears in this endorsement, it shall be construed to mean each numbered policy herein referred to, including endorsements attached thereto, and renewals and rewrites thereof affording insurance with respect to the period commencing FEBRUARY 1 19 72 and ending FEBRUARY 1 19 75 SECTION 2. Subject to all the provisions of this endorsement, the Retrospective Premium shall be the premium for the policy; provided, however, if such premium is less than the minimum retrospective premium, the minimum retrospective premium shall be the premium for the policy; and if such premium is more than the maximum retrospective premium, the maximum retrospective premium shall be the premium for the policy. SECTION 3. RETROSPECTIVE PREMIUM —The retrospective premium shall be the sum of: (a) The basic premium; and M Incurred losses; and (c) Fifteen percent (15 % ) of the incurred losses. SECTION 4. STANDARD PREMIUM — Subject to the provisions of Section 7 of this endorsement, the premium computed in accordance with the pro- visions of the policy, other than this endorsement, shall be known as the Standard Premium. The earned standard premium shall be used to determine the basic premium, the minimum retrospective premium and the maximum retrospective premium. SECTION 5. BASIC PREMIUM —The basic premium is that percentage of the earned standard premium stated in "Basic Premium" column of the "Table of Rating Values." SECTION 6. INCURRED LOSSES — Loss incurred under the policy shall mean (a) Actual paid losses, plus allocated loss expense; and (b) The reserves as estimated by the company for unpaid losses, including allocated loss expense. SECTION 7. It is further understood and agreed that, for the purpose of premium adjustment under this retrospective rating endorsement, the limits of incurred losses (exclusive of allocated loss expense which is to be included in full) shall be: 50P000.B.I. 50,000 -P.Dt and in consideration therefor, any premium charged in said policy or policies for insurance above such limits of liability or on account of any insur ante on which losses are not included under the provisions of this section shall be excluded from the operation of this retrospective rating endorse. ment. SECTION 8. MINIMUM RETROSPECTIVE PREMIUM —The minimum retrospective premium is that percentage of the earned standard premium stated in the "Minimum Retrospective Premium" column of the "Table of Rating Values." SECTION 9. MAXIMUM RETROSPECTIVE PREMIUM —The maximum retrospective premium is that percentage of the earned standard premium stated in the "Maximum Retrospective Premium" column of the "Table of Rating Values." SECTION 10. INITIAL COMPUTATION OF RETROSPECTIVE PREMIUM — Upon termination of the policy, the company will make an audit of the records of the insured in order to compute the earned standard premium and to determine therefrom the basic premium. The company shall determine the amount of incurred losses, including therein the estimates of the unpaid losses, including allocated lass expense, as of a date six months after termination of the policy and the company shall thereafter make the first computation of the retrospective premium on the basis of incurred losses so determined. SECTION 11. SUBSEQUENT RECOMPUTATION OF RETROSPECTIVE PREMIUM —The company shall make a second computation of the retrospective premium on the basis of the company's determination of the amount of incurred losses, including therein its estimates of the unpaid losses as of a date eighteen months after the termination of the policy and a third computation as of a date thirty months after the termination of the policy. (OVER) This endorsement forms a part of and is for attachment to the following described policy issued by the PACIFIC INDEMNITY COMPANY and is effective from the inception date of the policy unless another effective date is shown below. Form 18024a (869) AUTNORIZED REPRESENTATIVE _T POLICY NUMBER INBURIED OATS OF ISSUE EFFECTIVE DPTE aF HIS ENDORSEMENT LP 11624 Form 18024a (869) AUTNORIZED REPRESENTATIVE 53n1VA ONIM dO 319V1 —NVId ON)1VH 3AIDUSOHAS AillIlV11 IMN30 - 3116OWO1nV 'CI NO1103S '(p lot ul paynads so pauiwtatap aq lloys wniwaod aAipadsot4w wnw!xow ay4 'wn!wadd In 4uawAod -uou 4oj uo!tolaau00 In tuana ayl u! 4044 4daoxa 'wniwatd ptopuo4S pawoa yaps jo sisoq ayl uo patndwoa on ;jogs wniwatd aA!podsw4at ays puo s!soq o4m oid o no pa4ndwoa aq of at aato; ul s! 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O'CEI 0Es 5IC 000'09 O'Cat 069 0 s 000'11 O'PCI O'PS O ZC 000'SS 0591 0 0 O SC 00001 sain6g ayi ;o om1 Auo uaamtaq saq Aayod 0 "S[I 0 "SS 5 i 000405 0 L9l 0'IL 0450 000 "6 ayt JOI wniwatd ptopuows pawoa ay4 ;! :&ION O'act 0'9S 0 C COWS, 0'691 0 c 0 s coo's 0 'LE1 0 L 5 "EC 000'00 O'ILI 0 -C[ 0 S 000'L S'LEI 9 z 040E 00048E 0 -ELI 0 V 0 s 000'9 %S'LEL %S L9 %0'0E OOO'9C S %O SLI %0'9L %O SC 000'5 S -algoi w um04s w a.e a,e w.q, a.a wyi a°d so swn!wa4d aAlpadsoitaa wnw ^!i ad, ,d1 w {01004 »ds aA.� .d+ wnlw (atop a.iay -wia8 a,a aas! -wlaa o,wa a,a sasl -!xoW pVUO wnw!ulyr of palgns Inn .ow wowluiw +oa 4111 a,a Inn aow 9!w Ina(zi soa >(0 a,d '(SC'l ^ sassOl) + wn!watd lb (Z) p>opuDIS id p,vpuai. wa.d p,opuo45 fo sa6aNU,ad a.d P.opuog i9 vbnivavad ° al;og — wmwwd enpaadsdt4ad :o1lsuuo3 6u!4oy 53n1VA ONIM dO 319V1 —NVId ON)1VH 3AIDUSOHAS AillIlV11 IMN30 - 3116OWO1nV 'CI NO1103S '(p lot ul paynads so pauiwtatap aq lloys wniwaod aAipadsot4w wnw!xow ay4 'wn!wadd In 4uawAod -uou 4oj uo!tolaau00 In tuana ayl u! 4044 4daoxa 'wniwatd ptopuo4S pawoa yaps jo sisoq ayl uo patndwoa on ;jogs wniwatd aA!podsw4at ays puo s!soq o4m oid o no pa4ndwoa aq of at aato; ul s! Aailod ayt pouad ayi to; wniwatd ompuols pawoa aq4 'Auodwoa ay Aq uogolaauw 10 Juana ay4 ul — ANVdWOD 3H1 Ag NOIIVI3:)NV:) (q) "Aogod aq4 ;o atop uo!4ot!dxa lowtou ay o; papua4xa awoj u! si Aa!lod ayi pouad aql 10; 0404 ad pa0dwm wniwatd PJopu04S pawoa aq4 noun pesoq aq Iloys wniwatd aA!padsOt4at wnw!xOW aqi (PI "wniwatd aAlpadsm4at wnwlu!w aq4 aq goys paindwo os wniwatd piopunis pawoa ayi (C) 'Ao!lod ayt Lo; wnwatd a!soq ayi au!wta4ap o4 pasn aq lloys pa;ndwoa os wniwatd p�opuo4s pawoa ayi IZ) "papa)ja si uopolaauo> ya!gm u! pouad 044 to; 'AOilod yaoa o4 algovlddo ainpaowd puo algol aims !toys Atowotsro ay4 yt!m aauopooao u! paindwoa 'wniwaod pmpuois atoi 44oys aq4 puo spouad Aoilod lonuuo paieldwoa Ilo to; wniwatd piopuois ayi 40 Inns a4J so patndwoo aq Iloys wniwatd p,opuws pawoa eyl (1) :painsw aqt Aq uogolaxtw ;0 4UaAa aq4 ul —a3anSNl 3H1 All NOI1V13DNVD (0) :suo!siAOtd 6u!nsogo; a44 of palgns 4uewasiopua s!yt In su0!S!Amd 944 y{im a3uop4003o ui pojndwoo aq lloys wniwatd anpaatlsottat aq4 'Aailod ay ;o uo!toleouo0 In Juana ayi ul — 3iNVHnSNI 40 NOIIVNIW631 'CI NO103S 'wniwatd anpaadswlat wnwixow ayi 04 puo wn!wa>d 3Agaads0l4W wnw!u!w 9y4 o4 palgns a4o sapuna,.q s4uawtsnlpo IIV 'wniwatd enipadso>4at ay; jo uo!4otndwooat q>oa In awls ayt to apow aq goys %Iuaw4snlpo 6u!puodsa»oD ood Alsno!natd wn!waid aq4 uogi ssal s! wn!wadd 8A!13adsoilai 844 ;l AundwoD aq4 of piod Alsno!Aatd wniwatd aq4 puo wn!uretd aAipadsotta aq4 uaamtaq aaua4aj ;!p aq4 pwnsu! ey4 04 wniat Boys Auodwoo aql plod Alsno!Aatd wniwatd ay4 u044 ;8108;6 si wn!waid aAipadsat4ei ayt j! 'Auodwoo aq4 04 p!od Ajsno!natd wniwatd ayt pun wn!watd 9A1padsm4at ayi uaamtaq 8auatajjip a44 Auodwoa ayi of And lloys painsu! ay4 'wn!wa>d aA!padsoi4at aq4 ;o uopo ;nciwoa ;sdy ay; apow soy Auodwoa ay4 teyV -suo!s!AOtd Ao!lod ays yJ!m aauopto,,o u! plod aq !joys wn!wajd ' ptopuots aq4 puo Aallod a44 u! pagpads swniwatd puo Balm jo s!soq out no panss! aq llogs Aa!lod aql—wnlWB6d 30 1N3WAVd 'Ll NO103S 'uopo4ndwoa lout' ayi aq po4s uopotndwoaed 4aystn; g3n3 "Ao!lod ay4 jo uopou!wta; ays 1a44o sgtuow x!s -Ap!y4 atop o ;o so sassol piodun 94t 10 984nw1 4s8 s!! u!atag4 6uipnpu! 'sassol pannau! jo 4unowo ay4 ;o u01_ou!uua4ap s,Auodwoa ay; In s!soq a44 no wn!wa4d aA!padsot4ai ay; In uopotndwooat taypnj 0 allow po4s Auodwoo ayt 'uo!iotndwoo p!y4 aq4 tatjo pauadoa4 wo to undo u!owat sassol Auo It AOOMOBILE PHYSICAL DAMAGE ENDORSEMENT No. 3 (To be used with LP Policy) In consideration of the payment of the premium and subject to the limits of liability, exclusions, conditions and other terms of this endorsement, the company agrees to pay for direct and accidental loss of or damage, as defined herein, to automobiles owned by or registered in the name of the named insured, hereinafter called loss, during the endorsement period. The insurance afforded at the inception date of this endorsement applies to the automobiles listed in a motor vehicle record maintained by the insured, and only with respect to such and so many of the coverages as are indicated therein and as defined herein. AUTOMATIC INSURANCE FOR NEWLY ACQUIRED AUTOMOBILES The insurance afforded to automobiles newly acquired by the insured as owner or registered in the name of the insured during each 12 -month term of the policy shall apply as follows: COMM ERC I A L TYPE A U TOM OB ILES PRIVATE PASSENGER TYPEAUTOMOBILES Coverage E to all automobiles costing the insured $ NOT COVERED or more $ NOT COVERED or more Coverage F to all automobiles costing the insured $ NOT COVERED or more $ NOT COVERED or more (each loss subject to $ deductible $ - deductible Coverage G to all automobiles costing the insured 1 $ 250 DATE OF ISSUE or more $ 250 Coverage H to all automobiles costing the insured $ NOT COVERED or more $ NOT COVERED Coverage I to all automobiles costing the insured $ NOT COVERED or more $ NOT COVERED Coverage 1 to all automobiles costing the insured $ NOT COVERED or more $ NOT COVERED EXCEPTIONS or more or more or more or more The compan 's limit of liability under coverages E, G, H, I or 1, on any newly acquired automobile shall not exceed 100 % of the cost to the insured or $ $0 0�0 . whichever is the lower, and the company's total liability under E, G, I and 1, on all newly acquired automobiles shall not Bxeeed t 500, 000. Deposit Premium The provisional deposit premium for this endorsement is $ 1NCIDDED and is for the period beginning with the inception date of this endorsement and ending on the expiration of the policy or the next anniversary date of the policy. INSURANCE COVERAGES DEFINED Coverage E— Comprehensive Loss of or Damage to the Automobile, Except by Collision or of any fixed heating equipment serving the premises in which the automobile is located, Upset. Lass to the automobile, except lass caused by collision of the automobile with or (c) by the stranding, sinking, burning, collision or derailment of any conveyance in or another object or by upset of the automobile or by collision of the automobile with a upon which the automobile is being transported. vehicle to which it is attached. Breakage of glass and loss caused by missiles, falling Coverage H —Theft —Broad Form. Loss to the automobile caused by theft, larceny, robbery objects, fire, theft, explosion, earthquake, windstorm, hail, water, flood, malicious mis- chief or vandalism, riot or civil commotion shall not be deemed loss caused by collision or upset. Coverage I— Windstorm, Hail, Earthquake or Explosion. Loss to the automobile caused by windstorm, hail, earthquake or explosion, excluding lass or damage caused by rain, snow Coverage F— Collision or Upset —Full or Deductible. Loss to the automobile caused by or sleet, whether or not wind - driven. collision of the automobile with another object or by upset of the automobile, but only for the amount of each such lass in excess of the deductible amount, if any, stated in Coverage 1— Cambiaed Additional Coverage. Loss to the automobile caused by windstorm, the motor vehicle record or the paragraph entitled Automatic Insurance for Newly Acquired hail, earthquake, explosion, riot or civil commotion, or the forced landing or falling of Automobiles as applicable hereto. _ any aircraft or of its parts or equipment, flood or rising water, malicious mischief or vandalism, external discharge or leakage of water except loss resulting from rain, snow Coverage D —fire, Lightning and Transportation. Loss to the automobile caused (a) by or sleet whether or not wind - driven; provided, with respect to each automobile $25 shall fire or lightning, (b) by smoke or smudge due to a sudden, unusual and faulty operation be deducted from each loss caused by malicious mischief or vandalism. (OVER) This endorsement forms a part of and is for attachment to the following described policy issued by the PACIFIC INDEMNITY COMPANY and is effective from the inception date of the policy unless another effective date is shown below. FOR HOME OFFICE USE ONLY Form 1WO06 (568) MAST ALWAYS COMPLETE ONLY WHEN THIS ENDORSEMENT IS NOT PREPARED WITH THE POLICY OR IS NOT TO BE EFFECTIVE FROM THE INCEPTION BE COMPLETED DATE OF THE POLICY. POLICY NUMBER INSURED DATE OF ISSUE EFFECTIVE DATE OF THIS ENDORSEMENT LP 11624 FOR HOME OFFICE USE ONLY Form 1WO06 (568) 0 'totso!s!AOId algllonpap Aue Bwpnlow, 'Algige!l ;o sllw!l sloadsaJ se sal!gowolne aleaedas aq al play aq Negs olaaag; p843RIJO saal!eJl Jo JaneJl a pue 9131alaA JOIow a pue yoga as Ala ;eaedas Aldde lleqs ;uowasuopua sly; go swJal agl 7apunaJay painsm ale sallgowolne amw Jo oml uayM 'ial!eil!was apnioul pegs „Jalmij, prom agl 'o;uiayl pa43e11e Apuauewaad luawd!nba Jay ;o pue luawd!nba sit apnlaw Oslo Negs „ol!slow0lne, paom agl ial!eilwas Jo JapeJI 'alolyaA Jolow a ue01 lle4s luawaslopua slyl u! pasn Janaaa4m ,ajigowojne„ prom ag; 'Am woo ay; of palels Alleaglaads aiagm ldaox3 'sapgowaloy auaW JO_ mel Wapeil 'pougap opgowolny `l allgowolne 941 0; ssol Jot algep aal!eq Jo Jaweo Aue go;llauaq aq of Alloawpu! 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AluadoJd 941 Jo pied si ssol 941 aJOlaq awil Aue le olauagl aHewep luellnsaJ Aue Jot luawAed glim AlJadoJd ualols Aue wnpi Aew Jo 'pi,esaJOle se ';oaJagl lied yans Jo apgowolne aq 90e1daJ Jo JledaJ Am Jo Aauow w ssol aq1 Jot Aed Aew Auedwoo agl 'sal!gowolny pannboy AImaN Jot 93slanoO ogewolny pall!lue 4deJ?eJed JO PAN) OIDIgOA Jolow ay; u! palels Alll!ge!I }o jml algeopdde ay1 (E) Jo 'uoilmaJdap Jog uol;onpap 4l!m 'Al!lenb pue pu!q ayll ;o Jaallo gl!m goaJagl lied sloes Jo allgowolne ag1 aaeldoi Jo wedaJ of Isoo uaql pinom I! ;gym (Z) Jo 'ssol 10 ow!l le 'lied Bons go anleA ysea lenlae aq1 goaJaall ;Jed a 10 si ssol a4l It Jo 'apgowolne ag1;o onleA ysea lenlae 941 (I) J94l1a poaaxa IOU pays stool Jai A;!I!ge!I s,Auedwoo aqI go 11111 941 'Iuawuopuegy ON 'sualldo luawaglag 'Al!I!gel3 Io I!w!3 lesleJdde o; eupelaJ lag A11e Aq s ;431J s11 Io AN pOA1em OAe4 01 play aq lots pegs Auedw03 ayl 'aJ!dwn pue IRmidde lJ ay; go sasuadxa Jaylo a41 Allenba Jeaq pegs pue ias!eidde uasogo s1! Jo s!y had 4oea lleys Auedw03 941 pue palnsw 941-ssoi go lunowe a4l aulwialap pegs oml Aue 10 ?ullum w pieme uy awdwn 941 0l saouaial;i,p Ua41 I!wgns pegs aaJBe of 8wl!e; pue 'ssol 10 lunowe ayl pue stool go aw!; aql ;e onleA 4se3 lenlae aql Alaleiedas ?ujels'seal aql as!eldde uaql Ilegs sJas!eudde agl'Bwpuad si lesi.eidde flans yo!gm m elels pue Alum gal u! paooaJ ;o linoa a go a3pnl a Aq palaalas aq peals ncluin vans 'Andwo ay; Jo pamsui a4l its ;sanbaJ a4l uo 'uaql 'aJ!dwn vans uodn 0aJ?e of Shp uaalpi Jot 36p!el On 'awdwn pa ;saialwsip pue ;ualadwoo a loalas IsJg Ilu4s slas!eutlde aql aneld pue aw!; algeuoseaJ a 1e apew aq Ilegs lemidde ayl pue 9as!eudde palsaJalump pue;ualadwoo a loolas'Auedwoo a4l Aq ssol go IooJd go ld!anaJ Ja;1e SAep Alx!s u!gl!m spew 'J@41!@ ;o puewap ua ;lam ayl so 'Ile4s yoga 'ssol ;o lunowe 941 0l se aaAe of l!el Auedwoo aql pue painsui 941 11 'Iesieuddv 'aleu8!sop pegs Auedwoo a4l Be sa3eld pue Bawl; algeuoseai flans le Ile 'apew aq of imam l sa!doo Bu!lllwuad 'lsol aq slewH!io I! saidoo pagpaao JO 's9310nu! sales pue spJO3aJ luou!luad Ile uo!leu!wexa s,Auedwoo oq; Jai oonpoid pue awes ay1 aquosgns 'Rued -1103 041 Aq paleu8!sop auoAue Aq 4;eo Japun suo!leumon of 1!wgns pue Auedwo aall of AlJadoJd pa?ewep 1!q!gxa pegs pamsu! 941 IsanbaJ s,Auedwou 941 uodn 'AlJacoJd goes B1J9Ao3 anueJnsu! 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Peel? 10 ahleaaq ol'3 a?eaanoo Japan (3) 'aoueagwnoua Jaglo Jo 83e31JOw 'yuawagih ase4slnd 'ales leuogtpuoo 'areal luawl!eq a Japan ol!gowolne 94110 uo!ssassod u! uos)ad An Aq uo!lamas Jo luawalzzagwa 'UO!SJanuoo 01 gap ssal 01 'p pue 3 S001anoo Japan N) 'uollets!wgluoO aA!40e01peJ 0l anp ssol of (a) luaw - asJOpua s!4l Aq paa9no3 ssoi Jaylo se asneo awes aall woJ1 pue 4l!m luap!ou!oo aq ssol yans ssalun JO ualols Jo ws!IepueA Jo auy Aq p0owep ssalun s0J!1 as (p) 'sloa;la Ieuosaad Jo laJedtle Bupeom'sagoJ 101 (3) 'IuawasJOpua s141 Aq paaanoO ssol Ja4lu Io ;InsaJ ay1 sl aHewep yans ssalun 'ampel Jo umopgeauq 1e3uloala Jo leoluegoaw 'Ou!zaajj 'Joel pue Jeam 01 pauquoo pue anp si yo!gm allgowolne 941 01 aHewep Abe o; (q) '?u1029JO1 041 JO Aue 01 luap!nw UOII!puoo Jo toe AN o; Jo 'uo111110AW Jo uolpagsl 'uo!13aJJnSU1 'Jem 1!A10 'paJeloap lots its Ja4424m gem 01 anp ssol 01 (e) SNOIsm3X3 ' ;oaaagl slJOd tsaamlaq poluodsueJl Bu!aq s1 Jo 'paleool JBAam4m salels pal!up a4l ;o uolssassod me Jo e3uawy 411ON u!g1!m si apgowolne aql al!gm sagdde ;uawasJOpua s141 'AJO1lival algep 411ohl sawoaaq pamsu! ay1 4ot4m Jot sa?Je43 020AI¢P pue aBome !eaaua8 Aue Aed pegs 'yuawasaopua s!yl Aq papogge si se aoueJnsui uo11elmdtousll yans 04 ;oadsoi 4l!m 'Auedwoa a41'soDeg3 33ea!e5 pue 83euaey 1e4au86 Jaleap al!gowolne ue Aq ales Jot play pue paumo lots pue 83U0A9Atso3 AJaAII Jo O4gnd a se posts lots apgowolne Jahassed alenud a rem allgowolne ualols ayl 1! Aluo apew aq pegs luawasmgwlaJ gonS .11a41 yans Jai luawalllas sJapual Jo sagew Auedwoo aql se alep :Alddy ION saoo luawasJapu3 s!ql Jagaea yans uo Jo Auedwoo 94; m pamsw paweu ail; 01 tsmou? sawoaaq allgowolne aq1 go slnogeaJaym aql alep oql uo 'pwaad luawaslopua oql ;o uopendxa 110 ssalpJehi 'But - leu!wJal pue ao!1od aql pue Auedwon aqI o; palaodaJ uaaq sail gay; goes;alge smog lg3!a -Aluol Bulouawwo pouad aql Buunp paJJnow asuadxa Bons o1 pa1!wp; g luawasJngw!ay luawaslopua s!yl go Al!nge!1 10 l!wJ algeogdde ail; of uo!l!ppe u! Auodwoa a41 Aq algeAed st luawaslngw!aJ gonS -sgeo!xe1 Butpnlout 'apgowolne olnl!ls -qns a ;o leluaJ 041 Jot paJJn3w 'seal Si Janayo!4m '11aal1 10 awtl Is apgowolne aql Its a1110A ysea le013e 941 Jo ooE$ uegl aJOw Bu!Ie;o1 Jou Aep auo Aue Jot oj$ Builem 0 IOU asuadxa Jo; pamsui aql asmgw!aJ pegs 'apgowolne 9J!;ua a4l go luawaslopua slgl Japun paJanoa I ;agl a 3u!mopol 'Auedwoo a41 'luawasinqui lelued —llagl Aq asp 10 ssol SNOISIAONd 1tl1O3dS MUSTALWAYS COMPLEMORLY WNEN THIS ENDORSEMENT IS NOT PREPARED WITH THE POLICY OR 15 NOT TO RE4 . aE COMPLETZ, --41 PATE OF THE POLICY. POLICY-NUMBER LP 51624 - I R If(S{dBOFI f0lfll 1� 3 This endorse met d forms a , part of and It, for, attachment to the following described policy issued by the P A669. *111 effective from the inceptiop date of the icy unless another effective date is shown below. ' Ld f'JMNO OOM; OR'OFP AGENT l GATE OP'iSUE ° EFFECTIVE DNTE OF - TNIS ENDORSEMENT HORIZED RM y R .pA'b f ; it ... t m NI-- i •.L a.1r JC, YT1I 2 o- . .. ... ._.... ._.. I i .'.. ,.. - .. i. -..._. ::...f VII 1 n ' No. 5 CALIFORNIA FINANCIAL RESPONSIBILITY CANCELATION ENDORSEMENT It is agreed that the policy may not be canceled by the company or by the insured until the company has mailed written notice to DEPARTMENT OF MOTOR VEHICLES FINANCIAL RESPONSIBILITY, P. O. BOX 2431, SACRAMENTO, CALIFORNIA, stating when (not less than TEN (10) DAYS thereafter) such cancela- tion shall be effective. Delivery of such written notice by the company shall be equivalent to mailing. This endorsement forms a part of and is for attachment to the following described policy issued by the PACIFIC INDEMNITY COMPANY and is effective from the inception date of the policy unless another effective date is shown below. MUST ALWAYS BE COMPLETED Policy Numbor LP 11624 Form 2AO66 COMPLETE ONLY WHEN THIS ENDORSEMENT IS NOT PREPARED WITH THE POLICY OR IS NOT TO BE EFFECTIVE FROM THE INCEPTION DATE OF THE POLICY Imm.d I Eeoctlyo Deb of Thir Endonemonf AUTHORIZED RSPRESENTAT/ DO NOT USE THIS SPACE — FOR HOME O CE U ONLY 1r POLICY EXPIRATION E S. CAR TAX COMM. R STATE CITY CLASS D, EXPOSURE MOS. LIN PREM. WRITTEN PREM. CANCELED IOC. RATE MO. YR. MO. I YR. M -6. Limits of Liability— Products Subject to the li nobility with respect to "each Coverages A and C occurrence;' the a'Ii of liability under coverages A and C stated u. a declarations as "aggregate products" are respectively the total limits of the company's liability for all damages arising out of the use of or the existence of any condition in water sold or distributed by the insured during each annual period. 7. Limits of Liability The limit of errors or omissions liability stated in the declar- Coverage o ations as applicable to "each person" is the total limit of the company's liability for all sums payable under coverage D to any one person or organization. Subject to the above provision with respect to "each person;' the limit of errors and omissions liability stated in the declarations as "aggregate" is the total limit of the company's liability for all sums payable under coverage D during each annual period. 8. Limits of Liability For the purpose of determining the limit of the company's lia- bility, all bodily and personal injury and property damage arising out of continuous or repeated exposure to substantially the same general conditions shall be considered as arising out of one occurrence. 9. Severability of Interests The term "the insured" is used severally and not collec- tively, but the inclusion herein of more than one insured shall not operate to increase the limits of the company's liability. 10. Financial Responsibility Laws When this policy is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, such insurance as is afforded by this policy for bodily injury liability or for property damage liability shall comply with the provisions of such law to the extent of the coverage and limits of liability required by such law. The insured agrees to reimburse the company for any payment made by the company which it would not have been obligated to make under the terms of this policy except for the agreement contained in this paragraph. 11. Notice of an Occurrence Upon the happening of an occurrence written notice shall be given by or on behalf of the insured to the company or any of its authorized representatives as soon as practicable after an officer or an employee in charge of reporting such losses to insurance companies learns of the occurrence. Such notice shall contain particulars sufficient to identify the insured and also reasonably obtainable information with respect to the time, place and circum- stances of the occurrence, the names and addresses of the injured and of available witnesses. 12. Notice of Claim or Suit If claim is made or suit is brought against the insured, the insured shall immediately forward to the company every demand, notice, summons or other process received by him or his representative. 13. Assistance and Cooperation of the Insured The insured shall cooperate with the company and, upon the company's re- quest, shall attend hearings and trials and shall assist in effecting settlements, secur- ing and giving evidence, obtaining the attendance of witnesses and in the conduct of suits, and the company shall reimburse the insured for any expense, other than loss of earnings, incurred at the company's request. The insured shall not, except at his own cost, voluntarily make any payment, assume any obligation or incur any expense other than for such immediate medical or surgical relief to others as shall be impera- tive at the time of injury. The breach of any warranty or failure to comply with any l condition of this policy he part of any additional insured shall not affect or prejudice the rights of famed insured. The insured may, at the insured's own cost, have the insured's neys participate in the defense of any suit or in the prosecution of any appeal. 14. Action Against Company No action shall lie against the company unless, as a condition precedent thereto, the insured shall have fully complied with all the terms of this policy, nor until the amount of the insured's obligation to pay shall have been finally determined either by judgment against the insured after actual trial or by written agreement of the insured, the claimant and the company. Any person, organization or the legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this policy in the same manner and to the same extent as the insured. Nothing contained in this policy shall give any person or organization any right to join the company as a co- defendant in any action against the insured to determine the insured's liability. Bankruptcy or insolvency of the insured or of the insured's estate shall not relieve the company of any of its obligations hereunder. 15. Other Insurance If the insured has other valid and collectible insurance against a loss covered by this policy, the insurance extended by this policy shall be excess insurance only and not primary or contributing. 16. Subrogation In the event of any payment under this policy, the company shall be subrogated to all the insured's rights of recovery therefor against any person or organization not affiliated with or under the control of the insured, and the insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The insured shall do nothing after loss to prejudice such rights. 17. Changes No notice to any representative or knowledge possessed by any other person shall be held to effect a waiver or change in any part of this policy or estop the company from asserting any right under the terms of this policy; nor shall the terms of this policy be waived or changed, except by endorsement issued to form a part of this policy. 18. Cancelation This policy may be canceled by the named insured by mailing to the company written notice stating when thereafter the cancelation shall be effective. This policy may be canceled by the company by mailing to the named insured at the address shown in this policy written notice stating when not less than thirty days thereafter such cancelation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice. The time of the surrender or the effective date of cancelation stated in the notice shall become the and of the policy period. Delivery of such written notice either by the named insured or by the company shall be equivalent to mailing. If the named insured cancels, earned premium shall be computed in accordance with the customary short rate table and procedure. If the company cancels, earned premium shall be computed pro rata. Premium adjustment may be made either at the time cancelation is effected or as soon as practicable after cancelation becomes effective, but payment or tender of unearned premium is not a condition of cancelation. 19. Acts, Dinissions or Errors Any act, omission or error, on the part of any insured under the policy shall not prejudice the interest of any other insured under this policy. In Witness Whereof, the company has caused this policy to be executed and attested, but this policy shall not be valid unless countersigned by a duly authorized repre- sentative of the company. 44ZX/ PRESIDENT. Y �.;i frvtft F ^ s.Y 14S �e 1719�� I" �r �— END. #17 A.P. $25.00 (The Attaching Clause need be completed on lywhen thisendorsement is Issued subsequentto preparation of the policy.) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following coverage part(s), This endorsement, effective 10 / ?J74 forms a partof policy No. LP 11624 ( Ol A. M., standard time) issued to CITY OF NEWPORT BEACH by PACIFIC INDEMNITY COMPANY y� d. Authorized Representative IN CONSIDERATION OF AN ADDITIONAL PREMIUM OF $25.00, IT IS AGREED THAT THE STATE OF CALIFORNIA, ITS OFFICERS, SERVANTS AND EMPLOYEES IS AN ADDITIONAL INSURED BUT ONLY AS RESPECTS TO ITS INTEREST AS PROPERTY OWNER OF PARKING LOT ON THE NORTHWEST CORNER OF PACIFIC COAST HIGHWAY & NEWPORT BLVD., NEWPORT BEACH, LEASED TO OUR INSURED. FLAT CHARGE $25.00 CF:ma 11/1/74 Form 21039 (Ed. 1066) (5 PART) L- 6295(25M) u• i A. P. 25. END. #18 (7he Attaching Clause need be completed only when thisendoreement is Issuetl subsequentto preparation of the policy.) Thisendorsement modifies such insurance as is afforded bythe provisions of the policy relating to the following coverage part(s): This endorsement, effective IX /J, 474 ,formsapartof policy No. LP 11624 standard time) issued to CITY OF NEWPORT BEACH by PACIFIC INDEMNITY C� 4� if Authorized Representative IN CONSIDERATION OF AN ADDITIONAL PREMIUM OF $25.00, IT IS AGREED THAT THE STATE OF CALIFORNIA, IT'S OFFICERS, SERVANTS AND EMPLOYEES ARE ADDITIONAL INSUREDS BUT ONLY AS RESPECTS TO THEIR INTEREST AS PROPERTY OWNERS OF PROPERTY LOCATED AT S/S SEASHORE DRIVE BETWEEN 54TH ST., & SUMMIT DRIVE, CITY OF NEWPORT BEACH. ML:ma 12/9/74 Form 21039 (Ed. 10 -59) (5 PART), r� PAC K INDEMNITY 40MPANY HOME OFFICE: LOS ANGELES, CALIFORNIA —J (� —/f 3 BINDER OF LIABILITY INSURANCE Policy No. .11624 Previous Policy NEW Item 1. Named Insured and Mailing Address: (No., street, City, County, state, zip code) Underwriting Office ORANGE COUNTY CITY OF NEWPORT BEACH Predaer ANDERSON & MILUM CITY HALL 3300 NEWPORT BLVD. NEWPORT BEACH, CALIFORNIA BINDER Item 2. PA Period: From FEBRUARY 1 � 1972 to APRIL 1; 1972 12:01 A.M., Pacific Standard Time Item 3. The named insured is: ❑ County ® City ❑ Other Item 4. The insurance afforded is only with respect to such and so many of the following coverages as are indicated by specific limits of liability. The limit of the company's liability against each such coverage shall be as stated herein, subject to all of the terms of this policy having reference thereto. COVERAGES LIMITS OF LIABILITY $ 100, 000.00 each person A. Bodily and Personal Injury Liability $ 300,,000-00 each occurrence $ 3000000,00 aggregate products B. Property Damage Liability — Automobile $ each occurrence $ 100, 000.00 each occurrence C. Property Damage Liability — Except Automobile $ aggregate products $ 50 j 000.00 each person D. Errors and Omissions Liability $ aggregate Form Numbers of forms and endorsements forming a part of this policy at inception: AS PER USUAL POLICY FORMS AND ENDORSEMENTS Estimated first year premium is payable $ AS PER QUOATION SUBMITTED in advance. Countersigned at on Form nIW002a (Extra Dularnians) (568) JAN 31 1972 MANAGER �. CITY OF NEWPORT BEACH, CALIF. / v •Apadad In uopewweluoa aA!peo!pa ;o sw10; ne sapnlOU! „e8e1mp Ipadad„ '!e!�alew algeuo!ss!; ;o ssew leanua a weluoa of jo uonoeai wegqa'8u!lioddns -;las a w uo!ss!; mapnu u!e;sns o; pass in pau8!sap sn;eaedtle Aue sdeaw „zepwz mejo11„ 'suoneaado vans Jo; pasn sasmaid Ile pue aps vans no palanpuaa suoneado Ile 'paleaol s! 8wolazo; aql In Aue ya!gm no sops aql sapniaw pue 'gstM to Iesodsip jo a8eaols aql xo; pasn in pamdad aaeld ao sos!wad 'uoifeeoaxa 'u!se4 'a;n)aals Aue (p) • 'SEZ wn!uan ;o swei8 OSZ uegl aaow in ';oaagl uonewgwoa Aue io ESZ alpinoln Jo. wnpolnld ;o swez8 53 uegl slaw swe;uoa Jo ;o s;s!suoa paleaol s! saa?Aap to ;maw -d!nbe vans aagm ses!wozd ay; Is palsq ayl in Apolsna ay; u! leuafew Bqens In funowe Igol aqf aw!; Aug In p. lepgem Rejoin leloek ;o 8w6one JO 8wleauge; '8u!ss000ud ay; 301 pasn aomap insluawd!nbe Aue (a) 'alstM 8u!8egoed ao 8wssa3ad '8u!lpuey () in 'lso; loads 8u!z!I!ln in 8u!ssa3dd (Z) 'wnruolnjd zo.. wrowun in sadolos! ay; 8unaedas (p jol pasn jo pou8!sap 5o!Aap id• fuawdmba Aue (q) 'Alpeal R8I311 Aug (R) ';oauayl ((q) uo (e) ydeu8eued uapun p'Iloo; Ralae M •uo!puyap ayls!ypM papniaw Alllte; melons Aue in uo!lez!ue8io uo uosiad Aue Aq uo!leuado ay; wa; 8u!llnsai (Z) pue lepgen )tapolk 8u!u!elu03 (l) Ieualew alseM Aug sueaw „gseM„ 'Rhea Raises a w umle!peu of pasodxa uo pasn uaaq sey ga!gM 'p!nb!) in p!los 'luauodwoa Ian; uo; ;uawa)a Ian; Aue sueaw ,detl )nods„ ';oauagl fiolepueum Mel Ana u! 10 K6I !o lay A8iau3 a!woly ayl u! way; uaA!8 s3mueaw ay; aeey ,.Ieua)m p1 q„ pug '.Aelielem melons 1113 s„ ',Aelmlem asm/s., !leptlem lanpaLlq uo leualem mslool Iel3ods 'lepape somas sueaw „leliopm Repel„ 'sa!padad emsoldxa in Omni 'eA!laeo!peu apnjow „solpodozd slepmmq„ quawasiopua s!yl u! pasn sy 'll 0 •;eaagl Aliedad Aue pue Allloq melons vans of skimp Apadall of Aluo sa!ldde (S) uo!snjoxo s!q; 'epeueo in suo!ssessod io sauolwal s;! 'eauawy ;o sale35 pa ;!un ay; ulyllM paleaol s! Aln!oe; vans ;! A '(iq!aq melons Aue in asn uo uoi;eiado 'aoueualwew 'uw1on„su6 Twuueld ay; yq!M eallaaauda u! laawdlnbg io sped 'sle!ialew 'saa!tias ;o palsll us Aq $u!gslmn; ayf In foo Casio skimp Aluedod in fialgl glpaq ay; (E) JO 'pausal us ;o 1184aq no 10 Aq In posods!p is papodsuaq 'paio;s 'passaaod 'pasn 'palpuey 'possassod owg Aue in among ao Intl loads w pawelum s! It iolem melons aql (Z) 'wm ;amyl paaads!p ao paSjegas!p uaaq sey (q) in pausal us ' ;o ;legoq no ao Aq paleaado in 'Aq paa'm Al!Iloe; majosu Aue le s! (e) lepa)em malaao aql (l) ;! 'IolJgem mgona in saipsdod ssopmzeq aqf woz; 8unlnsaa akmap Almdod uo Amf1l Anpaq of Aejmq 4!I!geil Aue iapu0 .0 •uo!lenuello jo uosied Aue Aq dpnoe; maslItau a In uageiado ay; in lno 8u!sus pue lopomm metal ;o sa!pdad slapmmq aql won; 8u!llnsa Amfad Awn of loadsaa yq!M pajinaw sasuadxa of 'p!e asn; of 8u!lelaa uo!s!AO squaw -Aed fieluawalddnS Aue uapun uo 'a8eianq sluawh Ieo!paW Aue uapun .0 v011enue8uo uo uosiad Aue q;!M ';aauayf AauaBe Aue uo '8apawy ;o sa;els pallun agl Aq olw paaluo luawaau8e Aug uapun ';oauayl AauaBe Aue ua 'eauawy ;a salalS pa;iun eq wou; 4!uwapw of pall!;ue 'aq p!noM panss! uaaq ;ou Aanod s!ql peq io 'si pamsn aql (q) uo ' ;oaiayl Auolepuawg Mel Aug uo IS61 to lay A8u863 a!wofy agq of ;uensind uo!laa;Oud le!Odew; welu!ew of paumba sl uo!lez!ualo uo uosuad Aue (e) yo!gM of loadsw yj!M pue lopolem maltne ;o sa!padsd slopmnq ayl wou; Bunlnsau (Z) to '[;Illgell In q!wn sl! ;o uopsnegxa uodn uoileu!waal sf! uo; qnq Aanod vans Aue uapun paunsul ue ag pinOM JO 'epeue3 In uo!le!aossy aaueinsul malanN in sualuMUapun Aln!ge!n Mau] o!woly IenlnW 'uo!lemossy aaueunsul Al!I!ge!j A8uau3 ueapnN Aq panss! Aanod Al!l!gen ABuaua ueelanp a uapun - paunsw us osle. s! Aanod s!yl iapua .pags l ue yaip al loadsa ql!M (l) s8emep Apedad uo fitful Allpeq of 'a8oiae00 A4!nge!3 Aug uapun 'y :Aldde sou soup Aonod s!ql 'I :fegl paa8e s! ll (N80! Og000) 23113SNOON3 NOIS018R3 A11118tl11 A58313 8V3U8N I (PAYABLE AS SHOWIQ GN INSTALLPE1\JT EIZORSEMEIIT This endorsement forms a part of and is for attachment to the following described policy issued by the PACWIC INDEMNITY COMPANY and is effective from the inception date of the policy unless another effective date is shown below. 14, PREPARED WITH THE POLICY OR IS NOT TO RE EFFECTIVE FROM THE INCEPTION X_ N {f JAJ} I 1 IT IS AGREED i, i `_SHE SECOND J is PREMIUM PAYPIr,NT FOR THE Uf4DERNIEi3TI0 ,2 -1 6E, - =CY IS AS FOLLv;iS: EFFECTIVE DATE OF FEBRUARY 1, 1974 $16;"60..00 AUTO B.I. $8?+,898.o0 9,767.00 AUTO:P.D. 1/23/74 2/1/74 2;25171. 00 AUTO PHY, DAM, 40d�57.00 OTHER B. I;. 167.00 OTHE? P.D. (PAYABLE AS SHOWIQ GN INSTALLPE1\JT EIZORSEMEIIT This endorsement forms a part of and is for attachment to the following described policy issued by the PACWIC INDEMNITY COMPANY and is effective from the inception date of the policy unless another effective date is shown below. KIND I COMM. I SR. OFF.1 AGENT Form 1A026a PRODUCEi AUTHORIZED REPRESENTATIVE PREPARED WITH THE POLICY OR IS NOT TO RE EFFECTIVE FROM THE INCEPTION X_ N {f JAJ} I 1 PC DATE OF THE POLICY. GATE OF ISSUE EFFECTIVE DATE OF THIS ENDORSEMENT T B AcH 1/23/74 2/1/74 KIND I COMM. I SR. OFF.1 AGENT Form 1A026a PRODUCEi AUTHORIZED REPRESENTATIVE ,.T 0 ENDORSEMENT #16 r , (The Attaching Clause need be completed only w hen this endorsement is issued subsequent to preparation of the policy.) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following coverage part(s): This endorsement, effective 5/2/74 , forms.a part of policy No. LP 11624 (12:01 A.M., standard time) // .11 issued to CITY OF NEWPORT BEACH by PACIFIC INDEMNITY�CO . Authorized Representative IN CONSIDERATION OF THE PREMIUM CHARGED, IT IS AGREED THAT NO COVEREAGE IS AFFORDED FOR ANY CLAIM ARISING FROM ANY TYPE OF MOTORCYCLE INSTRUCTION OR TRAINING RENDERED BY AN INSURED TO THE GENERAL PUBLIC. SIGNED ACCEPTANCE �.,., Form 21033(Ed.10 -68) .L- 2373(20M) ai.' J ENDORSEMENT 415 (The Attaching Clause need be completed only when this endorsement is Issued subsequent to preparation of the policy.) This endorsement modifies such insurance as isaffordedbythe provisions ofthe policy relating to the following coverage part(s): This endorsement, effective 5/2/74 (12:01 A.M., standard time) issued to CITY OF NEWPORT BEACH by PACIFIC INDEMNITY forms a part of pol icy No. LP 11624 IT IS AGREED THAT THE POLICY IS AMENDED TO INCLUDE THE FOLLOWING ADDITIONAL EXCLUSION: G: UNDER COVERAGES A AND B THIS POLICY DOES NOT APPLY TO AUTOMOBILE LIABILITY AND AUTOMOBILE PHYSICAL DAMAGE FOR ANY BUS OR BUS TYPE VEHICLE OWNED, MAINTAINED OR USED BY THE INSURED, EXCEPT A 1972 FORD 24 PASSENGER BUS. SIGNED ACCEPTANCE �s►wrrd�aa_s�`.. ENDORSEMENT NO. 1� A. P, R. P. INSTALLMENT PREMIUM ENDORSEMENT - 2ND ANNIVERSARY It is undenetood and agreed that the premium change in the poZicy de to be paid in .ine.tat.Cmentb in the 4ottow.ing manner: DATE AMOUNT PAYMENT DUE DUE 2/1/74 $33,959.20 511174 $25,458.40 811174 $25,469.40 TOTAL $84,898.00 Th.ia endoAeemen.t 6on.ma a pant o4 and .La SoA attachment -to. the bo.2.Cow.ing deecr.ibed policy .ibaued by-the Paci6ic Indemnity u�Company and is ebbec,t.i-ve bnom the inception date o et�cy ano.then ebbee.ti-ve date .t_6 whobn bekow. EFFECTIVE DATE of this ENDORSEMENT is February 1 , All other terms and conditions remaining unchanged. Attached to and forming part of Policy No. LP11624 of the PACIFIC INDE TV COMPANY ISSUED TO: CITY OF NEWPORT BEACH DATED: )anUQAy 23, 1974 AT: NewpoA.t Beach, Cat.iboan.ia - Ao .orized Re entabve MILUM /GARVEV INSURANCE BROKE S, INC. 1974 Fo.m 9A0066 i -a -- �l <;: - a.. _. -.- -- �l cHUeta ACKNOWLEDGEMENT OF POLICY CHANT Please keep with your policy Policy No. LP 11624 Effective Da e — FEDERAL INSURANCE COMPANY _Y_ PACIFIC INDEMNITY COMPANY — VIGILANT INSURANCE COMPANY 92660 Expiration r P,S6Q� � Ch e 2 ang NEwi� CITY OF PiEfteRT Q6/7� ,1X ALI. Producer's Name and"AdciceQ� MILUM /GARVEY INSURANCE BROKERS 1617 WESTCLIFF DRIVE NEWPORT BEACH, CALIFORNIA 92660 J GREAT NORTHERN INSURANCE COMPANY SUN INSURANCE OFFICE, LTD. Other (Specify) This policy is hereby amended as follows in accordance with your request. The following automobile is added: Make Identification Radius of Year Model Body Style Number Operation 1972 FORD 24 PASSENGER BUS The following automobile is deleted: Year Make Garage Rate Original Location Class Cost —New 04 -86 5940 Identification Number Notice to Loss Payee: Such insurance as is afforded for loss of or damage to the automobile is payable as interest may appear to the Named Insured and: (Name and Address of Loss Payee) Other changes (additions, deletions, amendments of coverage or limits of liability): ADDITIONAL INSURED WITH REGARDS TO THE BUS, THE POLICE EXPLORER SCOUTS OF THE CITY OF NEWPORT BEACH, CALIFORNIA. If any premium adjustment or prescribed standard endorsement is required because of these changes, the premium will be adjusted or the appropriate endorsement issued at time of next audit or policy expiration. All other terms and conditions remain unchanged. Issued Form 1 A058 (671) 3/1/74 CF:rra AuthcY&T Representative • ' 0 IS -sa!ljed Ile ;o Aj!nba eq1 s;oa;ojd (uedwoo aq; pap!Aoid;sajalu! le Aped pea of apew aq Rew;UawALd a;ejeaes 'Ao!lod eq; japun anp sawooeq ajn;eu Aue ;o 1u9wA0d a janauagAq •w!elo sl! ;o lunowe pn; 041 JOA009J of japloqua!-I aq; ;o lg6u eq; iiedwi pegs uo!lebojgns ou ;nq'sai1pnoes jaylo gons 112 jo pue ;uaweeibe A1!jnoas jay ;o jo abe6 ;pow aq; ;o ja;suejl pue luawu6!sse pn; a aA!aoaj uodnajagl (legs pue 'lsajalu! q1!M ;uawaaj6e A;pnoas jag ;o jo abef5pow eq; uo anp Moj6 0l to anp led!owid alogM aq; japlogua!-j aq; o; Aed 'uoildo s;! le (ew jo 'lgap aq; o; Ieja;elloo se play sai1pnoas Ile japun 'apew aq Ilegs ;uawAed gons wogm o; Alied aql ;o s;g6u ay; Ile of pa ;ebojgns Allebal uodneiaq; aq 'luawAed gons ;o;ua;xo aq; ol'lle4s luedwoo eq; 'pals!xe jo;ajagl Al!I!gell ou 'jolgaa jaq;o jo jauMo 'jo6e6;jow 'aassa-1 eq; of se ';eq; w!elo (legs pue Ao!lod gons japun abewep jo ssol jol wns Aue japlogua!-I eql Aed llegs Auedwoo ay1 janauagm ;!ns bu!6u!jq ;o pue ;uaw (ed ;o awll pue Ieslejdde of 6u!lelaj Ro!lod ag1 10 suolslnojd ay1 0l loafgns aq pegs 'jagljn; pue 'Ao!lod agl Aq pap!AOjd se jauu0w pue wjo; ul 'ja;;eajaq; sAep !1x!s u!gl!m os op llegs japloqua!q gons 'suo!l!puoo Ao!lod eq1 ut pa;uej6 aw!l aq1 u!gl!m ssol ;o ;oojd japuej of sl!e; pajnsu! a4; ;I •luawaaj6e s!g; laoueo o; 'aogou a>I!l uo ';q6!j aq; aneq llegs.Auedwoo eq; pue u!ajaq; j9plo4ua1l p!es ;o lsajalu! 941 01 se angoa ; ;a aq hugs uolleleoueo gons ja;;eajaq; s (ep ual uegl ssal ;ou uegM japloqua!-1 aq; Apjou llegs /uedwoo aq; aseo gons u! 1nq 'swja; s;! Aq pap!AOjd se aw!l Aue le Ao!Iod gons laoueo o; ;q6!j aq; sanjasaj Auedwoo aql 'p!OA pue llnu aq Begs Ao!lod gons asimjaglo';oajegl asn aq; ;o wjal aq; jo; pjezeq poseajoui gons jo; wn!wejd ag; Aed 'puewap uo 'Ilegs japloqua!q aq; pue uoajagl pa;ou aq pegs ;l 'Ao!lod gons Aq pai !wjad sselun 'pue japloqua!l p!es ;o abpalmou� eq; o; awoo llegs 43114M pjezeq ;o aseajoul jo dlgsjauMO ;o a6uego Aue jo /uedwoo eq; A ;!;ou pe4s japlo4u91-1 ag ;;egl'osle pap!AOjd awes aq; Aed 'puewap uo Ileps japlogua!-I eq1 Ao!lod gons japun anp wn!wajd Aue Aed ol;oalbau (legs jolgap jaglo jo jauMo 'jobe6;joW 'aassal 941 9s0o u! leq; 'osle 'pap!AOjd pue'jo;ajaq; pled wn!wejd pue;su!e6e pajnsu! Alleoilpads,sselun'do!lod.4ons japun pajanoo;ou s! luew9aj6e Alimoas jay ;o jo a6e6;jow 'ales Ieuoll!puoo 'aseal ;uawpeq a japun pajnsu! Aljadojd aq ; ;o uo!ssassod ui jolgaa jaq ;o jo Aesegojnd 'jobe6;joyq 'aassa-1 ag1 6q uo!lajoes jo ;uawalzzagwo 'uo!sjanuoo aq; 1041 'janaMOg 'pap!Aoid'Aliedojd ag; ;o d!gsjauMO jo al1!; a41 u! 96uego Aue Aq jou jolgaa jaglo jo al!gowolne paq!josap uNl!M ay; 10 jauMo 'jo6e WON 'aassa -i aql ;o;oal6au 10 loe AUe Aq palep!lenu! aq ;ou Ilegs (japlogua!l aq1 palleo u!ajaq) Aped pajnoas jeglo jo 996e6 ;jow 'jopuaA leuo!l!puo0 'joss9-1 ;uawpea ;o aau6!ssV jo /lied pajnoas jay ;o jo aa6e6ljolnl 'jopuaA leuo!;!puOO 'joss9-1 ;uawl!e8 aq; ;o;soja ;u! aq1 0l Be eouejnsu! s!ql 39nV10 318VAVd SS01 Ze61 •jggW9A0N N011103— g19'0N Vf1VN 11 (9�eld An6u►ence broke n&- MILUM GARVEY .. 1617: WESTCUFF DRIVE / SUITE 204 / NEWPORT BEACH, CALIFORNIA 92660 714/645.0800 Febxuaicy 6, 1974 06jiee ob the City Manage) � City os Newpo &t Beach 3300 Newport Bouteva)d Newport Beach, Catijonnta Re: Comp&ehena.ive Genexat L.iab.izi.ty- Pacijic Indemnity In6uxance Company Pdtk'cy No. LP 11624 Genttemen: We have enctoaed he&ew.ith the eux&ent veh.icte U-6t jot the C.ity.'oj Newport Beach. The ann.ive &waxy .inatattment gox the team of febxuaxy 1, 1974 to Peb&ua &y 1, 1975 hae been invoiced and det.ive&ed to you) obs.iee. However, the enekoaed U.6t o6 veh.icted ahautd be attached to your potiey. IS you have any queat.ione, pteaae beet j)ee to give our o66 ice 'a Batt. Since &eCy, >MTLUM Y TNSURANCE BROKERS, TNC. ,Ln a e ea n, Ojjiee Manage& Enctoau &e/ Ppg I PACIFIC INDEMNITY COMPANY Policy No_AKx PREMANALYSIS FOR COMPREHENSIVE LIABILITY POLICY LP 11624 *..- (Long Form) Nine lm red CTfI'Y OF- NEWPOR EACH A. ELEVATORS Type Class Elevator Inter- Car Gate PREMIUMS Ele.ator Location of Building on Which Elevators are Located Pa :r. Fe. Code Number lack Conloct' -. B.I. P.D. l 2nd ANNI?I RSAUY SUXTEY: /i 74 TO 2 1/75 t� 2. 4 3. 4. TN!'. T.TTT -) Rn. B. OWNER'S, LANDLORD'S AND TENANTS' Class Location of Premises Code NEVIPORT BEACH, CALIF. 9 55 INCLUDED Ing n B.I. P.D. FLAT 1HARG each occurrence each.:person Med. each accident Pay D. MANUFACTURERS' AND CONTRACTORS' Class I poy�oll (a�nor ai Rotas per$ 100 Classification of Operations Code Receipts hl B.I. P.D. 1 INCLUDED Class asnmmea Hates per $ l UU Annual Cost of Code w„rs Ie. .., c..ue, B.t. P.D. INCLUDED F. PRODUCT — COMPLETED OPERATIONS Class Units: (a) Sales Code (b) Receipts (c( Gall 'INCLUDED Form M1001b Page I Rates B.I. P.D. 4o,957.1 14,967. i Page 2 �" PACIFIC INDEMNITY COMPANY PREMIUM ANALYSIS F R COMPREHENSIVE LIABILITY POLICY (LON G. AUTOM ILE = NONOWNERSHIP Name or Number Location County 2nd ANNIVELSARY SURVEY: 2/1/74 TO 2,'1/75 S Policy No. YADX _ 25 NEWPORT BEACH CALIF. ORANGE 15.3 ) 7• i L s 560 NEWPORT BEACH, CALIF. ORANGE .959 •43 2 H. AUTOMOBILE — HIRED CARS Class or Type Location I Commercial Passenger Ind. Contractor I. AUTOMOBILE — DRIVE OTHER CARS Limited Form Broad Form I J. GARAGE LIABILITY D.e.....a. — rl..e...n..... (1) CIS (3( Class (I) 191 i 177. 537. 2 241. 920. 4 (01 K. AUTOMOBILES AND TRAILERS - NED - BODILY INJURY AND PROPERTY DAMAGE ... Cost of Hire 383;, 1 177. 537. 2 241. 920. 4 418. Location o Bad. ln' Premium Item Year Trade f non w.;gni i. i..a L. c.e. Serial Number Prncipal Garaging hopDam o i y roperly Medical . No. Model Name a s °sue °:ccc°vo. Motor Number Cit County, Class Dama a Payments ( Y. y, In'ur, g SEE SCHEDULE ATTACHED: v - I L. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Item Purchased Com'I Car Cost Collision Amount of Fire Theft Comprehensive CAC Same Mo. Yr. „5 as K Nev, or S.H Priv. Pass. Syn. wa Form Premium Insurance Rate Premium Rate Premium Rate Premium Rate Premium LE HE D: rorm WWII) Yage 2 I I L. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Item Purchased Com'I Car Cost Collision Amount of Fire Theft Comprehensive CAC Same Mo. Yr. „5 as K Nev, or S.H Priv. Pass. Syn. wa Form Premium Insurance Rate Premium Rate Premium Rate Premium Rate Premium LE HE D: rorm WWII) Yage 2 I rorm WWII) Yage 2 I U cr+ueB • • Policy No. LP 11624 AUTOMOBILE SCHEDULE PAGE 1 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE It.. No. Year Model Trade Name 8ee "T'''° T•°•�vhe� T' " "c ° °e t.e. Ta ^�ca. c °r s°. s...... c°e. Identification Number Moron Number Location of Princepal Garaging (City, Covnty, State) s.e. ^i t.' o.L a °" Premium Bodily Injury Property Damage Medioal Payments 1• 1973 DODGE 4 DR. SEDA 948 ADMINISTRATIVE o4- 86- 1998 -oo 60. 33• 2. 1970 MERCURY 4 DR SDF, 546 PERSONNEL 1998-00 66. E. 1967 PLYPT 2 DR 88 FINANCE lc)qa-QQ 66 4. 196c) CHEV 2 DR EN 2 iqQ8-oo 66 5. 1955 YALE ELE' CI J ORI'=FT 2101 PU iCI-I & WAREHOUSE INC UDED 6. 1970 CHEV. 1 TON PU 789 6 50. 32. 7. 1971 DODGE 4 DR. 5DN. 222, CITY ATTORNEY 1998 -00 66. 33. 8. 1368 CH V. - TON PU GEN. 50C SERV. -BLDG. MALT. 6 50. 2 1969 FOR"' 1 TON VAN 372 RCA ' 0. 19TO !NT'L TON PU 46 ' 1. 1973 DODGE 4 D R, S.r. 18 POLICE. 0 _ 2. 1973 DODGE 4 DR. SDN. 20 108 -00 66 AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Sapme Above Pjjoc I, ..d Now or S.H. Com'I Car Cost Priv. Pass. Sym. i c w- Collision Amount of Insurance Fire Theft Comprehensive CAC Farm Premium Rate Premium Rate Premium Rate Premium Rate Premium 1. 0301 4 2 4000 .12 5. 2. 0401 4 5 2400 .12 3. 3. 0602 4 0 1500 .12 2. 4. 0603 4 161 2200 .12 3. 5. 0701 NOT COV 6. 0702 2400 .16 4 7. 0801 4 4 00 12 4 8. 1001 1000 .16 2 9. 1002 1 1' 0. 1003 00 16L 4 1. 200 4 2 )' 2 2 Form M1020c 1571) 1 1 1 1 C, Policy No. LP 11624 crtuss AUTOMOBILE SCHEDULE PAGE 2 Item No. Year Model Trade Name Boer Trw I'M rave, T7.1t.°d t °.. ° ^�a °'.t °° c°.. Identification Number Serial Number Motor Number Location of Principal Garaging Cit Count State ( Y. Y, ) B.d. i ^. v,°..o.�. Premium Bodily Injury Properly Damage Medical Payments 3• 1973 DODGE 4 DR. SDN. 922 POLIC .1998 -00 66. 33. 4. 1973 DODGE 4 DR. SDN. 915 1998 -00 66. 33. 5. 19 DODGE 4 DR. SDN. 2 1 98 -00 66. 33. o'. 1273 DODGE 4 DR. SDN. 914 1998 00 66. 33. 7. 1973 DODGE 4 DR SDN. 926 1998 -00 66. 33. S. 10M DODGE 4 DR SDN. gig 1998-00 66. 33• 1973 DODGE 4 DR SDN.1 917 1998-00 66. 33. n. 1973 T,,or,,Gr 4 nm 912 1q08-O0 66. ' .1. 1973 DODGE 4 DR. SDN. 925 1998-00 66. 33. Q. 1 DODGE 4 DR. SDN. 921 1998-00 66. 33. 1 DODGE 4 DR SDN 91 1998-00 66. '4. 1 DODGE 4 DR SDN 16 1998-00 66. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Some Above Pjroy red New or S.H. Com'I Car Cost Priv, Pass. Sym. 9 c cl Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium .3. 2005 4 2 ..4000 .12 5. .4. 2006 4 2 4000 .12 5. .5. 2007 4 2 4000 .12 5. .6. 2008 4 2 4000 .121 5. 2009 4 2 4000 12 5. .8. 2010 4 2 1 -9. 2016 4 2 4000 .12 5. ?0. 2021 4 2 4000 .12 5. 21. 2022 4 2 4000 .12 5. ?2. 2023 4 2 4000 .12 5. ' -3• 2024 4 2 4000 .12 5. t4. 2025 4 2 4000 .12 5. Form M1020c 1571) G Policy No. LP 11624 dues AUTOMOBILE SCHEDULE PAGE '� Item No. Year Model Trade Name s.er rrr• r,,,n •.wx� * ° °x� =i. c.x s.. s..u.v o,. Identification Number Motor Number Motor Number Location of grind pal Garaging � City, County, State) e >a. i °;. P.cl- c' °" Premium Bodily In'ur I Y Property Da ma a 9 Medical Payments Y 5. 19/3 DODGE 4 DR. SDN. 924 C 1998 -0006. 33• 6. 1972 PLYM. 4 DR. SDN. 491 1998 -00 66. 33• 7. 1972 PLYM. 4 DR. SDN. 492 1998 -00 1 66. 33• 8. 1972 PLYM. 4 DR. SDN. 493 1998 -oo 66. 33. .9. 1973 ARLEY -D MOTORCYC E 29H3 1998 -00 66. 33. 0. 1972 ARLEY -D MOTORCYCLE 891-2 1008 -00 66. 33• 1. 1973 ARLEY -D MOTORCYC E 13x3 1898 -oo 66. 33. ;2 1 MILEY-D PHOTO C E - 7. 8 -Oo 66. ; 3 WHEEL 10 -- - ' {5. 1964 USHMAN 3 WHEEL LOOTER 800 1998-00 66. ;6, 10 ARLEY -D MOTORCYC E -- 1998-00 1 1 66. �7• 1973 ARLEY -D MOTORCYC E -- 1998 -00 66. 33. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above PMo. Y= °d New or S.H. Com'I Car Cost Priv. Pass. Sym. w� Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium ' -5• 2026 4 2 4000 .12 5. ?6. 2029 4 3 3500 .12 4. )7. 2030 4 3 3500 .12 4. >8. 2031 4 3 1 3500 .12 1 4. 2042 2000 M. 2043 120 U. 0 '2--- 2049 2000 33. 2050 600 2. 34. 2051 2860 9. i5. 2052 5 00 2. ;6. ;7. 1 2055 2860 Form M1020c 15711 3 L L I4 P AUTOMOBILE SCHEDULE Policy No. LP 11624 dues PAGE 4 AttTAMnAII Fc ANn TRAII ERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Made Trade Name e.er r.>. n„n "••s ^� n..0 ��e c=.. ... T —k °u.o -P Identification Number Serial Number Motor Number Location of Prin <i pol Ga ro Bing (City, County, State) me. i.i, v.q. o.m. °ai Premium Bodily Injury Property Do mage Medical Paymamn 8. 1973 3U SHMAN .?HEEL SCOOTER 1998 -oo 66. 33• 9. 1970 ARLEY -D MOTORCYC E 53HO POLICE 19 8 -o0 66 117 -0. 1970 TILLYS 1 TON JE P 8 6 �1. 1970 ,1ILLYS 1 TON JE P 55 6 F2. 1972 FORD g T. HU14 TRUCK NE 805 6 50, 3. 1970 CHEV. z T. HUM TRUCK NE 132 A. 1973 DODGE 4 DR. SDN. 927 1 08-0 1 6 INTIL. VAN 02 .6. 1971 DODGE 4 DR. SDN. 219 1 66 33 7• 1973 DODGE 4 DR. SDN. 928 1q 8 -0 ' .8. 1971 DODGE 4 DR. SDN. 220 1qq8-QO 66 9. 1972 PLYM. 4 DR. SDN, 4g8 lqq8-oc 66 33 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE tem Some Above P.rch ..d Mo. Yr. New or S.H. Com'I Car Cott Pri.. Pot-. Sym, E� u c . a Collision Amount of In....... Fire Theft Comprehensive CAC Form Premium Rata Premium Rote Premium Rate Premium Rote Premium 8. 2056 2 00 8 9• 2058 loo 0. 205 1. 2o60 2000 3 2. 2065 3. 2071 4. 2072 4 2 4000 .12 5. 5• 2073 1000 .1651 2. 6. 2074 4 4 3500 .12 4 7. 2075 4 2 4000 12 8. 2077 4 4 500 12 I 20781 4 Form M1020c (571) E Policy No. LP 11624 AUTOMOBILE SCHEDULE • C*4US13 PAGE 5 AnTnunnu cc AWn TRAtt coc _ nwNPn - Rnnit Y INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Nome Baer `'!' - 1'e.•s� n�ni,.ec. >. a :'s..1. �;e. Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) e,e.i- r..r. mm. n °" Premium Bodily Inlury Propery Damage Medical Payments 0. 1971 DODGE 4 DR. SDN 221 l9 8 -o0 66. 1. l 64 FORD 1 TON PU 2 POLICE - 2 1C)72 PT o6o 13. 1 1972 PLYM. DR. SDN 672 1 8 -oo 66. A. 1972 PLYM. I DR. SDN 494 19 8 -o0 66. i5. 1,972 PLYM. DR. SDN 495 1 8 -00 66. 56. 1971 DODGE DR. SDN 218 1 8 -oo 66. i 7. 10 TQ DODGE e 1 58. 1973 DODGE I DR. SDN 0 1998-00 66. 59' 1973 DODGE D.R. SDN -- 1 8 -oo 66. )0. 1972 BORD DR. SDN -- 1 8 -00 66. il. 1 1c)64 I ORD 2 DR SDN 901 1 FIRE 1 8 -00 1 66 AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE some Above c sed P ..o b New or S.H. Com'I Car Cost Priv. Pass. Sy m. Eu ui.2 Collision Amount of Insuronce Fire Theft Comprehensive CAC Form Premium Rote Premium Rote Premium Rote Premium Rate Premium 30. 2079 4 4 3500 .12 1I. i1. 2081 2000 .165 3. 32. 2082 4 3 3500 .12 4. 33. 2084 4 500 .12 4. 54 208 4 Ll. 35. 2086 ]r 56. 2087 4 4 3500 .12 4. 57. 2088 4 2 4000 .12 5. 58. 2089 4 2 4000 .12 5. 59. 2090 4 2 9600 12 4. D0. 2091 4 284 2 Form M1020c (571) E E .E E wl Policy No. LP 11624 AUTOMOBILE SCHEDULE cF+uum PAGE 6 AnTinunDU cc ANn rout DRC _ nwNFn _ isn Dlt.Y IN It] RY AND PROPERTY DAMAGE Item No. Year Model Trade Name °ed' r 1. .: .e C.P. 12 G. "C'P s.,. s.°rs C.,. Identification Number Serial Number Motor Number Location of Princi I Gans n po g� 9 (City, County, State) Pep. Ni.. a° Premium Bodily Injury Property Damage Medical Payments 2. 1973 PLYM 4 DR S r1 844 FIRE 1998-00 66, ,3. 1968 DODGE 2 DR SDN 6 66 32 )4. 1962 INT'L, /4 TON PU 89B2 6 1 5o. 2 )5. 1965 CHTJ. 1 TON PU 768 6 50. ,2. i6, 1956 FORD 1 TON PU 824 6 0. 2. )7• 1972 PLYM. 2 DR, SDN, 802 1998-00 66 i8. 1959 CROWN FIRE TRUCK 412 5CA 83, 51, )9. 1965 SEAGRAV FIRE TR CK 900 '0. 1952 LA FRAN E FIRE TUCK 107 qcA 8 1 '1. 1956 MACK IRE TRUCK 052 9CA 8 1 '2. 1950 MACK IRE TRUCK 42 8 1 '3. 1966 FORD 2 R. SDN, 66 1998-00 66 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE lorn Same Above Pjjoy'ed New or S.H. Com'I Car Cost Pri v. Pass. Sym. w� Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium i2. 2302 4 121 4000 )3. 2303 4 6 1500 .12 2 -)4. 2504 NOT i . 2 0 ' >6. 2306 600 1 )7. 2307 4 i8. 23o8 1 )9. 2309 '0. M10 '1. 2311 10,000 OR R '2. 2 1 L Form M1020c 15711 Policy No. LP 11624 muss � AUTOMOBILE SCHEDULE PAGE 7 ellTnunaN cc sun To All PRC - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name e.d'TrP' T�• =. ••vF T ...d C.P. T -^ ..I. C., w. s..�:.v c. r. Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) e• <.� ^i. P.P. D... ci °" Premi m Bodily I odil Property Damage Medical Payments 4. 1961 SEAGRAV FORD LA 85' DER TRUCK 947 Rate 5CA 83. 51. 4. 5. iggi 1 HTT TON RESCUE TRUCK 084 FIRE 04 -86 CA 160. 104. 6. i 6 iq67 I FLYM 4 8 1 8 -00 66. 500 l 6 L 2 DR. SDN. 292 1998-00 66. 6. 8. 1969 6 062 1200 CA 8 1. 1970 MACK FIRE TRUCK 2 CA 8 1. -q-- 0. 1970 r.RQl4TJ 5' AERIA TRTTrK 6-18 CA 8 1. B- 1. 1969 CNN 4 DR S I 274 MAR= SAFETY 1Q 8 -00 OR 66. r R84 2 21 6 50. 32. 3. 1970 PIILLYS i TON JE P 844 6 50. 32. 0. �4. 1971 WILLYS i TON JE P 305 80 000 6 50. 32. . 1971 WILLYS i TON JE P 371 2801 6 50. 32. 150Q 12 2 Some Above PMjoy red New or S.H. Com'I Car Cost Priv. Pass. Sym. wl Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 4. 2315 30,000 .08 24. 5. 2316 500 08 1. 6. 2 18 4 6 1200 .12 1. 1 B- P3pn 0 OR 36 9. 2 21 50,000 08 40. 0. 2 80 000 08 6 ;1 2801 4 6 150Q 12 2 PROP 1900 .16ci 2-- 2809 -nco 165 2. n 5- P806 Form M1020c (571) Policy No. LP 11624 AUTOMOBILE SCHEDULE I K] - 0 CHUE3M PAGE 8 .t n TnwinRD PC AM TRAIT FRC - DWNFD - RnnII YIN HIRY AND PRn PFRTY DAM ADF Item No. Year Model Trade Name ..av Tv - T- %w.qn, -1 �.m c... s..i e,::o c:v. Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) e.e. i.i. P..>. o... c' °" Premium I;odil Injury Pro ert Damage Medical Payments 6. 1972 WILLYS i TON JEEP 266 6 50. 32. 7-- 1973 WILLYS 1 MARINE SAFETY 04-86 0 2 .1 1 66 0. 1973 WILLYS i TON JEEP 965 6 50. 32• 1. 1974 WILLYS i TON JE P -- 6 50. 32. 2. 1967 CHEV. i TON Pu 478 6 50. 32. 13. 1943 i0MEMADE TRAILER 688T 8CA 17. 11. 14. 1959 H014EMAD BOAT TRAILER 72 25 8CA 17. 11. 1970 FORD 2 R SDN. 610 OMMU1998 -000 ELO 66. 6 1 PLYM 2 Di SDN 151 1 q8 -00 66. 1 6 o i or Pu 744 6 5o. 32. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above Purcchased New or S.H. Com'I Car Cost Priv. Pass. Sym. U wa Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 6. 2807 2,000 .16 3. s7. 2808 2,400 .11 3. 98. 2809 2,000 .16 3. S 2810 4 6 1,750 .12 2. )0. 2811 2 400 .11 3. )1. 2812 3 460 .11 4. )2. 2818 1 000 .165 2. . 2871 NOT COV )4. 2872 NOT COV . 2902 4 1,200 .12 1. )6. 2903 4 2 4,00o .12 9. Form M1020c 15711 Ic - 0 cr+uss AUTOMOBILE SCHEDULE 0 Policy No PAGE 9 LP 11624 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name e °ar *r°• T..=te.'C. u..< °.a <.e. G.1' C., Z. Soil "a C°I. Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) a °e. i "i. v..e. oam. C,... Premium Bodily In i I Y Property Damage a 9 Medical Pa menu Y 98. 1969 CHEV, 1 TON PU 562 6 50. 32. 1973 PL DR SDN 152 1998-00 66° 00 1 PL M SDILL 150 COMMUNITY DEV. o4 -86 -1 8 -Oo 66. 01 ic)67 i 67 PL D.J 19c)8-00 66. " .02. 1967 PLYM. 2 DR. SD14 29'0 1998 -00 66. 33. .03. 1969 CHEV. 2 DR. SDN 538 1998 -00 66. 33• .04. 1969 CHEV. D',. SDN 563 1998 -00 66. 33• .05. 1'-'70 FORD 4 DA, SA-; 6o8 10 8 -oo 66. 6 1072 PL 812 1 8-0O 1 66. _0 . 1972 PLY1. 2 DR. SDN 314 1998-00 66. 33. 08. 1072 PL1714° DR. SDN 813 1 98 -00 66. 33. 0 1 4 FORD PINTO -- 1998-00 66. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above P .,ach Yfed New or 5.H. Co.,] Car Cost Priv. Pass. Sym. E w.L Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 8. 2905 1500 .16 2. 99. 2906 4 2 4000 .12 5° LOO. 2907 4 2 4000 .12 5. L01 2oo8 1 61 500 1 1 LOP. P209 2 r, I 5 L03. 2911 4 6 1500 .12 2. L04. 2912 4 6 1500 .12 2. L05. 2914 4 5 3000 .12 4. Lo6, 2915 4 3500 .12 4. 107. 2916 4 3 3500 .12 4. L08. 2917 4 3 3500 .12 4. 018 1 2580 .12- Form M1020c 1571) C cr+uss Policy No. LP 11624 AUTOMOBILE SCHEDULE PAGE 10 AnTnunou ce AND TRAILERS OWNED _ BODILY IN URY AND PROPERTY DAMAGE Item No. Year Model Trade Name a °dr T.v. n.n w.�Pn, C.P. s�� ^i °,n:a °;v Identification Number Serial Number Motor Number Location Princiyal Garaging (City, County, State) a °e. ^�. P,w. D °m. n °" Premium Bodily Injury Property Damage Medical Payments 10. 1974 FORD PINTO -- 1998 -00 66. 33• 11 1974 FORD PINTO -- 1998-00 00. 33• 1 IQ72 I PLYM. SDN 815 PUB. WORKS-ENGII 1998-00 EERING 66. 33• 1 i 6 HEV . t DR SDN 303 1998 -00 66. 33• 1070 CHEV z TON FU 778 6 50. 32. 6q 1 TON VAI 983 8CA 67. 42. 6 i 6 iq67 FORD LTON Pu 366 6 50.1 32. 2 1 8 -OO 66. .{ SED 242 1998-00 66. 33. 1070 ROa I DR, SDN 496 1998-00 66. 33. WO GEN. SERVICES -A 1 8 -00 MIN. 66.1 33• 21. 13 MERC. DR. SDN 547 1 1998 -00 66. 33. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above Purchased Naw or S.H. Com'I Car Cast Pri Y' Pass. Sym, c wa Collision Amount of Insuronce Fire Theft Comprehensive CAC Form Premium Rote Premium Rate Premium Rate Premium Rata Premium _10. 2919 3 1 2580 .12 3. _11. 2920 3 1 2580 .12 3• L12. 3002 4 31 3500 .12 4. L13. 3003 4 6 1500 .12 2. L14. 3004 1500 .165 2. L1 005 2000 .16 L16 3oo8 1000 .161 2. L1 009 3 6 60o .12 1. L " 6 2000 .12 2. L1 911 000 .12 4. L 1500 12 2 21 1 4 2400 12 Form M1020c (571) C Policy No. LP 11624 AUTOMOBILE SCHEDULE a'"BB PAGE 11 A"TftMnPU Pc AMm TPAtt PPS _ OWNED - LkOD! Y 1M L1RY AND PROPERTY DAMAGE Item No. _m�� Yeor Model de -- Trade Name *••� " "r "' Tan4 G„ec e. e.. �;,. Identi ficotion Number Serial Number Motor Number Location of Principal Garaging (City, County, Stata) 9oa�I,, veo:w -. Premium Bodily Injury Property Damage Medical Payments _22. 1971 INTIL, z TON PTJ 821 PUB. WKS- ELECTRICAL 6 50. 32• _23. 1966 FORD TRUCK 8 8CA 6 L24. 1967 1 FORD 1z T. 3 AERIAL ' 711 8CA 67 4P- -25. 1065 ''.'IL VS 1 r2O *T JF P 252 GEN. SERV. -FILL MA N.- '2 .26. 1967 Fo:; log PU 367 6 50. 32 -27. 1965 1', 4T L 1 TON DU .4P 01.3 -5 8CA 67. 42. X28. 1973 FORRD 3 TON VACUW 364 8CA 67. 42. 29. 1965 CHEV. i TON PU 566 6 -30. 1965 INTIL. T. DUMP TRUCK 1003-15 67 42 -31. 1973 JOHN DEERE MOTOR GRADER -- 67 4P 32. 1973 FORD z T. DUM TRUCK -33. 1973 1 F oRD 242 T. DUMP. TRUCK 372 18CA, AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Same Above P.ochyfed New or S.H. Com'I Car Cost Priv. Pass. Sym. w� Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium .22. -)201 2 00 16 -23. 3203 4500 .16 .24. 3204 1' 680 16l 26. 25. 1301 - o .26. 02 .27• 3303 1-000 16 2 .28. 3304 15000 .11 1 .29. 3305 'D 00 . 16 1 .30. 3307 1 -000 16 31. 3308 26 0 1 ) 32. 09 8000 10 Bonn —L Form M1020c 1571) • AUTOMOBILE SCHEDULE Policy No. LP 11624 PAGE 12 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name Bed' r B�. =s w. °any c..n i..e C.p. * ° ^sv °.'c °° s.. S.m.. C., . Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) a °d.i ^„ P,.p. D... Cl... Premium Bodily In br I Y Property Dama a 9 Medical Pv ments Y 34. 1967 PIT IL. 22 T. PA TRUCK rCH 617 GEN. SE3V. -FIELD MAIP. 8CA 67. 42. 1(�64 DO T. DUM TRUCK P. 6 6 1Q 7 0 �mIL 2 T. DUM 1580 50 '2 106 TRACTOR -�8 1(] JOHN .i 4 �7E . l I �3 48CA67. 6 1968 PQOBIL SGdEEPER 371 42. 40. 190j CASE LOADER 987 8CA 67. 42. 41. 193-0 INT'L. BACKHOE 371 8CAj 67. 42. .42. 1967 ESSICK VIE-ROLLER COMPACTOh 920 INC UDED _43. 1,066 T INTILp CT -LOADS BACKHOE o56 8CA 67. 42. _44. 1 62 ESSICK VIB. COMPACTOR 8 INCLUDED L45. 1969 TALION g T. S ROLLER ATIC 928 INCL DEU AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above PF,ccy ied New or S.H. Com'I Car Cost Priv. Pass. Sym. u- u Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rote Premium Rate Premium Rate Premium Rate Premium L34. 3311 18 650 .16 31. L35. 3312 4700 .16 8. L36. 3314 2500 .16 4. L37. 3317 NOT COV. 8. 3318 5810 1.08 r L 20 14 2 50 16 24 L40. 21 1 1 .16q 22 L41. 22 1 8 1' L42 2 L4 24 L44. � 25 2240 1 C, 1 Form M1020c (571) AUTOMOBILE SCHEDULE Policy No. LP 11624 cfFUSa PAGE 13 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Nama e ^d. rrv' n.a ^ °e c°,. -1 L..0 e.� ^sa °.a c:. Identification Number Serial Number Motor Number Location of Pry ciyal Ga rogang (City, County, State) s °a.i ^i. c. v.el... n °'• Premium Bodily Injury Property Damage Medical Payments 6. 1966 LLIS CHALMERS TRACTOR GEN. 207 SERV. -FIELD MAI,. 8CA 67, 42. T. FLAT r� 080 p UCA 07. 42. 48.1 1966 ALLIS CHALMER3 TRACTOR 0 8CAI , 42. 4 . 1966 MOBIL SWEEPER 850 8CA 67. 42. 50. 1967 FORD 3 4 TON DUMP PU 629 6 50. 32. 51. 1973 MOBIL SWEEPER -- 8CA 6y. 42. .52. 1972 FORD z T. UTI BODY ITY 166 6 50. 32. iq6q CHEW- 1 T 649 6 0 2 J-2 T. FLA 367 8CA 67. 42. - IT1L. z LADDER T. TRUCK 6 8CA 67. 42. _ 6. 1 68 ALLLIS CHALMERS TRACTOR 140 8 A 67. 42. 1 6 INTI L 2 T, IL TRUCKI 87q 1 18QAI 67. 1 42. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above PMo. Yr. New or S.H. Com'I Car Cost Priv. Pass. Sym. 0 w-a Collision Am aunt of Insurance Fire Theft Comprahensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium _46. 3328 102450 08 8. _47. 3329 3190 .15 5. L48. 3330 10 450. .08 8. L49. 3331 11 70 161 2 . 0. 2 1000 16 L91, 1 L52. 3336 3 000 .16 L53. 3339 1500 165 2. L54. 3340 3000 .16 L55. 3341 118,465 .16 0. L56. 3342 7400 08 6. Form M1020c (5711 AUTOMOBILE SCHEDULE Policy No. LP 11624 .cNUSe � PAGE 14 AltTnunnll ec AM TO All PRC - OWNFD - ROnILY IN IIIRY AND PROPERTY DAMAGF Item No. Year Model Trade Name s'dr r T,�n w. v *e, .2 � -d c, ^s ;°.6 C., Identification Number Serial Number Motor Number Location of Prin <i pal Garaging (City, County, State) ..d. ia. Pew. D- cl- remium Bodily Injury Property Damage Medical Payments 58. 1969 MOBIL SWEEPER 695 EN. SERV. -FIELD MAIi. 8CA o 42. 59• 1970 CHEV. '- TON PU 769 6 50. 32. 60. 1970 INTIL. z T. DUM PICKUP 170 6 50. 2. 61. 1970 DODGE /4 `(IO1 FIJ 362 6 50. 2. 62. 1970 FO T 1g T. DUMP TRUCK 745 8CA 67. 42. 6. 1 0 INTIL. x 3L4 TON 74o 8CA 67, 42 64. 1970 F.11.D. YH P CKER 0'6 8 6 2 65. 1972 INTIL. x 2 TON 965 8CA 67. 42. 66. 1971 WAYNE SWEEPER 376 8CA 67. 42. 67. 1972 TENNANT PO ER SWEEPER 988 8CA 67. 42. 68. 1972 TEDT ANT PO4iER SWEEPER 1 989 1 18CAI 67. 42. 69. 1970 ESSICK CEMENT MIXER 025 INCL ED AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE rtern Same Above PMO. Y`. New or S.H. Com'I Car Cost Priv. Pass. Sym. ws Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 58. 3345 16,635 .16 27. 59• 3346 2500 i6 4. 60. 3347 2500 .16 4. 61. 3348 2500 .i6 4. 62. 3349 63• 3350 6125 16 io. 64. 51 48.16o 1. 16 65• 3352 r,5oo 16 2 66. 6-1 54 29.000 -169 41. 68. 69• 3373 NOT COV Form M1020c (571) C a AUTOMOBILE SCHEDULE Policy No. LP 11624 cHUSa PAGE 15 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trads Name w +T +?• T.. =1 M..YM i.;�L..' o. e.. s..1. c.,. Identification Number $miol Number Motor Number Location of Princiyal Garaging (City, County, State) e,e. ia. P=.,. oem. emium godi ly Injury Property Damage Medical Payments 0. 1968 WACKER TAMPE11 337 EN. SERV. -FIELD MAIL• INC UDED 2. 1967 HAWKE TRAILER 165 25 a 8CA 1Y. 11. 1966 ALLIS CHALIM13 BEACH CLEAIMR 161 8CA 67. 1 42 74. 1966 AL, IS CHALMER33 BEACH CLEANER 166 8CA 67. 42. 75. 1966 INGERSO RANT COMPRESS R go6m INCLUDED .76. 1966 INGERSO RAPTD L PUMP 2 1 INCLUDED 196 L T FAVER 8.023 8. 1967 ESSICK TRAILER 11 25,0 8CA 17. 11. 79• 1967 HAUCK KETTLE TRAILER OT 25 8CA 17. 11. .80. 1968 CHIPPER CEMENT 557 INCLUDED 81. i 68 ALLIS CHALIER BEACH CLEANER 192 8CA 67. 42. AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Same Above Purchased '. New or S.H. Com'I Car Cost Priv. Pass. Sym. w� Collision Amount of In surnnce Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 70. 3377 NOT COV. .71. 3381 NOT COV. 72. 3382 140T COV. 73. 3383 11,700. 16 1g. 74. 3384 11 00 16 1 . 3385 NOT Coy. 6. 86 8 79• 3389 NOT COV 80. 2120 NOT C Farm M1020c (571) Policy No. LP 11624 C AUTOMOBILE SCHEDULE PAGE 16 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name *...I •:''cn rv.. L -.c °v. T =•�c °i. c.v a,. s.,..v c... Identificotidn Number Serial Number Motor Number Location of Principal Garaging (City, County, State) a °e. �.�. r,w. o.m. c' °•• Promi m Bodily Injury Property Damage Medical Payments 82. 1970 INGERSOL RAND COMPRESS )R 901 EN, SERV. -FIELD MAIL. INC '=ED .83. 1970 ESSCO E SICK 4 x PUMP 104 INC UDED .84. 1 6 DODGE TON FLA RACK 090 8CAl 6. 42 .85. i()6 ML PAINT STRIPER I C UDED .86. 1968 CHZV. 1 T. Are /RAC, 611 6 50. 32, .87. 1970 MARK RITE PAINT STRIPER 107 INC UDED .88. 1971 MARK RITE STRIPING MACHINE INCLUDED .8 1a 1 TON FLIT RAC 4 8PA 0' 42, o 6 7 GlIG GREEN LI qrPRIPER E INC UDED 91. 1964 FORD 12 T. DU TRUCK P 862 GEN. SERV. -REFU E 8CA 6 42. 2. 1970 INTIL. YD. LO PACKER D 020 8CA 67. 42. 1 0 INTIL 2 T. DUM PICKUP F. 820 50. 2. AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Same Above PM.. Y'. New or S.H. Com•I Car Cosi Priv. Pass. Sy" � � tua Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium .82. 3392 NOT COV. -83. 3393 NOT COV. .84. 3601 1500 .16 2. .85. 3603 800 1.169 1° .86. 36o4 1000 .169 2. _8 6o5 1000 16 X88. 60'0 -89. 3607 4500 .11 5. 0. 673 1000 .16 2. 1. 5001 1000 16 2 2. 5002 158 165 26, 5003 4P90 i _LE! Form M1020c (571) Policy No. LP 11624 AUTOMOBILE SCHEDULE • 'CHUBS PAGE 17 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name °edr''°' r..a w.;an, n'.0 ewe op. .: ;��:a`<ap Identification Number Serial Number Motor Number Location of Principal Garaging (City, Count State) Y. e.e. ^. P. >n. o... °••• Premium Bodily Injury Property Damage Medical Payments 94J1970 INTIL. lb YD. LOAD PACKER 260 GEN. SERV. -REFU E 8CA 67. 42. 95.11971 !,: T' L YD. LAD PACKER 373 8CA 67. 42. q6. 1q68 GMC -F -f. -DUN? PICKUP 793 6 1 5o. 2. 1970 FORD 12 T. DUMP 46 8 6 42 8. 1971 INTIL 6 YD. LO PACKER D 8C 67. 42. 1 mI 16 YD. LAD !00. 1971 INTIL. PACKER 398 8CA 67. 42. 201 1972 TIIT'L. 16 YD. UAD PACKER 354 8CA 67. 42. ?02. 1972 ITTT I L. 25 YD. L PACKER AD 61 8CA 67. 42. ?0 . 1972 INTIL. 29 YD. LAD PACKER 402 8CA 67. 1 42. ?04. 1973 INTIL, 29 YD. LAD PACKER 812 8CA 67. 42. )05. 1973 INTIL 29 YD. LAD PACKER 208 8CA 67. 42. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Item Same Above Purchased Mo. Yr. New or S.H. Com'1 Car Cost Priv. Pass. Sym, E °u c w° Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium -94. 5004 18,125 -165 30. L95. 5005 17,750 .16 29. L96. 5006 1,500 .16 2. X97. 5007 4500 .16 7. 8. 5008 17, 50 .16 29. L 99- 5009 17, 5o 16 2 ?00. 5010 1 118 1 16 ?01. 9011 1 18.124; ?02. 5012 18,250 .16 r, go- 203. 5013 18 00 .16 1. >04. 5014 1 122.000 11 24 Form MI 020c (57 1) CAUTOMOBILE SCHEDULE Policy No. LP 11624 • ct+ues o AUTOMORILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE g A--g 12 Item No. Year Model Trade Name T.p• r,.n w•', c.o. ^s ;P.:6`.-1,. Identification Number Serial Number Motor Number Location of Principal Garaging (City, County, State) e,e. i.�. P,ev. o... o "" Premium Bodily Injury Property Damage Medical Payments '06. 1973 INTIL. 29 YD. L ACKER AD 2 GEN. SERV. -REFUSE 8CA 67. 42. .0 1 INTIL. 1 YD . LOAD ; y: QR 1968 T 16 YD. LAD .09. 1969 INTIL. 16 YD. LAD PACKER 699 8CA 6y. 42. '.10. 1965 CHEV. 4 TON PU 112 QUIP, MAINTENANCE 6 50. 32. '.11. 1964 FORD ' TON PU 142 6 50. 02. '12. 1964 HARLEY-D 3 WHEEL MOTORCYCLE 098 1998 -00 66. 33. '13. 1970 DODGE 4 TON PU 15 r 6 50, 2. t14. 1 2 0 1 TQN DU4F 8 8 PUB. WKS. -S 8 CA 2 t15. 1968 CHE'd 1 TON PU 4c6 8(.A 2 '16. 1968 CHEV. SEWER CLEANER 142 8CA 67• 42• t17. 1971 INTIL. = TON PU 826 6 50. 32. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Item Sam Above Purcho sad New or SM. Com,I Car Cost Priv. Pass. Sym. g W,a Collision Amount of Insurance Fire Theft Comprehensive CAC Form Pramium Rate Premium Rate Premium Rate Premium Rate Premium '06. 5016 22 000 .11 24. '07. 5019 203000 .11 22. 08. 50N 13,500 1.161 22. 0 5031 1 120 .16 25. '10. 5201 X11. 520' >l 5234 ,,.SL ?13. 520-D 00 16 6 >14. of 45oO 16 �15. 5502 1000 0 X16. 5o r Form M1020c 1571) I L L I C Policy No. LP 110'24 • AUTOMOBILE SCHEDULE • cHUSS PAGE 19 AUTOMOBILES AND TRAILERS — OWNED — BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Nome e.er T,.. L..k v.;.w. Tm.k L «e c.n T..k ai. c.v a. s...1.. c.v. Identification Number Serial Number Motor Number Lo tali on of Prinoiyal Garaging (City, County, State) e.a. i.i. v..cr oe.. pr mi m Bodily Injury Property Damage Medical Payments 18. 190'7 CHEV, i TON PU 534 PUB. JKS. - SEP�E° 6 Do. "2 19, 1969 GMC inRocRAN. P. 161 20. 10 71 INT'L. V4 TO 7 21. 1,69 DODGE 21 TON DUMP 481 8CA 67. 42. '22. 1959 FLEXIBL a SE'IEROD R 073 INCLUDED 23. 1068 F.SSCO ESSICK c PUMP 256 INCL DF.D '.24. 1968 INTIL. CRLR. -TR LOADER T. 233 8CA 67. 42. '.2-. ic)69 i 69 MELAUE LOADE 145 INCL DED ?26 1 ` ' TRCTii -LD . 1956 FORD i TON PU 116 TRAFFIC & PARKING 6 50. 32. PLYii. 4 DR. S 201 1c 8 -00 66. )29 1 6- F0 3D i TON FU 4 1 6 0. 1 32. AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Same Above Pj.oy red New or S.H. Com'I Car Cost Pri v. Pass. Sym. E u wJi Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium )18 o6 1 oo 16 1 5508 21?, 240 161 48. ?20. � Og 6 1 5r1 ' '22. 5571 4615 16 8 ?23. 5573 2020 16 >24. F 4 84" .08 7. 72r. 57 4a2 1a pp U >26. 5576 1 '2 0'02 >28. 500 4 u > r r Form MI 020c (5711 I � CPolicy No. LP 11624 �UEIO • AUTOMOBILE SCHEDULE • PAGE 20 AIITOMOBIL FS AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name rti':V=' r...0 Mme c•r. *• ^�a °�c °v Identification Number Serial Number Motor Number Location of Princi pal Garaging (Cie ,Count State Y Y, ) a°e. m. v.,r. o=m. a °•• Premium Bodily Injury Property Damage Medical Payments 3'. 1956 FORD LUB WAG0 1 726 TRAFFIC &. PARKING i098-o0 1 66. 33. ' 1 68 PQaD 4 4 LIBRARY 1 -O0 66 32. 1973 L YM. DR, SDN 460 P.B & R- ADMIN. 1 8 -00 66. 33. 33. 1969 GHEV. DR. SAT 883 P.B & R- RFCR,AT 198-00 OX 66. 33. )34° 1905 INTIL. 1 T. PU 18A -5 P.B. & R. -PARKS 6 50. 32. 235. 1971 INTIL. z T. DUM PICKUP 8 6 0. 32. '-36. 1972 FORD DUM PICKUP D. 820 6 5o. 2. 1 6 2 T. AERIAL '- 7 c,6 ?38. 1o68 CHZV. -)/4 TON PU 618 6 50. 32. X39. 1966 PLYM. 2 DR. SUN. 502 1cq8 -00 66. - ?40° 1o"1 !NT IL. 12 T. DUMP TRUCK 127 8CA 67. 42° 241• 1912 FORD a TON DUI PICKUP 4P 821 ID 50, �2 AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE tem so.. Above Purehased Mo. Yr. New or S.H. Com'I Car Cost Priv, Pass. Sym. 00 w.I Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium 0. 56o5 3 6 800 1 1 )31. 7001 4 6 1500 12 2 M. 7501 4 2 > 6 ?34. 7700 600 .16 1° ' -35. 7701 3000 .16 5. '' -36. 7703 3500 .16 6. '37. 7704 6580 .16 11° X38. 7705 1000 16j 2. 239. 7706 3 0 500 .12 1. '4o. 7707 82 °16 14. 8 6 i \Form M1020c 15711 G G C L L L L G C AUTOMOBILE SCHEDULE Policy No. LP 11624 cr+u�e • • � PAGE 21 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name *�w s:�eA• r.,,.0 �°.a C.°. "i.°Wr:: C, Identification Number Seriaf Number Motor Number Location o{ Princi pal Garaging (City, County, State) a °a. ^b P.°P. o.m. Ci °'• Premium Bodily Injury Pro ert Damage Payment. 42. 1970 INTIL. z TON DUMP PICKUP 650 P.B. & R. -FAITS 5 50. 32. A3, 1964 Ii T I L 2 T. WIN DUMP TR, H 6-,.F4 ECA 6' 42 44 1971 TRACTOR 45. 1968 CHSV. 2 T. DUMP. PICKUP 714 6 50. 32. '46. 1966 FORD 1 TON STAKE FLATRACK 115 8CA 67. 42. '47. 1,070 INTIL. 1 TON DUI TRUCK 4P 890 8CA 67. 42. M. 1966 FORD TANK TRUCK 572 8CA 67. 42. 1c)67 FO TUN DUM 68 ' 2. )50. 1967 INTIL. z TON DUMP PICKUP 530-7 6 0. 2. ?51. 1969 CHEV. 1 TON DU 14P o63 8CA 67. 42. ?52. 1969 CHEV. 2 TON: DUMP PICKUP -'81 6 50. 32. ? aa, 1970 DODGE TON PU 257 6 50. 1 32 . AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above PMochY'ed New or S.H. Com'I Car Cost Pri v. Pass. $ym, u .0 wP Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate T Premium Rate Premium Rote Premium Rate Premium ?42. 7709 3440 .16 6. '43. 7710 4030 .16 7. ?44. 7711 NOT COV. ?45. 7713 1 1500 .16 2. ?46. 7714 3635 .16 6. 247. 7715 4800 .16 8. 248. 7718 665 .16j i1. >49. 7717 1 o0 .16 2. 250. 7718 Soo i 1. 251. 7721 455-D .16 8. 252. 1'723 1500 .16 2 )13 7724 o Form M1020c (571) C- • crau�s AUTOMOBILE SCHEDULE . Policy No. LF 11624 PAGE 22 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJUKY ANU rKOPEKTY DAMAGE Item No. Year Model Trade Name e•e. T.P. n.n w•me. nook L•nd C.P. aV..se 1.C.o Identification cati on Number Serial Number Motor Number Location of Principal Garaging (City, County, State) s•a. „„ P, D•.. ci °" Premium Bodil Injury Property Damage Payments 54. 1970 CHEV. i TON PU 027 F.B. & B -PARKS 6 50. 32. 1- TON A RIAL 6 56. 1c72 FORL z TON DUMP PICKUP 841 6 1 50. 32. 57. 1973 I`1'JT1L. 2 T. AERIAL LIFT -- 8CA 58. 1= I4OHA6'iK BOX TRLR 262B 25go 8CA 17. 11. G. 1 "4 ROOF ROTARY MOWER -- INCLUDED '60. 1064 MOHAWK BOX TRLR 67A 25;0 8CA 17. 11. 1 c)6 DRUSH ?62. !966 TORO TRACTOR J MOWER 100 INC UDED ?6 1967 VERMEER ROOT CUTTER 175 INC UDED ?64. 1 HOMEMADE BOX TALE,- 620T 25% 8CA 17. 11. ?6 1o,68 JOHN EE +' 0 0 I INC ZI)ED AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Iran Sama Above Purchased Mo. Yr. New or S.H. Com'I Car Cost Priv. Pass. Sym. p c wa Collision Amount of Insurance Fire Theft Comprehensive CAC - Form Premium Rate Premium Rate Premium Rate Premium Rate Premium '54. 7725 2500 ,16 4. '55. 7726 17,520 .16 29. 256. 7727 500 .16 6. 28 111,500 Ill 11'. )8 1 259. 7772 2385 .08 2. 260. 7773 140T COV. 261. 7774 3950 .16 6. 262. 7775 NOT COV. '63. 7776 NOT COV. 264. 7777 1 1 1140T COV. ?65. 7778 110' 16 i 2 Form M1O20c 1571) . L L L f L f ' L L i Policy No. LP 11624 • AUTOMOBILE SCHEDULE • craws PAGE 23 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Model Trade Name aw, .,n 1..n w.�rs� 1..��..e c.v. t. .r I i. c.e r..sw�.,.v c.v. Identification (i cati on Number Sarial Number Motor Number Leeati ono Princi I Garaging (Ci y, aunty, State) r.a. i,�. a =v. o.m. CF... Premium Bodily Injury Property Damage Medical Payments 56. 1958 ON"` P. B.. R. - PARKS 25 8CA 1 11. ,6y. io 0 JOHN TRACTOR !68. 1073 TRAILtR -- 8CA 1. 11. '59. 1972 PLYP T, DR. SDN 816 PUB, WKS -WATER i998-o0 669 '70. 1971 INTIL. /4 TON P 720 50. 32. 71. 1971 INTIL, TON PU 835 6 '72. 1964 FORD i TON FU 293 6 '73. 1972 FOi�O iON PU W /UTIL, 3ODY 842 6 0. 2. '74. 1960 FORD 1 T. FLA' HACK TR 647 8CA 6 75. 1061 INTIL. 1z T. WI TRIO CH 21D1 76. 1 DODGE U IL 1 '77. 1965 INTIL, 2g TON DUMP TRK, 98Fs 18CAI 67. 42. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE tern So.. Above Purc hosed Mo. Yr. New or S.H. Com'I Car Cost Priv. Pass. Sym. E$ 'u , ruJi Collision Amount of Insurance Fire Theft Comprehensive CAC Form Premium Rate Premium Rate Premium Rate Premium Rate Premium '66. 7779 NCT COV '67• 778'0 NUT COV ,68. 7781 26 .11 1. '69. 9201 4 3 3500 .12 4 0. 9202 '7 1. 9203 2500 4. '72. 9204 00 F165 1 '73. 9205 �000 5. '74. 9206 702 15 1 '75. 9207 ___a4_15_ 16 'o '76. 9208 Q20 Form M1020c 1571) CPolicy No. LP 11624 cHUBe • AUTOMOBILE SCHEDULE • PAGE 24 AUTOMOBILES AND TRAILERS - OWNED - BODILY INJURY AND PROPERTY DAMAGE Item No. Year Modal Trade Name s.e. *... B•• =k w•wB• iva c<ia cp. e.., -inp c.p. Identification Number Serial Number Motor Num bar Location of principal Garaging (City, County, State) B,d. i.�. P•�i.o'm. Premium Bodily Inlury PropaHy Domage Medical Paym enta -e. 1 0 INTILw 1 TON PU 80 PUB. WKS. -MATER 6 50. 32. zi UB LO -BO L >80. lq6q CHEV. 4 TON PU 547 6 50. 32. ?81. i 68 F0 2D 1 'TON PU 593 6 50. 32. !82. 19 L INT'1Lp 1 TON TRUCK 740 8CA 67. 42. 03. 1970 I iT 1 L. 1 TON Tit CK 580 8CA 67. 42. ?84. 19yo INTIL, 1 TON TRUCK 810 8CA 67. 42. 1 611 1998 -oo 66 >86. 1973 CASE BACKHOE 446 8CA 67. 42. ?87. 1961 N ERS 0 RAITD COMPRESS'R 059 INCLUDED ?88. 1955 NG>JRS 0 RAND COMPRESS DR 9162 INCLUDED >89. 1967 HAJKEYE TRAILER 0141 1 25T, 18CAI 17-1 11. AUTOMOBILE AND TRAILERS - OWNED - PHYSICAL DAMAGE Same Above PhjohY'ed New or S.H. Com'I Car Cost Priv, Pass. Sym. V Collision Amount of Insuronca Fire Theft Comprehensive CAC Form Premium Rate Premium Rote Premium Rate Premium Rate Premium ?78. 0,210 1.300 .16 3. >79. 9211 2740 .08 2. ?80. 9213 1 2800 .16 5• ?81. 9214 1000 16$ 2. ?_82. 9215 4000 .16 7. >8 216 4000 .165 7. ?84. 9217 1 4000 .16 X85. 218 4 5 1910 1 .12 2. ?86. 0270 2-0,000 .08 16. >8r. 9273 NOT COQ ?88. ,274 NOT COV. Form M1020c (571) f L . L 11111110 CPolicy No. LP 11624 cMU�ls AUTOMOBILE SCHEDULE � � PAGE; 25 AUTOMOBILFS AND TRAILFRS _ OWNED — BODILY INJURY AND PROPFRTY DAMAGE Item No. Year Model Trade Name sw *r,• r,.n �, T —. Ira c.,. e:�.i m,...,. Identification Number Serial Number Motor Number Ll tion o Principal Garaging (City, County, State) e,e. i.. o.m. °... remium Bodily Injury Property Damage Medical Payments 90. 1967 INGERSOU RAND COMPRESS R 92M PUB,`' S.-WATER INC UDED 91. 1961 JAEGER '$ PUMP 388 Ii C LED 2. 19 55ti3 { 4" PL`I'IP 505 INCLITTiLL !a3. 1972 JOHN DEERE LOALER 6 4. 10,71 LINCOLN WELDER �� 1c)6 ELE `' I ,i1HEEL 10 1 A I L E R 472 25 0 17- 11 6. 1 ESSI K CEMENT - -- . 1960 FELKER:: CEMEIJT S L± TRLR 04 25; 8 17. 11. '98. 1973 JAEGER 6" PUMP 7X43 INC UDED .-,9. 10ol m I u L, = 014 PU 815A MARINA PARK 6 50. 32. ;00. 1957 GO D� i4 STATE 1 I 11OU5 TaAILQ 165 25;, SCAI 17. 1 11. ;01 1957 GOLDEId STATE 1' HOUSE TRAILER 25s 8C 11 L16 t 9,349 AUTOMOBILE AND TRAILERS — OWNED — PHYSICAL DAMAGE Sage Above PuhlrochY'ed New or S.H. Com'I Car Cast Priv. Pass. Sym, * c u w� Collision Amount of Insurance Fire Theft Comprehensive CAC Farm Premium Rate Premium Rate Premium Rate Premium Rate Premium ?90. 9276 NUT COV. '91. 9279 NOT COV. '92. 9280 NOT COV 282 55 g "95. 0,286 NOT COV. '96. 9287 430 '97. 9289 NOT COV. !98. 9290 6000 .16d lo. '99. 9901 NOT Cov. 100. 9271 0 .24 01 a u Form M1020c (571) i 6 No. 11 . " A.P.$20.00 R.P. IN CONSIDERATIO: OF Aid ADDITIONAL PREMIUM THE COAST COMMUNITY COLLEGE DISTRICT IS AN ADDITIONAL I "SURED FOR THE PERIOD OF 7 -1 -73 TO 8 -24 -73 WITH RESPECTS TO THE OFEP,ATI02; A` D USE OF 770 SHIELDS SAILBOATS;. FLAT CHARGE $ 20.x.._::. rR. This endorsement forms a part of and is for attachment to the following described policy issued by the PACIFIC INDEMNITY COMPANY. and is effective from the inception date of the policy unless another effective date is shown below. FOR HOME OFFICE USE ONLY LINQ I VINO I COMM. I BR. OFF, I AGENT Form 1A026a CF /kb r.ILr AP,VEY INSIJRAN B 'ORS P , AUTHORIZED R PR ENTATIVE MUST COMPLETE ONLY WHEN THIS ENDORSEMENT IS NOT PREPARED WITH THE POLICY OF IS NOT TO BE EFFECTIVE FROM THE INCEPTION BE CO DATE OF THE POLICY. POLICY JA INSURED DATE OF 1550E 7 -1 -73 TO LP1 1CITY OF NEUPOP.T BEACH -73 .0-2 FOR HOME OFFICE USE ONLY LINQ I VINO I COMM. I BR. OFF, I AGENT Form 1A026a CF /kb r.ILr AP,VEY INSIJRAN B 'ORS P , AUTHORIZED R PR ENTATIVE F A+- � . }+MOk._. yr' om! i;T ni vE Kr � A lgn :.� NOT " . { 't v J4 . ,.. a . .ir`Y�,.. +r-y 'k• w +--. j+M• ', y} a 4. insurance brokers MILUM GARVEY September 27, 1973 1617 WESTCLIFF DRIVE / SUITE 204 / NEWPORT BEACH, CALIFORNIA 92660 714/645 -0800 V ��o '\C CITY OF NEWPORT BEACH OG� C�o`a�cN 3300 Newport Boulevard Newport Beach, California 92660 Attn: Judy L. Kelsey, Administrative Assistant Re: Bond No: 80354280 Dear Miss Kelsey: Enclosed please find a re -write of Wdorsement No. 3 correcting the intent and the terminology of the Bond. You will recall when the Bond was issued on July 1 Endorsement No.. 3 was issued and it had the opposite effect of what the Bond was intended to accomplish. A new Endorsement No. 3 has been issued to replace that one and the correct wording with the proper coverage has been included. Please check it over carefully and let me know if you have any questions regarding it. Very truly yours, ROBERT B. MILUM MILUM /GARVEY INSURANCE BROKERS enclosure RBM/vn r 0 • U a+UBB PACIFIADEMNITY GROUP 3200 Wilshire Boulevard, Los Angeles, California 90010 Effective date of this endorsement: July 1, 1973 Issued to: City of Newport Beach. 0 ENDORSEMENT PACIFIC INDEMNITY COMPANY Endorsement No. 3 To be attached to and form part of Bond No. 80354280 It is understood and agreed that coverage under this bond shall apply to loss or losses sustained through the act or acts of any person who is required by law to furnish an individual bond to qualify for office, including but not limited to any Treasurer or Tax Collector by whatever title known. AIZ DTI -MR. TERR4S AND CONDITIONS RD14AIN UNCHANGED. Form 11"0 (Ed. 12 -701 PI PACIFIC INDE10TITY COMPANY BY: Aut rized Employee July 2, 1973 Date i C 7713 (SM) &D. #12 ADD;L PREM.$51 0 (The attaching clause need be completed Only when this endorsement Is Issued subsequent to preparation of the policy.) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following coverage part(s): This endorsement, effective 4/9/73 , forms a part of policy No. LP 11624 (12:01 A. M., standard thee) issued to CITY OF NEWPORT BEACH by PACIFIC INDEMNITY ADDITIONAL INSURED IN CONSIDERATION OF AN ADDITIONAL PREMIUM OF $50.00, IT IS AGREED THAT THE DISTRICT ENGINEER, U.S. ARMY ENGINEER DISTRICT IS AN ADDITIONAL INSURED BUT ONLY AS RESPECTS AS PROPERTY OWNERS TO A PARCEL OF LAND AND WATER AREAS 3.01 ACRES SHOWN ON EXHIBIT C ATTACHED #347 K -2 BASED BY OUR INSURED. FLAT CHARGE BI $35. PD 15. FORM 21L39 Ie0. 10.66116 PA RTI q; K-1227 (ISM) I - 1 -1 y F CHUBB /PACIFIC IIMEMNITY GROUP 90 John Street 3200 Wilshire Boulevard New York, N. Y. 10038 Los Angeles, Calif. 90010 f'a of party to whom this certificate 1%,,,jesued r IIISTRICT URANCE CO. _GREAT NORTHERN INSURANCE CO 1.y), INDEMNITY CO. X _VIGILANT INSURANCE CO. P.O. BOX —SUN INSURANCE OFFICE LTD. LOS ANGELES, CKOW 9M3 Name 8 Address Insured Name & Address Producer ` CITY OF NEgMRT BEACH + SBUCIllo FF INS. BROKERS 33M NW MT BLVD. 111EMMRT BEACH, CALIFORNIA CALIF. 92610 This is to certify that the Company indicated by X has issued to the Named Insured insurance affording such coverages as are in- dicated by a specific (X) entry in the Coverage column subject to the terms, conditions, and exclusions of the pollcy(les) and that such insurance is in force as of (date) 'OPTIFICATE OF INSURANCE Certificate No. If the policy(les) is cancelled or changed in such manner as to affect this issued„al N = address shown above, 10 days notice of any such change of FAS This certificate shall not be valid unless signed by an authorized represents a; ;i Mt�O x -0274 (30M) TYPE OF POLICY Coverage POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY Standard Workman's Compensation 3 Empleyers'Llablifty Eff. Ex p. Statutory—In conformance with the Compensi tion Law of the State of General LIabillty— BODILY INJURY Premises - Operations X LIP 1 16 2 Efi.111/73 ExpIM7 75 1(111 1000080. Each Person IS 300000 Each Occurrence $ 3000000. Aggregate-Producte- Compl. Oper, S 1000000. Each Person If 311110e000. Each Occurrence S 100000000 Each Occurrence $ 100 Agg.- Prem.Oper. $ 1Oe000 Aggregate -Pro $ 1006000• . Aggregate-Products- Compl. Oper• $ 1000000. Each Occurrence ' $ 100 000. Aggregate Escalators Independent Contractors X Products - Completed Operations X Incldental Contractual Specified Contractual' Blanket Contractual X General Liabllily -- PROPERTY DAMAGE Premises - Operations X Escalators Independent Contractors X Products - Completed Operations X Incidental Contractual Specified Contractual' Blanket Contractual X Automobile LiablBly— BODILY INJURY Owned Automobiles X It 1 16 = Er. 2/ 1/0.7�2 Exp. $ 1000000. Each Person $ 300s00. Each Occurrence $ 100#000. - Each Occurrence Hired Automobiles Non-owned Automobiles X Automobile UabllBy— PROPERTY DAMAGE Owned Automobiles X Hired Automobiles Non-owned Automobiles X ' Coverage Is provided for liability assumed by the Named Insured for the contract between the Named Insured and dated as provided in the contractual liability coverage part attached to the policy. SEE M f 12 THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AME EXTENDS OR ALTERS THE COVERAGE AFFORDED BY ANY POLICY DESCRIBED HEREIN. If the policy(les) is cancelled or changed in such manner as to affect this issued„al N = address shown above, 10 days notice of any such change of FAS This certificate shall not be valid unless signed by an authorized represents a; ;i Mt�O x -0274 (30M) i ie r. y;�'( � '. �'. t .. . T � s � � '1 t E CITY OF NEWPORT BEACH POLICE DEPARTMENT August 25, 1972 0 SPECIAL ORDER NO. 12 -27 (DEPARTMENT MANUAL AMENDMENT) SUBJECT: TO: All Personnel EFFECTIVE: Immediately CARRIER OF PROCEDURE: Watch Commanders, learning of an incident in which there is serious personal injury and the possibility that city liability exists, shall notify the city insurance representative immediately so they will have an opportunity to respond to the scene. Notification shall be made as follows: MDa time Business Hours: it is In emnity Insurance Co. Dave Rielley - 836 -6671 After Hours Emergency (In Order Listed) Dave Rielley - 833 -8756 Heather Lothian - 979 -4545 Carl Warren Assoc. - 547 -5571 Dean Smith - 860 -8402 Watch Commanders approving reports of city property damage and/ or possible city liability shall stamp such reports "CPI" with the appropriate stamp, and forward them to the Records Section. DEPARTMENT MANUAL AMENDMENTS: This order amends Sections 3/405 and 3/405.10, and deletes Section 3/405.05 of the Department Manual. ames G avas Chi f of Police 1. �' ' �.{i.( �. i J� L ✓Lt?^+ AUG: J i97 ?> t;:.ay: \GEft CITY OF NEWPORT BEACH TO: FINANCE DIRECTOR FROM: City Clerk SUBJECT: Contract No. 1423 CALIFORNIA City Hall 3300 W. Newport Blvd. Area Code 714 673_2110 DATE February 7, 1972 Description of Contract Liability Imurwm Authorized by Resolution No. 7615 , adopted on 1 -31 -72 Effective date of Contract 2 -1 -72 ttu 2 1 --j /- 7S Contract with Pacific Indamity Cmpany Address Aaent • Anderson 6 Mil>m Amount of Contract see attached. Ogg city 6lerk in acOftdaace with, the specifications dated December 1, 1971" bids were- received: and publicly opened and declaredy and: WHERRU, it appe_�:rs that the lowest responsible bidder therefor is Anderson and Ki.lum representing Pacific :%ndemnity Company as the primary carri�:r 4nd Midland InsuraAft Ce s►y.*S the excess carriert ANY" "14iiiRM=v SH 19 R9"WED by the City Council d$,; the city of NoWozrt.Reach that the bid of Anderson and Milum representing Pacific Indewiity Company as the - primary carrier and Midland Insurance Company as the excess; carrier far 43"000,000 combined single Unit personal injury and party damage iAsuranov be accepted, and that a three -year contract, womencing February 1, 5 �r 1472, and ending January 31" awarded to said bidden RZ IT FIMMU RE'30LVED tbat Cite Mayor and .City Clerk are hereby authori, "d and directed to execute a contgact in accordance with the specifications, bid and this award on mil£ of the City. of Nevport Beach. AVOP'M this 3,La day of January,. 1929, Mayor 2-t rt��'yy ?" t - F' sr� YrS To a. y. )')� ._� K4` r: ``! - '3''rC *pJ*d4W S `• >W+ r'fdra,m ar '•fie''Y ,xt a %i {e . * J � � �� R'%�L � "ya } f �S p Y g�� F} �•? Y � +Y 4 h dim J- rit 6 r, 40 IM X. v 'Z AV �,di ,dry �I!a x •iL. - 4 'wfri '^A" L "Op a,r,} �✓� 's� r� a >�zF "�� ,. e .,rt ...��y� '�� IN - }.+A@'jy' Y�.',YC ';R�y+�yr v x��y"R.'" s h ♦ � .L tir,r '^Ac R � 'S� t . r R , ldeNk •% .� $S'�"q, x" + - E'K3m+'vu; ,,,r )j_'� .sa fl ?yR,,. a.;� }a`s'h .• � � ;• r } Y r rf, ,� S, s n._ ,` �RP-£� f C Z , b� C r_✓7'n r b i -- 4 a a £,., .c �+d�,�, � "i °N` >i� ( x ,}'S µ d �— 1 x° is J y 2 '+ vy�yy� xi r. 'kz't 'ZS ,fir .J� f`iM t ` I1_4 k3 y { ~ -i { }{ y, P � yk. S�'.�. F' �. h 4 K ,q F� y 1'. � e y Y� � S 4i.h 'F6}Y• L h Y .. _c•.?#. t. ...+� =�Y` .. nY ,%'w*tC+>~�l+f ., c k.a t -?: Z^.r�.. ....ti+{:a.f: ,.u... i:i%��ca, . -. +. R. Ong; y -M 4V {4#: ;n{:'� r Y p,ar .?,i5a0{ '° .:er anal +a!#+:i •�rFy;? !'•s $` - da� - ✓zd �fi.%r3. pi�< 'Afd r_ r xrP�+' + -iF° a x rrJ +.r'� All �t >y ivS - r � #'S+ ¢ �i { "ffig Xd '^Y" .y 'Ca �E •i\ M� -f F y At r yr .� 1ti� ! r. �3, a4^q 1" al L° ' t WAS �4y`�y�1a3� : s xd f r 1I X. r t i r 0 5. r _ CITY OF NEWPORT. BEACH CALIFORNIA City Hall - - 3300 Newport Blvd. - - -_ . (714) 1, 1972 EPA- 8 2 yFivac�ry cF 19;c 9 Mr. Robert Milum Anderson and Mildm {j 333 Bayside Drive ti O Newport Beach, California 92660 Dear Mr. Milum: I am pleased that your firm has been selected as the comprehensive public liability insurance carrier for the City of Newport Beach. _I am looking forward to developing_a. businesslike working relation- ship between our two agencies. At your earliest convenience, would you please review the attached "Memorandum of Understanding" that was developed between the city staff and our previous broker. I look forward to meeting with you, Newport Beach City Clerk Laura Lagios, and our Safety and Training Coordinator, Mr. Bill Brown, at your convenience to refine account administration procedures. Very truly yours, PHILIP F. BETTENCOURT Assistant City Manager PFB:sh Enclosure c: City Clerk Safety and Training Coordinator Mund, McLaurin and Company