82-018 Insurance for Summer Program at Certain FacilitiesOi'Irl OF L't~!.00;. ~AfJ:
10300 ~s AV".e~
o~rtioo~ CA 95014
TYPE OF INSURANCE
GENERAL LIABILITY
I!] COMPREHENSIVE FORM
~PREMISES-OPERATIONS
!!) EXPLOSION AND COLLAPSE
HAZARD ~ UNDERGROUND HAZARD i!J PRODUCTS/COMPLETED GitJ OPERATIONS HAZARD
LJ CONTRACTUAL INSURANCE !!! BROAD FORM PROPERTY
r,fi DAMAGE
LJ INDEPENDENT CONTRACTORS
~ PERSONAL INJURY
AUTOMOBILE LIABILITY
~ COMPREHENSIVE FORM ~OWNED ~HIRED
E':I NON-OWNED
EXCESS LIABILITY
D UMBRELLA FORM
D OTHER THAN UMBRELLA
FORM
wom<ERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
POLICY NUMBER
COMPANIES Ai=FORDING COVERAGE§
COMPANY
LEITER
COMPANY
LEITER
COMPANY
LETTER
D
POLICY
EXPIRATION DATE
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
PERSONAL INJURY
BODILY INJURY
(EACH PERSON)
BODILY INJURY (EACH ACCIDENT)
PROPERTY DAMAGE
$
$
~·~ ~mit t.() u~ C!'t'tid.n faeilltit.ts of .t:Jie district] desmri~ as f.'OlJ~;: ~~ t:bllinli
~~ Fm:la-r ~rt~ ~$r .. h~~t:t ~iclt
C~m:ell<ll~ion: Should any of the above desc!j(led policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail -~~ days written notice to the below named certificate holder. but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
&~NO UN~ fi~ 'Dim!U:CT
t030i V.L~tm. OX'i'lffi
Orre't'tioo~ CA. !1f1'014 (Att!'!~ r~~Y & In:sur~oo L'lept.
J'Jly l 6 r 1982
°Et~~~.~~~r-o~rommt-n«
' NON-PREMIUM ENDORSEMENT • Endorsement No.
'Issued by -(Type in full name of Insuring Company)
HOME INSURANCE COMPANY
POLICY NUMBER NAMED INSURED
ISTP194"1 CITY OF CUPERTINO, ETAL
EFFECTIVE DATE AND TIME OF ENDORSEMENT DATE PREPARED POLICY EXPIRATION
8·10-83
PRODUCER PRODUCER NO.-OPC
ALEXANDER & ALEXANDER OF CALIFORNIA INC.
It is agreed that this policy is hereby amended as indicated. All other terms and conditions of this policy remain unchanged.
SIVlf!A!lblJI OF l!ftEREST
IT IS AGREED THAT THE INSURANCE AFFORDED BY THIS POLICY APPLIES
SEVERALLY AS TO EACH INSURED EXCEPT THAT THE INCLUSION OF MORE
THAN ONE INSURED SHALL NOT OPERATE TO INCREASE THE LIMIT OF THE
COMPANY'S LIABILITY: ANO THI INCLUSION HEREUNDER OF ANY PERSON OR
ORGANIZATION AS AN INSURED SHALL NOT AFFECT ANY RIGHT WHICH SUCH
PERSON OR ORGANIZATION WOULD HAVE AS A CLAIMANT IF NOT SO INCLUDED.
C&Uilbb!T I Ot4 Cl.JUJSE
IT tS HEREBY UNDERSTOOD AND AGREED THAT:
CUPEATIHO UNION SCHOOL DISTRICT
10JOI VISTA DAIVE
CUPERTINO, CA. 95014
ATT: SAFETY 6-INSURANCE DEPT.
BUSINESS SERVICES DIVISION
WILL Bl GIVEN THIRTY (30) DAYS WRITTEN NOTICE BEFORE ANY REDUCTION
OF COVERAGE OA CANCELLATION OF THIS INSURANCE IS EFFECTIVE.
SIGNATURE OF AUTHORIZED REPRESENTATIVE
H22300 FH 4/77
NON-PREMIUM ENDORSEMENT • Endorsement No.
lssued by -{Type in full name of Insuring Company)
HOME INSURANCE COMPANY
NAMED INSURED CITY or CUPERTINO, ETAL
EFFECTIVE DATE AND TIME OF ENDORSEMENT DATE PREPARED POLICY EXPIRATION
8-10•82 7•16-82 rew 8-10-83
PRODUCER PRODUCER NO.-OPC
ALEXANDER & ALEXAIOER Of CALIFORNIA INC.
It is agreed that this policy is hereby amended as indicated. All other terms and conditions of this policy remain unchanged.
IT IS AGREED THAT THE "PERSONS INSUREDu PROVISION IS AMENDED TO INCLUDE
AS AH INSURED CUPERTI NO UN t ON SCHOOL 0 I STRICT, I TS BOMD OF TRUSTEES•
THE INDIVIDUAL HEMBEftS THEREOF, ALL DISTRICT OFFICERS, AGENTS AND
EMPLOYEES, BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE
NEGLIGENT ACTS OR OHISSIONS OF THE NAMED INSURED IN CONNECTION WITH TitE
USE Of SCHOOLS OWNED BY SAIO SCHOOL DISTRICT SUBJECT TO THE FOLLOWING
ADDITIONAL EXCLUSIONS:
THE llSURANCE DOES NOT APPLY:
I. TO ANY OCCURRENCE WHICH TAKES PLACE AFTER THE NAMED INSURED
CEASED TO USE SAID PREMISES:
2. TO STRUCTURAL ALTEMTIONS. NEW CONSTRUCTION, MAINTENANCE\\OR
DEMOLITION tlPERATtONS PERFORMED SY OR ON BEHALF OF THE CUPERTINO UNION SCHOOL DISTRICT.
Plffft\Y CLJ\USE
IT IS UNDERSTOOD AND All\IEO THAT THE INSURANCE PROVIDED BY THIS ENDORSEMENT
IS CONSIDERED PRIMARY INSURANCE AND Atff INSURANCE AVAILABLE TO CUPERTINO
UNION SCHOOL DISTRICT IS CONSIDERED EXCESS.
J; ·~ .. ~ ~ . " .. :.··
SIGNATURE OF AUTHORIZED REPRESENTATIVE
H22300 FH 4/77
At~~~ ·& Af~fi1l)f"~
,Of tlt~~. INC,
p,,()~ ~ 57-0ft
~~art Jo~, Q '951!it1 ( 4f16} 2~ ... £760
NAME AND ADDRESS OF INSURED
crw or ~100.. inAr..
'HJl~G ~~ AYent.~
~rtin.0!' ("A, ,5014
COMPANY B LETTER
COMPANY c LETTER
COMPANY D LETTER
COMPANY lE LETTER
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition
of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the
terms, exclusions and conditions of such policies.
TYPE OF INSURANCE
GENERAL LIABILITY
l!J COMPREHENSIVE FORM
~ PREMISES-OPERATIONS
~ EXPLOSION AND COLLAPSE
HAZARD I!] UNDERGROUND HAZARD
~ PRODUCTS/COMPLETED
OPERATIONS HAZARD ~ CONTRACTUAL INSURANCE
~ BROAD FORM PROPERTY
DAMAGE I!] INDEPENDENT CONTRACTORS
~ PERSONAL INJURY
AUTOl\llOEllLE LIABILITY
~ COMPREHENSIVE FORM
~OWNED
KJ HIRED
~NON-OWNED
EXCESS LIABILITY
D UMBRELLA FORM
D OTHER THAN UMBRELLA
FORM
WORKERS' COMPENSATION
and
EMPLOYERS' llABllffV
OTHER
_____ ...:._~--~---· --'--
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
POLICY NUMBER POLICY
EXPIRATION DATE
limits of liability in Thousands (000)
BODILY INJURY
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
EACH
OCCURRENCE
$
$
PERSONAL INJURY
BODILY INJURY
(EACH PERSON)
BODILY INJURY (EACH ACCIDENT)
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$
AGGREGATE
Cam:eila~i<m: Should _any of the above des".ftped policies. be cancelled before the expiration da.te thereof, the issuin.g com-
pany will endeavor to mall ~·~-~-days written notice to the below named cert1f1cate holder. but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
~ !ilttiff ~"'BOO!~ DIS1'ru:C'Jl
SM ~$t. F.r~t AVtanttrtt
~ltzr C'A 94'1®7
Jn."ty 1~" 19~2 pjr
DATE ISSUED:==-,,-~~=~=c=---==---=~c=~7'CC'"==-c:=cc-= Ar»~~ a n..r~ av \'.'At.J~'l'A INC: __ ';!,,,-#'i:-J_ ........ ---·-·· Fl~, ... -f~;:r.::~1.'.~:;::~::_. --~;~.~~~--
EPRESENTATIVE
(Jebn :P .. IM~) ~9ifl9 Vice r~si&m
This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein.
(The following information is required only when this endorsement is issued subsequent to preparation of policy.)
Endorsement effective 8· 10•82 Policy No. I STP 19464 l Endorsement No.
Named Insured
G109
(Ed. 7-66)
CITY OF CUPERTINO, ETAL
Additional Premium$ AT AUD IT ~ Countersign~ ·. . "'"'lL-0 uw ~esentative)
ALEXANDER & ALEXANDER OF CA. INC.
This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS AND CONTRACTORS LIABILITY INSURANCE
OWNERS, LANDLORDS AND TENANTS LIABILITY INSURANCE
SMP LIABILITY INSURANCE
STOREKEEPERS INSURANCE
ADDITIONAL INSURED
(Premises Leased to the Named Insured)
It is agreed that the "Persons Insured" provision is amended to include as an insured the person or organization designated below, but only with respect
to liability arising out of the ownership, maintenance or use of that part of the premises designated below leased to the named insured, and subject to the
following additional exclusions:
The insurance does not apply:
1. to any occurrence which takes place after the named insured ceases to be a tenant in said premises;
2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organization designated below.
Designation of Premises
(Part Leased to Named Insured)
SPONSORED FUNCTIONS AT
FREMONT HIGH SCHOOL
G109 (Ed. 7-66)
SCHEDULE
Name of Person or Organization
(Additional Insured)
FREMONT HIGH SCHOOL DISTRICT
589 WEST FREMONT AVENUE
SUNNYVALE, CA. ,g4087
7-16-82 rew
Annual Premiums
Bodily Property
Injury Damage
Liability liability
AT AUDIT