HomeMy WebLinkAboutHuntington Beach Police Officers Association - HBPOA - 1968-02-09 �--1 �K.
January 6 , 1972
[[))
Ronald Pomeroy, President
[I Huntington Beach Police Officer' s Association
Huntington Beach , Calif.
Dear Mr. Pomeroy:
With reference to the lease for the pistol range between
D the Huntington Beach Police Officer' s Association and the
City, please refer to Paragraph 11. The required certificate
of insurance must be filed with the City Clerk immediately.
The enclosed form may be used by your insurance carrier.
— Yours very truly ,
(17 Brander D. Castle
Acting Administrator
BDC:bwo'
enc.
January 7, 1972
Mr. de Pfyffer
County Assessors Office
630 N. Broadway
Santa Ana, CA 92701
Dear Mr. de Pfyffer:
Enclosed is a copy of a renewa ease w the Huntington
Beach Police Officer's Assoc = appro ed by the City
Council on January 3, 1972.
Sincerely yours,
Paul C. Jones (:2)
City Clerk
PCJ:aw
Encl.
9
Pr t
• . I
LEASE
THIS LEASE, made and entered into this day of
, 1972, by and
BETWEEN
CITY OF HUNTINGTON BEACH ,
a municipal corporation,
hereinafter designated as ,
LESSOR
AND
HUNTINGTON BEACH POLICE OF-
FICERS ' ASSOCIATION, Incor-
porated, a California non-
profit association, herein-
after designated as
LESSEE
W I T N E S S E T H :
Lessor for and in consideration of the covenants and agree-
ments herein contained and for the payment of the rents hereinaf-
ter to be paid, does hereby lease , demise and let unto Lessee the
surface of that certain real property located in the County of
Orange , State of California, described as follows :
The north 535 .00 feet of the west 300 .00 feet of the
east 445 .00 feet of the southeast one-quarter of the
northwest one-quarter of the northwest one-quarter
of Section 35 , Township 5 South, Range 11 West as shown
on a sectionalized survey map recorded in Book 51, Page
11, Miscellaneous Maps , Records of Orange County,
California, being a portion of the Rancho Las Bolsas .
This lease is made by the Lessor and accepted by the Lessee
on each of the following terms , conditions and covenants :
l �
1 .
JG : cb
a
1. The base term of this lease shall be for fifteen (15)
years from the date of this lease .
2 . The Lessee shall pay to the Lessor, as rental during
the first ten (10) years of this lease the sum of one
(1) dollar per year payable on the first day of each
of said ten (10) years .
At the conclusion of said ten-year period either
party shall have the right to review the amount of
rental to be paid and the times of such payments , whether
yearly or monthly, by giving the other party hereto
ninety (90) days ' written notice prior to the commence-
ment of the next year under the lease and said rent
shall be agreed upon between the parties and if they
cannot agree they shall each select one arbitrator and
if they cannot agree, the two arbitrators shall select
a third whose decision as to the amount of rent , shall
be final.
3. Any holding over after the fifteen- (15) year term
shall be on a year-to-year basis and shall be subject
to all the terms and conditions of this lease including
the rental procedure outlined for the llth through the
15th years contained in paragraph 2 and said year-to-
year tenancy may be terminated by either party by giving
the other party sixty (60) days ' written notice prior
to the commencement of any lease year.
4 . Lessee shall use the premises for the purpose of a
police firearms training range and related uses . The
public may use the premises as a firearms range . The
premises shall be used for no other purpose unless
written consent of the Lessor is first obtained.
2 .
5 . In addition to the rental herein described the Lessee
agrees to pay when due all water, electric , gas and
other public utility charges , license fees , real and
personal property taxes , special assessments and
other public charges accrued or payable in connection
with the use of said premises by Lessee during the
Lessee ' s possession under this lease .
6 . This lease is personal to Lessee and Lessee shall not
sell, assign or transfer any portion of this lease or
permit the same to be transferred by operation of law
without the written consent of the Lessor first obtained .
7 . Any improvements or construction on said property shall
be approved by Lessor and shall be constructed at Lessee ' s
own expense . Lessee shall keep said property from all
liens and save the Lessor harmless of and from any
liability of any nature arising from the use , occu-
pancy or construction of any improvements on said leased
property . Lessee shall at all times maintain in good
order, repair and appearance all buildings on the de-
mised property .
8 . Regardless of any provision to the contrary in this
lease , the Lessor shall have the right to terminate
this lease by ninety (90) days ' written notice if in
the opinion of Lessor the land is necessary for a
higher and better public use . In such event the Lessor
shall reimburse the Lessee for the undepreciated cost
of any improvement upon the property, such depreciation
to be determined by a ten- (10) year straight line
method and to be figured from the time that such im-
provement was actually made .
9 . Lessor shall not be called upon to make any improve-
ments , replacement or repairs on said premises , and
Lessee accepts the same in their present condition.
3 .
r
10 . Lessee shall not commit , suffer or permit any waste
on said premises .
11. Lessee agrees to indemnify and hold Lessor harmless
from any loss or damage , including public liability
and property damage , resulting from the use or misuse
of the demised land and the buildings thereon, and
Lessee hereby releases Lessor from any and all liability
for damages which might be sustained by Lessee in con-
nection with the use and occupancy of said premises .
Lessee agrees to carry public liability insurance in
the sum of not less than $100 ,000 for any one person,
and in the sum of not less than $300 ,000 for any one
accident , and property damage in the sum of $50 ,000 .
Said policies of insurance shall name City of Huntington
Beach as an additional insured.
12 . Lessee agrees to pay to Lessor all costs and expenses
including a reasonable attorney ' s fee in any action
brought by Lessor to recover any rent due and unpaid,
or for the breach of any of the covenants or agreements
contained in this Lease , or to recover possession of
said premises , whether such action progress to judg-
ment or not .
13 . Lessee agrees to promptly observe , comply with and exe-
cute, at its cost and expense , all present and future
laws , rules , requirements , orders , directions , ordi-
nances and regulations of the State of California, City
of Huntington Beach, County of Orange , and of the United
States , and of any and all governmental authorities or
agencies , and of all municipal departments , bureaus ,
boards or officials of the City of Huntington Beach,
and of the Board of Fire Underwriters or any other board
or organization exercising similar functions , concern-
ing said premises , and shall at its own expense make
any and all improvements thereon or alterations thereto,
4 .
structural or otherwise , that may be required at any
time hereafter by any such present or future law,
regulation, rule , requirement , order, direction or
ordinance .
14 . If the Lessee shall at any time during the term hereof,
become insolvent , or if proceedings in bankruptcy shall
be instituted by or against the Lessee, or if the Lessee
shall compound the Lessee ' s debts or make an assignment
for the benefit of creditors , or if any execution shall
issue against the Lessee or any of the Lessee ' s property
whatsoever, whereby the demised premises shall be taken
or attempted to be taken, or if a receiver or trustee
shall be appointed of the Lessee ' s property or if this
Lease shall, by operation of law devolve upon or pass
to any person or persons other than the Lessee , except
by descent , then and in each of said cases , this Lease
shall terminate .
15 . Lessee agrees that if any rent shall be due and unpaid,
or if default should be made in any of the covenants ,
conditions or agreements on the part of Lessee , con-
tained in this lease, Lessor may at its option at any
time after such default or breach, and after giving
written notice to Lessee of such default or breach,
and upon failure of Lessee to remedy the same within
fifteen (15) days from date of such notice , then Lessor
may reenter said premises and take possession and re-
move all persons therefrom, and any rents theretofore
paid shall be retained by Lessor.
16 . At the expiration of said term, or any sooner termina-
tion of this Lease , Lessee agrees to quit and surrender
possession of said premises and its appurtenances to
5 .
Lessor in as good condition as reasonable use and
wear will permit , damage by the elements or other
casualty excepted.
IN WITNESS WHEREOF, the Lessor has caused its corporate
name and seal to be hereunto annexed and Lessee has hereunto set
its hand as of the date and year first written in this Lease .
CITY OF HUNTINGTON BEACH
By e 71kQ i
Mayor
By �� e
Clerk
LESSOR
HUNTINGTON BEACH POLICE OFFICERS '
ASSOCIATION, INC .
By •
By
LESSEE
APPROVED AS TO FORM:
Ci y Attorney
(/
6 .
i ertificate of Insuran _ _ - ,,,�
c`rV a • THIS CERTIFICATE IS ISS A MATTER OF INFORMATION ONLY AND CONFE' RIGHTS UPON THE CERTIFICATE HOLDER ;
THIS CERTIFICATE DOES END, EXTEND OR ALTER THE COVERAGE AFFOR I . _THE POLICIES LISTED BELOW.
t,Am AN( A(SL'REs� OF AGE NCB ___ _—..
COMPANIES AFFORDING COVERAGES
:::)scruff-,& Associates Insurance --
P .O. Box 156 COMPANY A American States Insurance
Westminster , CA 92683 LETTER
t' ( 714) 895-1222 COMPANY
LETTER B
i NAME AND ADDRESS OF INSURED
COMPANY C
LETTER
Huntington Beach Police officers Assn .
18211 Gothard Street COMPANY D
LETTER
C/O P .O. Box 896
1 Huntington Beach, CA 92648 COMPANY E
LETTER
j 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.
I• COMPANY POLICY Limits of Liability in Thousands(000)
LETTER 'TYPE OF INSURANCE POLICY NUMBER EXPIRATION DATE EACH AGGREGATE
OCCURRENCE
j GENERAL LIABILITY
BODILY INJURY 5 1 , 000 $ 1 , 0 0 0
u
t A ®COMPREHENSIVE FORM r�
a]PREMISES-OPERATIONS CL 102'-119 2/20/84 PROPERTY DAMAGE S 50 , $ 50 ,
. ❑EXPLOSION AND COLLAPSE
HAZARD
i` ❑UNDERGROUND HAZARD .
1. ❑ PRODUCTS/COMPLETED
k OPERATIONS HAZARD BODILY INJURY AND
'I ❑CONTRACTUAL INSURANCE _ PROPERTY DAMAGE $ $
BROAD FORM PROPERTY Ilv,t I ;�j�;�I �L C { , .
COMBINED
DAMAGE DE1 L.L 0,-'I'.,';..,•%I ... I\�+1C ES •
INDEPENDENT CONTRACTORS, •y
I„
ElPERSONAL INJURY PERSONAL INJURY S-
•
`'; AUTOMOBILE LIABILITY �`1 BODILY INJURY t. ',
(EACH PERSON)
,.I' ❑ COMPREHENSIVE FORM P. C. E2X _20 BODILY INJURY $ r —
❑ OWNED II� .,+ZV.-:1 - •..�.), CA 0 ' (EACH ACCIDENT)
,, - PROPERTY DAMAGE $
d; ❑ HIRED ! 1 CV BODILY INJURY AND
NON•OWNED \
PROPERTY DAMAGE $
`,\f COMBINED
EXCESS LIABILITY
¢ �`I' �� ® BODILY INJURY AND
85• ❑ UMBRELLA FORM R�G� 4 PROVED AS TO FORI,�I PROPERTY DAMAGE $ $
t ❑ OTHER THANUMBRELLA� _ `•ii C] \CQ. IL fIUT'ON COMBINED
FORM �� J 'c
• WORKERS'COMPENSATI N" �8, E ity At rne,y STATUTORY
'� and •\ ...q% T a.
EMPLOYERS'LIABILITY 1N•`•-8 6' - �' IJ EACH ACCIDENT)
OTHER _ ,
--� ZElputy City Attof� � • ,
:� DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES ....
Land owner: 18211 Gotherd St. , H.B. , CA Operations : Pistol and rle'' range
IT IS HEREBY AGREED AND UNDERSTOOD THAT THE CITY OF HUNTINGTON BEACH IS NAMED
= AS ADDITIONAL INSURED.
t. Cancellation: Should any of the above descrjb d policies be cancelled before the expiration date thereof, the issuing com-
'• pany will I XrXto mail -__J___-u. days written notice to the below named certificate holder,MOMIXXX0X
'i NAME AND ADDRESS OF CERTIFICATE HOLDER:
4. City of Huntington Beach DATE•ISSUED: January 20, 19.3
e• 2000 Main Street
;, '
Huntington Beach, CA 92648 .,f \.)C.i. I 1<w
AUTHORIZED RE E ATIVE 1;
4(
ACORD 2525( 9`79)
' J
13)(1
Revision of Lease Agreement between the City of Huntington
Beach and the Huntington Beach Police Officers Association
The Police range will now be made available for use
by the public under the terms of Paragraph 4 of the lease .
Written consent must be approved by the Mayor and City
Council for this public use . Approval for the Mayor and
City Clerk to sign the revised lease is herewith requested.
Paragraph 4 will now read as follows :
"Lessee shall use the premises for the purpose of a
police firearms training range and related uses . The public
may use the premises as a firearms range. The premises shall
be used for no other purpose unless written consent of the
Lessor is first obtained. " �``• ;;� ,
.rr"
`/7
mo. ,,,(t3 170 4,a e, /cigsSill•
February 13, 1968
Mr. Don Thomas, Real Property
County Assessors Office
630 N. Broadway
Santa Ana, California
Dear Mr. Thomas:
Pursuant to our telephone conversation of last week,
we are forwarding copies of one renewal lease and
one new lease on City property.
If we can be of further service, please feel free to
contact my office.
t' Sincerely yours,
Paul C. Jones
" PCJ:aw
Enc: vH.B. Police Officers Assn. Lease
H.S. Humane Society Lease
e
LEASE
THIS LEASE, made and entered into this 9 day of
Fo-gRitiq-aj , 1968, by and
BETWEEN
CITY OF HUNTINGTON BEACH,
a municipal corporation,
hereinafter designated as,
LESSOR
AND
HUNTINGTON BEACH POLICE OF-
FICERS' ASSOCIATION, Incor-
porated, a California non-
profit association, herein-
after designated as
LESSEE
N I T N E S S E T H:
Lessor for and in consideration of the covenants and agree-
ments herein contained and for the payment of the rents hereinaf-
ter to be paid, does hereby lease, demise and let unto Lessee the
surface of that certain real property located in the County of
Orange, State of California, described as follows :
The north 535.00 feet of the west 300.00 feet of the
east 445.00 feet of the southeast one-quarter of the
northwest one-quarter of the northwest one-quarter
of Section 35, Township 5 South, Range 11 West as shown
on a sectionalized survey map recorded in Book 51,Page
11, Miscellaneous Maps, Records of Orange County,
California , being a portion of the Rancho Las Bolsas
This lease is made by the Lessor and accepted by the Less-
ee on each of the following terms, conditions and covenants :
1.
If
y Y t i
1
le The base term of this lease shall be for fifteen (15)
years from the date of this lease.
2. The Lessee shall pay to the Lessor, as rental during
the first ten (10) years of this lease the sum of one
(1) dollar per year payable on the first day of each
of said ten (10) years,
At the conclusion of said ten year period either
party shall have the right to review the amount of
rental to be paid and the times of such payments, wheth-
er yearly or monthly, by giving the other party hereto
ninety (90) days written notice prior to the commence-
ment of the next year under the lease and said rent
shall be agreed upon between the parties and if they
cannot agree they shall each select one arbitrator
and if they cannot agree, the two arbitrators shall
select a third whose decision as to the amount of rent,
shall be final.
3.
Any holding over after the fifteen (15) year term shall
be on a year to year basis and shall be subject to all
the terms and conditions of this lease including the
rental procedure outlined for the llth through the 15th
years contained in paragraph 2 and said year to year
tenancy may be terminated by either party by giving the
other party sixty (60) days written notice prior to the
commencement of any lease year.
4. Lessee shall use the premises for the purpose of a police
training pistol range and uses related thereto and for
out
no other purpose with/ the written consent of the Lessor
first obtained,
2 .
54) In addition to the rental herein described the Lessee
agrees to pay when due all water, electric, gas and
other public utility charges, license fees, real and
personal property taxes, special assessments and
other public charges accrued or payable in connection
with the use of said premises by Lessee during the
Lessee' s possession under this lease.
6. This lease is personal to Lessee and Lessee shall not
sell, assign or transfer any portion of this lease.or
permit the same to be transferred by operation of law
without the written consent of the Lessor first obtained.
7. Any improvements or construction on said property shall
be approved by Lessor and shall be constructed at Less-
ee's own expense. Lessee shall keep said property from
all liens and save the Lessor harmless of and from any
liability of any nature arising from the use, occupancy
or construction of any improvements on said leased,
property. Lessee shall at all times maintain in good
order, repair and appearance all buildings on the demis-
ed property.
8. Regardless of any provision to the contrary in this
lease the Lessor shall have the right to terminate this
lease .by ninety (90) days written noticeuif in the
opinion of Lessor the land is necessary for a higher
and better public use® In such event the Lessor shall
reimburse the Lessee for the undepreciated cost of any
improvement upon the property, such depreciation to be
determined by a ten (10) year straight line method and
to be figured from the time that such improvement was
actually made®
3•
•
9. Lessor shall not be called upon to make any improvements,
replacement or repairs on said premises, and Lessee ac-
cepts the same in their present condition.
10. Lessee shall not commit, suffer or permit any waste on said
premises.
11. Lessee agrees to indemnify and hold Lessor harmless from any
loss or damage, including public liability and property dam-
age, resulting from the use or misuse of the demised land
and the buildings thereon, and Lessee hereby releases Lessor
from any and all liability for damages which might be sustain-
ed by Lessee in connection with the use and occupancy of
said premises. Lessee agrees to carry Public Liability in-
surance in the sum of not less than $100,000 for any one
person, and in the sum of not less than $300,000 for any one
accident, and property damage in the sum of $50,000, Said
policies of insuranfe shall name City of Huntington Beach as
an additional insured and shall contain language to the effect
that the policy may not be cancelled without 30 days notice
to the City of Huntington Beach.
12e Lessee agrees to pay to Lessor all costs and expenses in-
cluding a reasonable attorney's fee in any action brought
by the Lessor to recover any rent due and unpaid, or for the
breach of any of the covenants or agreements contained in
this Lease, or to recover possession of said premises,
whether such action progress to judgment or not.
13. Lessee agrees to promptly observe, comply with and ex-
ecute, at its cost and expense, all present and future
laws, rules, requirements, orders, directions, ordinances
and regulations of the State of California, City of Hunt-
4.
ington Beach, County of Orange, and of the United States,
and of any and all governmental authorities or agencies,
and of all municipal departments, bureaus, boards or of-
ficials of the City of Huntington Beach, and of the Board
of Fire Underwriters or any other board or organization
exercising similar functions, concerning said premises,
and shall at its own expense make any and all improvements
thereon or alterations thereto, structural or otherwise,
that may be required at any time hereafter by any such pres-
ent or future law, regulation, rule, requirement, order,
direction or ordinance.
14. If the Lessee shall at any time during the term hereof,
become insolvent, or if proceedings in bankruptcy shall be
instituted by or against the Lessee, or if the Lessee shall
compound the Lessee's debts or make an assignment for the
benefit of creditors, or if any execution shall issue against
the Lessee or any of' the Lessee's property whatsoever, where-
by the demised premises shall be taken or attempted to be
taken, or if a receiver or trustee shall be appointed of the
Lessee's property or if this Lease shall, by operation of
law devolve upon or pass to any person or persons other
than the Lessee, except by descent, then and in each of
said cases, this Lease shall terminate.
15. Lessee agrees that if any rent shall be due and unpaid,
or if default should be made in any of the covenants, con-
ditions or agreements on the part of Lessee, contained in
this lease, Lessor may at its option at any time after
such default or breach, and after giving written notice
to Lessee of such default or breach, and upon failure of
Lessee to remedy the same within fifteen (15) days from
5.
date of such notice, then Lessor may re-enter said prem-
ises and take possession and remove all persons therefrom,
and any rents theretofore paid shall be retained by Less-
or.
16. At the expiration of said term, or any sooner termina-
tion of this Lease, Lessee agrees to quit and surrender
possession of said premises and its appurtenances to
Lessor in as good condition as reasonable use and wear
will permit, damage by the elements or other casualty ex-
cepted.
IN WITNESS WHEREOF, the Lessor has caused its corporate
name and seal to be hereunto annexed and Lessee has hereunto
set its hand as of the date and year first written in this
Lease.
CITY OF HUNTINGTON BEACH,
Na ro
Clerk
LESSOR
APPROVED AS TO FORM: HUNTINGTON BEACH POLICE OF-
FICERS' ASSOCIATION, Inc.
� BY _ z4
K a DAL.c,
"geco.
City' Attorney nn
ByUDiizye
2-ic(= 6-'
LESSEE
6.
• ' 7
1 , • •
STATE OF CALIFORNIA ) ss
COUNTY OF ORANGE )
On `_ , 1968, before me a Notary Public in _and
for said CoVanty and State, personally appeared DONALD D.
SHIPLEY, known to me to be the Mayor and PAUL C. JONES known
to me to be the City Clerk of the Municipal Corporation that
executed the within instrument, known to me to be the persons
who executed the within instrument on behalf of the Municipal
Corporation therein named, and acknowledged to me that such
Municipal Corporation executed the within instrument.
WITNESS my hand and official seal
,pc.,., OFFICIAL SEAL
¢R 1EST1NAD! r•M910INOTARY PUBLIC CALIFORNIA
I 4141,.
PRINCIPAL OFFICE IN MY Commission Expires June 25, 1969
"'`m•g— ORANGE COUNTY j
STATE OF CALIFORNIA )
COUNTY OF ORANGE )
on.,,,„_*,,, _.- Y _,, 1968, before me a Notary Public in
and for sai bounty and state, personally appeared JACK
REINHOLTZ , known to me to be the president and Dewayne
BROWN, known to me to be the Vice-president of the Hunting-
ton Beach police Officers' Association, Inc. a non-profit
corporation of the State of California, that executed the
within instrument, known to me to be the persons who exe-
cuted the within instrument on behalf of the non-profit
association therein named, and acknowledged to me that such
non-profit association executed the within instrument.
WITNESS my hand and official seal.
*Dna OFFICIAL SEAL k
~LL4
`9—
, �oali ,,._'. ERNESd!1A DI FABIO
A),
NOTARY PUBLIC CALIFORNIA WMy Commission Expires June 25 1969
� ' PRINCIPAL OFFICE IN
,
•'s�: ' ORANGE COUNTY
i :OVFR:1 c
I', - •, r
RENEWAL CERTIFICATE _ s ' ro tf%`,N , rl= l' -11F i D , •
\I '`...---L A STOCK, IR=.NCF C:- IPA'. r
(HEREIN CALLED THE CC".IPANYI
F1 1 NATIONAL UNION FIRE INSURANCE
COMPANY OF PITTSBURGH,PA
NAME OF Huntington Beach Police Officers Assoc. 2 AMERICAN HOME ASSURANCE COMPANY
INSURED PO Box 896
Huntington Beach, California 92648 THE INSURANCE COMPANY OF THE
3 STATE OF PENNSYLVANIA
L _J MEMBERS OF THE
AMERICAN INTERNATIONAL GROU
T- -1 EXECUTIVE OFFICES
70 PINE STREET
AGENT OR Joseph Chia rello & Co, Inc New York, N.Y, 10270
PRODUCER 31 parker Road BROKER'S CODE
_Elizabeth,NJ 07208 30625
NUMBER OF POLICY . POLICY EXTENDED
BEING RENEWED '
FROM TO TOTAL PREMIUM
MO DAY YR MO DAY YR
S154 40 96 04 01 87 04 01 38 $2500.00 Min & Deposit J
IN CONSIDERATION OF THE PAYMENT, IT IS AGREED THAT THE POLICY DESIGNATED ABOVE
IS RENEWED FOR THE POLICY PERIOD STATED ABOVE, SUBJECT TO ALL ITS TERMS EXCEPT AS
STATED HEREIN.
THIS CERTIFICATE SHALL NOT BE VALID UNLESS COUNTERSIGNED BY A DULY AUTHORIZED
REPRESENTATIVE OF THE COMPANY.
l/i.41 ttw+76.7�"/ 's �t�u( .- _ dal•• �'"�'� �f�-,... t�+-7
� G v�
Secretary President,National Union Fire President,American Home President,The Insurance Company
Insurance Company of Pittsburgh Pa. Assurance Company of the State of Pennsylvania
/ --' -')/t/k/t,
5/1/87
COUNTERSIGNED BY )(2_ - '7,-
h
20222 (6/80) AUTHORIZED REPRESENTATIVE
- I
(a) Area(Sq.Ft.) (a) Per 100 Sq. Ft. of Area
(b) Frontage (b) Per Linear Foot
(c) Remuneration (c) Per $100 of Remuneration
(d) Receipts (d) Per $100 of Receipts
(e) Units (e) Per Unit
(I) Admissions (f) Per 100 Admissions
Escalators(Number at Premises) Number Insured Per Landing
N OT COVERED ,
Independent Contractors Cost Per$100 of Cost
N OT C O V E RE D
Completed Operations at Receipts (a) Per$1,000 of Receipts
N OT COVERED
Products fb) Sales (b) Per$1,000 of Sales
Range R/A; Shooting Galleries 39982 Intl Intl Incl Incl Intl
Reload Mfr-R/A; Ammun Mfg 19612s 42,000 37.66 Incl Incl Incl
---------------- -- - - - - - 1 — — ' —
RODUC-t=R
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
JOSEPH CHIARELLO & CO. , INC. COMPANIES AFFORDING COVERAGE
31 Parker Rd.
Elizabeth, NJ 07208 COMPANY A
LETTER National Union F`.r: Iris. Co. i
COMPANY
} INSURED LETTER 0 4
sso
_ _ COMNY
Huntington Beach Police OfficersA � PA C
PO Box 896 COMPANYCOMPANY D
Huntington Beach, CA 92648 LEI I R
f,
LETTER
,bTsi� VN . -al a' si. :k „*,';'xi0k .a .tom , _.,,r',,,,L,4 ',3.3. s g--.1* �,t ' , ,,S=,LL:.
POLICIES O THISF NANCE ID EVE EN SSO INS NAMED E Y D
NOTWITHSTANDING ISTOCERTIFY ANYTHAT REQUIREMENT I,TERM OR CONDITION B OFLOW ANY
HA C ONTRACTBE I UED OR OTHERTTHE DOCUMENT URED WITHMABOVRESPECTFOA TO
THE WHICH THISPOLIC CERTIFICATE PERIOINDICATED,MAY
BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS,AND CONDI- "
TIONS OF SUCH POLICIES. F
CO POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS f
v.' LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DNYY) DATE(MM�D(VYY) OCCURRENCEiii E
AGGREGATE
GENERAL LIABILITY - t
BODILY
'— INJURY
A X COMOREHENSNE FORM $ $
- :: X PREMISES/OPERATIONS S154 40 96 4/1/86 4/1/87 PROPERTY
UNDERGROUND DAMAGE
EXPLOSION &COLLAPSE HAZARD $ $ i
- X PRODUCTS/COMPLETED OPERATIONS
^: CONTRACTUAL COMBINED $ 1,000 $ 1,000 I
•jye- INDEPENDENT CONTRACTORS
.. BROAD FORM PROPERTY DAMAGE
=_=k PERSONAL INJURY PERSONAL INJURY $
•
( — _—
AUTOMOBILE LIABILITY — &OLY
I
pY $ANY AUTO IPER PERSONIALL OWNED AUTOS(PRIV PASS.) BOLY
OTHER THAN IALL OWNED AUTOS\PRIV PASS iR ET $
HIRED AUTOS
PROPERTY
:; NON-OWNED AUTOS DAMAGE $
GARAGE LIABILITY BI&PD
-:, a I COMBINED $
9 EXCESS LIABILITY
Bi&PD
-�•:a I UMBRELLA.FORM COMBINED $ $
I I OTHER THAN UMBRELLA FORM
STATUTORY
WORKERS' COMPENSATION
=:,,1 $ (EACH ACCIDENT)
AND
EMPLOYERS' LIABILITY • $ (DISEASE-POLICY LIMIT
-. $ (DISEASE-EACH EMPLOYE_
OTHER
DESCRIPTION OF-OPERATIONS/LOCATIONSNEHICLES/SPECIAL.ITEMS r
.°.,.=:..-i-r.' �� '.I.,. et,.,,��^�r'�' a,e�'r__;�'.'.` ar_ '-;�'r'w?;.�ya�: �:3.:� e��. �ONF'a"P ,�5��`('��.n�',:F;;;i*ar ^T�,.-,..---a,. .... -, . ... . --. �,._,.y..�.-�
tj City of Huntington Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ZOOI� Main St. , PO BOY. 70 .y EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DA'(S WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
-a Huntington Beach, CA 92648 LEFT,BUT FA►LUfR E TQ MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
._I OF ANY KINQUP,QCYTHE COMP NY, ITS AGENTS OR REPRESENTATIVES.
Attn: Gil Coerper - s. AUTHORIZE RESE TAT IV ty� j
- *o7siyFrms- ;714 r,`s- s "tnw+ dr.E"a v 14I -'4' s i Yt d T
,,..2.2 -,_-2.
•
.
.. ,...o+,c - _ „w., 4r% �yw•`C25 F�'i=: C,ak 'y:� - .r^^z -..Lt.s,- � _
:l2 •.-• c .- -, 4s re n- F _ `J •. ".` - .:sue, e . Vi : :.... : , 1,a: - -
ENDORSEMENT
This endorsement, effective 12:01 A M April 1, 1986 forms a part of
policy No S154 40 96 issued to Huntington Beach Police Officers Assn.
by National Union Fire Ins Co
It is hereby understood and agreed that the following is added as additional
insured as their interest may appear:
City of Huntington BEach
2000 Main St
Huntington Beach, calif
NO CHANGE IN PREMIUM
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
II; 771
Air L/Lifr 719.
Authorized Representative
AFFIDAVIT
OF
NON-RESPONSIBILITY
CITY OF HUNTINGTON, BEACH)'
' - COUNTY OF ORANGE ) SS...
STATE OF CALIFORNIA )
I hereby declare that 1 am Alicia M. -Wentworth, City Clerk, City of Huntington
Beach. .
I further declare that the' City of Huntington Beach has on file in my office an
agreement with the Huntington Beach Police Officers Association dated January 4,
1972. Said agreement states that the property known as the Huntington Beach
Police Pistol Range is located at 18211 Gothard Street, Huntington Beach and
is leased to the Huntington Beach Police Officers Association. The Huntington
Beach Police Officers Association is responsible for ‘the maintenance, upkeep,
use or occupancy of the land and/or buildings at said location.
The agreement has a hold harmless clause and a stipulation that the Huntington
Beach Police Officers Association shall keep in force liability insurance and
that the City shall be named additional insured under said policy.
Section #4 - "Lessee shall use the premises for the purpose of a police firearms
training range and related uses. The public may use the premises as a firearms
range. The premises shall be used for no other purpose unless written consent
of the Lessor is first obtained. "
Section #7 - "Any improvements or construction of said property shall be approved
by Lessor and shall be constructed at Lessee' s own expense. Lessee shall keep said
property from all liens and save the Lessor harmless of and from any liability of any
nature arising from the use, occupancy or construction of any improvements on said
leased property. Lessee shall at all times maintain in good order, repair and
appearance all buildings on the demised property. "
Section #11 - "Lessee agrees to indemnify and hold Lessor harmless from any loss
or damage, including public liability and property damage, resulting from the use
or misuse of the demised land and the buildings thereon, and Lessee hereby releases
Lessor from any and all liability from damages which might be sustained by Lessee
in connection with the use and occupancy of said premises . Lessee agrees to carry
public liability insurance in the sum of not less than $100,000 for any one person,
and in the sum of not less that $300,000 for any one accident, and property damage
in the sum of $50,000. Said policies of insurance shall name City of Huntington
Beach as an additional insured. " '
I certify under penalty of perjury that the foregoing statements are true and correct
to the best of my knowledge.
Dated: 111111110ilm .
Alic a M. Wentworth, ty er
City of Huntington Beach
g/ y
AFFIDAVIT
OF
NON-RESPONSIBILITY
CITY OF HUNTINGTON BEACH)
COUNTY OF ORANGE ) SS.
STATE OF CALIFORNIA )
I hereby declare that I am Alicia M. Wentworth, City Clerk, City of Huntington
Beach.
I further declare that the City of Huntington Beach has on file in my office an
agreement with the Huntington Beach Police Officers Association dated January 4,
1972. Said agreement states that the property known as the Huntington Beach
Police Pistol Range is located at 18211 Gothard Street, Huntington Beach and
is leased to the Huntington Beach Police Officers Association. The Huntington
Beach Police Officers Association is responsible for the maintenance, upkeep,
use or occupany of the land and/or buildings at said location.
The agreement has a hold harmless clause and a stipulation that the Huntington
Beach Police Officers Association shall keep in force liability insurance and
that the City shall be named additional insured under said policy.
Section #4 - "Lessee shall use the premises for the purpose of a police firearms
training range and related uses. The public may use the premises as a firearms
range. The premises shall be used for no other purpose unless written consent
of the Lessor is first obtained. "
Section #7 - "Any improvements or construction of said property shall be approved
by Lessor and shall be constructed at Lessee's own expense. Lessee shall keep said
property from all liens and save the Lessor harmless of and from any liability of any
nature arising from the use, occupancy or construction of any improvements on said
leased property. Lessee shall at all times maintain in good order, repair and
appearance all buildings on the demised property."
Section #11 - "Lessee agrees to indemnify and hold Lessor harmless from any loss
or damage, including public liability and property damage, resulting from the use
or misuse of the demised land and the buildings thereon, and Lessee hereby releases
Lessor from any and all liability for damages which might be sustained by Lessee
in connection with the use and occupancy of said premises. Lessee agrees to carry
public liability insurance in the sum of not less than $100,000 for any one person,
and in the sum of not less than $300,000 for any one accident, and property damage
in the sum of $50,000. Said policies of insurance shall name City of Huntington
Beach as an additional insured."
I certify under penalty of perjury that the foregoing statements are true and correct
to the best of my knowledge.
Dated: Feoru. •y rfi 9&2
licia M. Wen worth, City Cler
City of Huntington Beach
Complete only when this endorsement prepared with
the policy or when the effective date dil om the policy.
Pol,No,: CL 102-119 Eff.: 2/20/82 ADDITIONAL INSURED
Insured: HUTN . BEACH POLICE (Owners or Contractors)
OFFICERS ASSOC .
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
G 116
SCHEDULE
Name of Person or Organization
(Additional Insured) Location of Covered Operations
CITY OF HUNTINGTON BEACH Land owner : 18211 Gothard St.
2000Main St. Huntington Beach
Huntington Beach , CA ( Pistol & Rifle Range)
Premium Bases Rates Advance Premium
Bodily Injury Liability Cost $100 of cost $
Property Damage Liability Cost $100 of cost $
Total Advance Premium $
It is agreed that:
1. The "Persons Insured" provision is amended to include as an insured the person or organiza-
tion named above (hereinafter called "additional insured"), but only with respect to liability
arising out of (1) operations performed for the additional insured by the named insured at the
location designated above or (2) acts or omissions of the additional insured in connection with
his general supervision of such operations.
2. None of the exclusions of the policy, except exclusions (a), (c), (f), (g), (i), (j) and (m),
apply to this insurance.
3. Additional Exclusions This insurance does not apply:
(a) to bodily injury or property damage occuring after
(1) all work on the project (other than service, maintenance or repairs) to be performed
by or on behalf of the additional insured at the site of the covered operations has
been completed or
(2) that portion of the named insured's work out of which the injury or damage arises
has been put to its intended use by any person or organization other than another con-
tractor( or_._subcontractor,,engaged in performing operations for a principal as a part of
' y .'i ..,c the same project; l?�=< ;. ; ;,
(b) to bodily injury or property damage arising out of any act or omission of the additional
insured or any of his employees, other than general supervision of work performed for the
additional insured by the named insured;
(c) to property damage to
(1) property owned or occupied by or rented to the additional insured,
(2) property used by the additional insured,
(3) property in the care, custody or control of the additional insured or as to which the
additional insured is for any purpose exercising physical control, or
(4) work performed for the additional insured by the named insured.
4. Additional Definition When used in reference to this insurance; "work" includes materials,
parts and equipment furnished in connection therewith.
All other terms of this policy remain unchanged.
American States Insurance Company eAmerican Economy Insurance Company
' ito
� INDIANAPOLIS, INDIANA
President
Countersigned by ED E T 'V . ..a./Y.
Form 9-701 CL, ML Secretary
(7-73)
s T c, " 'P I• c�yy Fi /,r c, .'; ,4, , R r tra w-�•vtr ,.,r:;• rnt •� y - y;, a it - s 7..,r,
'+`'Mti fdq •• Yt��T�• ,t � r Y 5Y. '�' iTi� .d fit; 'xr}• ��t k� i /[��{�y;r 1�YJ7I a��t..ir S� �.Y low• 'lk 'ry�Jp�r. �'� trs �.� R��t` �S]
t °(• �,,' +x (f ) - ', ��{{yyy�,,�LL��1(pp 4,4- 4-I I �•ty'� ,T,i.'• 'ki `§ -,, k 1. +( �;,t vE i MAY' �j °r4.:-. d , f.
{,4_ a 1.. h t" } 1, i.�fr's. f "0 1^ �.7 T 6'} .y 1 g''..svej.,,1", 1 ,j` - y" :, 'nel :4,�
yy C ''it .F* t;.�3' I • - • ..la .i ,.if' '.�X 'iyy+.y1, 'M.�yy1, •,t.
le,' _.wI 1 -1M M�}'..'+�yF�F{Y� 1•..R .}NO**,G. •I�' I i. �r f S-.• '{ '/ . t 1.^'. ,1,� W { , " �
.t sS�A. � zv �M �'°f]7".t" �q,,�;vrqq�� [q�__yy��,,�r, i't•T'-'ttid d ,,�t,�iD .r+ :t* 'a,t `• ^+ , i`' 7r',�rr ��'A!� -'�,.��
F i•'r`r F cp. IF. ATE`IS I SUEII•�5rK- AT7E v:, ,INFO t . f0,L `.t. r v-b-!+fir• ' L,/ �FIi AT�L'D>P'�,. '
w',z: " '�I�• •M,,,: .F11S CEltTIFICAf bO S 'NbT'7 MtlViSr fa ; M L• `?` E! TFi 41C E STEIViiti lifk- '1,V.3`ICI`.`V. i s�
5`�t'
0.4 -• NAME AND ADDRESS OF AGENCY
,: VANDRUFF & ASSOCIATES COMPANIES AFFORDING COVERAGES > J
P . O. Box 156 //
co
? 1." Westminster, CA 92683 LE11EhNy A AMERTCAh ,STATFS_ r.
.,, , 848-4413 LEOMPANY
B i
` - . NAME AND ADDRESS OF INSURED COMPANY
1 X
• HUNTINGTON BEACH POLICE OFFICERS ASSOC ;ETTER
18211 Gothard St. , COMPANY
J` ;., c/o P . O. Box 896 LETTER
!''_-`•-' Huntington Beach, CA COMPANY
'' •'i•'
'M LETTER _
s`Se.,,,' 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 •
:r}: 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
c;zx: terms,exclusions and conditions of such'policies.
'g'`4 : corm+ANY POLICY — Limits of Liability in Thousands(000) -_
LETTER' TY PE O(INSURANCE POt.ICY NUMB[It I.XPIRA TIIIN DATr (ACH A(CRr.GATr
'Tf�"•,� • OCr UPRt NCE
‘'"If"
"r.
x GENERAL LIABILITY
v Boom,INJURI $1 000 $ 1 000
' J��J��dq]]COMPREHENSIVE FORM -. ._ .,. - _„ . _ - , -:...,r . ., .,?"e. �O 00,f, t;,r;c �f.,000
f
A El PREMISES—OPERATIONS CL 10 2-119 2I 2 0I 81 PROPERTY DAMAGE S S
❑ EXPLOSION AND COLLAPSE •. ..5 0,0 0 0 50, 00 ,
` y.;• HAZARD j
ax"'' ❑ UNDERGROUND HAZARD
FT' ❑ PRODUCTS/COMPLET ED '
•.,.F OPt.RAI IONS HAZARD BODILY INJURY AND
_
CONTRACTUAL INSURANCE PROPERTY DAMAGE S S -
'.+n ❑ BROAD FORM PROPERTY COMBINED
It DAMAGE
_' 'T ' ❑ INDEPENDENT CONTRACTORS • I,
1l L=a,', El PERSONAL INJURY PE RSONAI INJURY S
AUTOMOBILE LIABILITY BOD't v lNJutt, S : ," •% ''1041c`
'14 uP(ua N, . , .�
❑ COMPREHENSIVE FORM $ ;.;':I,,^Y,.+^. y Y;
I ' t ❑ OWNED -_IEACIi AC(IOEN11 �- •
- J.," ❑ - r•PC!PEPTY pANTAI,( S {.;k
'' HIRED ----_ 1 .'' •..y..•+ll.'
, :;.. BOnn.v IN IIJR,AND~ }}�tr�t� T t,:� :I
w,E;# ❑ NON.OWNED PROPER rv,pAMAG[ r_ ,
«— ccI,lTlINr.D_ .-_.._ `'}[1.r,1' "4,°.
tt EXCESS LIABILITY
}� BODILY INJURY AND '
Pr ❑ UMBRELLA FORM PROPERTY DAMAGE $ S
❑ OTHER THAN UMBRELLA COMBINED L!,
FORM
:'r WORKERS'COMPENSATION . STATUTORY — tr} , ie s
I 0� F ,' .i'l''' I ' and ., i • td}`i i ` S'jYi` ^4!�t
--i -} EMPLOYERS'L1A8IL�TY — - — —----•,..,.+..tA.-t, ,,I.i..w•..,i...,.•� . .,Accmr-IT
1- OTHER —T—
t:
ig• '-:w..0.40,A - ,i..•r P. Aj-- : .,' ,..L•,f.1•,.• '• J:... z't'-, ,.;tt3. ,,,,;;?i C. Y,' ..1_n..vs^... Y.:.,1::,.. a ZTEE4• rY' ,i.•=1:-8 3e...%f.,$ •�`.�^ar;;"'l _ .
4 i\. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES i
•( ' ' Land Owner : 18211 Gothard St . , Huntington Beach, CA
', Operations : Pistol and rifle range �o
r to
`'• Ai' --- - -- - r.
t.
,. Cancellation: Should any of the above described policies be cancelled before-the r'xp,ration date thereof the issuing corn-
>;, pany will endeavor to mail 10 days written notice to the below named certificate holder, but failure to
f mail such notice shalt impose no obligation or liability of any kind upon the company
�s' 4 o NAME AND ADDRESS OF CERTIFICATE HOLDER'
o DATE ISSUED Feb . 19 , 1982 t
``7; CITY OF HUNTINGTON BEACH
,, H[TNTT?irlT(_'N r-', 11r_T-i , (7 A T Tr,''T:+;1 ^ ,'/) /� 7
;f -(: �(•: gt,{ _.:%'ta x't?t'r' - .y, rrJ ,-t(�q-,7, - •qy -i :.r.^' ,,,y ,�.yi :�e.^:x.�-� ,/ .:a4-•-4r: qeg,;�v,�:
,,--rr •ef'd�""i'.','S i1:'Mt,` 'fit' .. - . .•:.j'g'yC; •1 i1C! 'el +,v,, .'f',�'a(. c;,,'ei!1:4,.FEr tG 4 p- ,2 e14.7.1. 1;i4'y10.8,,,,R,: •Yry'',T4,i ',i,f�.»a /!-:*k'T�r1, C'. 7, ,G'
.�.�P;;` `l�<. .tw i{ • "�,�7,7''+`� tvr• I�s'i'x taS N+`,"'M,`.rA (1T';,t,� �•,t; ?!9q �sif` Y � S fe"� •; v° +! h��.� ,�a'•�', c..Y� R}
tbrø
..A ri • '. 6'+�' �Fe ¢r, z. o .h,y s f r 4+.: IS; ' � '*.E.cif 19 r'p. *•��„�„CERTI ! 0- `'1 i�. ' R tSTt..�..Ui ! ..,tea.! .. .,.,.. �` 'f
s` ,Tk.• NAME 'AND.
ADDRESS OF AGENCY
' COMPANIES AFFORDING COVERAGES
t
VANDRUFF & ASSOCIATES --------- — — — --
,� $ P . O . Box 156 COMPANY
A
g ,,, Westminster, CA 92683 LETTER AMERICAN STATES P
!, ' .$ COMPANY A.,/
:{-,) LETTER
NAME AND ADDRESS OF INSURED C
,�'44 HUNTINGTON BEACH POLICE OFFICERS ASSOC . COMPANY _
18211 Gothard St .
COMPANY D
c/o P . O . Box 896
Al
LETTER
:'Y
• Huntington Beach, CA COMPANY
• (.1, 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
• re
.. 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
r;at• terms,exclusions and conditions of such policies. •
sl ;
4. POI ICY -_Limits of Liability in Thousands(000)
COMPANY
LETTER TYPE OF INSURANCE POLICY NUMBER EXPIRATION RAIL EACH AGGRfGAII
•19 OCT URPF NCF
n+ ''' GENERAL LIABILITY
e. .I, A rr BooilvINJI1'7Y s1 , 000 , 51 , 000
U COMPREHENSIVE FORM '� ""-"-a' '� r.t.•,
e' ' CL 102-119 2/20/82 '^ 000 ` •'�' '000
.A = ® PREMISES—OPERATIONS PROPERTY DAMAGE $ $ - i
❑ EXPLOSION AND COLLAPSE P:-'1,2i,1;:. d :%r,•'', ' 50 , 000 50 , 000'
•,• ,t, HAZARD ,
❑ UNDERGROUND HAZARD T. I:*{i ❑PRODUCTS/COMPLETED
+;.: OPERATIONS HAZARD RODII Y INJURY AND ,
T PROPERTY DAMAGE 1 1 s
" TSk CONTRACTUAL INSURANCE
F' '. ❑ BROAD FORM PROPERTY COMPINID
DAMAGE
-LIT•. ❑ INDEPENDENT CONTRACTORS •-- --T
£ ElPERSONAL INJURY PERSONAL INJURY 1 .
n
AUTOMOBILE LIABILITY l}Oalr INJUFTr
i i� ifACIfPEFISOhl .
Y`` IliBOOII,IN)4 RY COMPREHENSIVE FORM f •t 1
t ; (EACH ACCIDENT) I'•
r TT. ❑ OWNED
t.^,,,. mortal.,DAIAAC.I I,,-
❑ HIRED - •,
•Ta,, ❑ • BOCAV 1711URY Alt''J .it •-
.,}t NON OWNED - •YRlX'LRD D.& .IO,( E•• • c
�' EXCESS LIABILITYT , ' ,t .. r o
• i +601fltAfI11I1•A'�' aZ a y A.
L ❑ UMBRELLA FORM rs,' 4 t Y ,n l ;raja
'r OTHERTHANUMBRELLA' i;f Y., .)%t.1,,• :4.'A.?.x ,,• : .t .tI•vy;t:wp4.•tiQ ott,i 4,, ��ci.•,t.o mow` "s 1,
'i ❑ .,:, .a I,((-. 'rr .C; '.I ro--e,i.t• .,i'•,I, .t.,, :,-.Y.', .,t,v •.i't•,i :T. .
7 °'L' ,,t• 0.p�;;.�L •; .(., t` _,h ,, :,,„ 4,,,•; ;r.,,,,,•fi,,:. ....It ,k.q,aj,-� •!l,. nt 1t`(�-'Y' ,ty,. 7,p. ��,;...,,, gl'4�.k ai $ �.a•,,.'fY,.'- ''� �t. n�:. C"�'
,
•, r.- iOAWI ,,':'y .;'��''�";:, ,� M �il=S�.Sn11 .�pF`rl wN'�tr,�' n 1 .y t
'tr'C.;l;.r,; WORKERS'yCOMPEN,$*VON :f ;f`' '° ,L , ,� -t , '' , , Fo I
i,— c Y ',1,:. ,..q k 4A r -, J d { >,:. ^{t., tr y , •, ,i 4^." 'Ni..- t 2Z
.F •- ! T T. w JAI a fti x .v Z iY, r F , i # Ir e , t .,:
.4' .`i t irti V P ie 6 e4s�Kcw.ows T .�.li'wrie " 'y 49�!�tt#2l •
MftA�i
;, aswwr.ar OTf>•fplt • ,._ JIi. .2 (,' '.. - .. . \, •t" �'t',�i. 1 ;'entrh:, , ~' ',r'Q
�
YY
.,,04,y;,.,`„`>"i'.•,, `,tf•'..iF'•IN', .-.:m Y+t r X.r`0 ,t•'f,!( „••Y• .?a.-4 r _ t
I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
t;4 Land Owner : 18211 Gothard St. , Huntington Beach , CA
R' ':4 Operations : Pistol and rifle range
bkr•• Cancellation: Should any of the above descili,ed policies be cancelled before the expiration date thereof the issuing com-
pang will endeavor to mail days written notice to the below named certificate holder, but failure to
e f mail such notice shall impose no obligation or liability of any kind upon the company
M NAME AND ADDRESS OF CERTIFICATE HOLDER: Feb . 19 , 1982 (original
DATE' ISSUrc sent 87-I271-
CITY OF HUNTINGTON BEACH
:r HUNTINGTON BEACH, CA
�''
11,
(�tM AL. , !'iv-. RF&ELENTATIVE
�,.G'( ACORD 25(1•)9) ^_ j :` :^'. -m �,rt,: ''>cd r...39 61f ,•;1;;;?s = .
='tTia.._ ;t�•.7.1e`•E?1aFa,i-,xt"LS°#a_tl�s 's°�'�;:A�, '�.i _ .s.u:'t�;rr,.f-,�'���!ii�,�19.i5., ,. __� _. _.
t t t. f"j, � 9' �;' i. .�3r':� .ri•-4" •yt:Y�� •fti# t' h
1 " �: A. el. r64;;•, 0 r �'".,';
4 � -4`'xf vtlii C I{TIF ATewitSu x . �,TTEtt OF ANFORFAATI< INLY4 &f4L &i
fTE+'DeESfeKsAM'EN~b, EiITEiVD-OFI`Illli' I IICO l3 I'E ��'iiireo p I�P#41ers',.r . j F' c .
yy�F }6y pe} l
• NAME AND ADDRESS OF AGENCY S
V�'+ - VANDRUFF & ASSOCIATES COMPANIES AFFORDING COVERAGES
P .O. Box 156 J�
Westminster , CA 92683 COMPALETTER A AMERICAN STATES % '"
If
} 895-1222 COMPANY B
o LETTER
NAME AND nUDRE SS OF INSURED A I
1- HUNTINGTON BEACH POLICE OFFICERS CETTER
OMPANY
C ';
` ASSOC.
18211 Gothard St. LETTER
COMPANY D
Y'' c/o P.O. Box 896
Huntington Beach , CA L ERNY
E •
'•'.t' This ET 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
.,J terms,exclusions and conditions of such policies. i.
r j Limits of Liability in Thousands MOO)
-♦ COWAN.; POI ICY .----___—__.____--_ :.
TYPE Of INSUF7ANr1 Pill ICY NUMBER E A(;FI
��. LETTER fx,p�HAlluh I�AIE A,CREGAii.
, GENERAL LIABILITY
r6,1 t r f,r,IFIIIINIIII.r $ 1 ,000 , $ 1,000 '.
�.
A I�COMPREHENSIVE FORM 000 00
^a Ex PREMISES—OPERATIONS CL 102-119 2/20/83 PROPERTY DAMAGE $ $
4.;c ❑ EXPLOSION AND COLLAPSE 50 , 000 50 , 000 ,`
441. HAZARD
iy t, ❑ UNDO RO ROUND HAZARD
+y;,: ❑ PRODIICTS.COMPLETED
(}.iri OPERATIONS HAZARD BODII Y INJURY AND to
?' ❑CONT RAC UAL INSURANCE PROI't RTY DAMAGE $ $ r
i' it ❑ BROAD FORM PROPERTY VOMRmL[1 I':
y. DAMAGE
0 ❑ INDEPENDENT CONTRACTORS _._ —__.__ ,1
}
'w El PEF75UNAL INJURY $
PERSONAL INJURY (4g.
,,. [
AUTOMOBILE LIABILITY BODILY INJURY +t�{.k-"'-tP
• • 74
fir/1 PE RSON)
❑ COMPREHENSIVE FORM BODILY INJURY $. fF•h 1
„. ❑ -EACH ACCIDENT- r. r.':
' etOWNED •
¢J,t, t LA, W{. -,gl
ram,( ❑• HIRED "ROPEPTY DA."A•_.L $ •
`y BODILY INJURY'AND ti 3P'
'f tf*• ❑ NON•OWNED PROPERTY DAMAGE' $ -{tt' ;3 '� i'Lil{y;
14 _ _COMBINED `,,,e,i
f.. EXCESS LIABILITY p.'
F' BODILY INJURY AND
'.,i,.;F� El UMBRELLA FORM • PROPERTY DAMAGE $ $ �c:
qi, n
❑ OTHER THAN UMBRELLA COMBINED
i FORM '
1 " WORKERS'COMPENSATION :=? '" - STATUTORYc.
f
-. ... . ` and 4�5;'?; -- ,',��:''�°' (^:nr�"+it'•,r1., � ��" "+. '
W. .,.,,wary,✓ .,::, L. _ J 1•.4'J r t;,: 'y. ,l�{.: r ,- , - , -4.. - K 4t
EMPLOYERS'LIABILITY 'i; � i :�?' r +'x ;
' A OTHER
� i.t. 's1nW �'y'v s3 °�� 1�� 1 :T'aZ�� �rn '�' + i4w L3i.S�V 1 av Cte..) �: �"F ..7yi� .. :t4.E H,,:,, r-R"- , _.41,,
,!,,,,,i,, DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES /'e. RECEIVED t!
, Land Owner : 18211 Gothard St . , Huntington Beach , CA rf,
•
1- Operations : Pistol and Rifle range NAP I ; �I. -g
v - --- -- --irk.
' Cancellation: Should any of the above desc i ed policies be cancelled before the expiration d. N, `eT RIA'SURE(� Fi c rig• 1
i?, pan,, will endeavor to mail i$ days written notice to the below named certi ;� folder, but fail .`re,
_ 1, F
t.' mail such notice shall impose no obligation or liability of any kind upon the company ti �) `f `•,
t▪o
,' NAME AND ADDRESS OF CERTIFICATE HOLDER h,
DATE ISSUED _F�-b.�9_,_-1982 —
pp '� CITY OF HUNTINGTON BEACH
Gzr
k-% HgIGTON5EACHNTN B , CA !,
t. �r _ :
••tt! Huntington Beach CA AUTHURIc PR TATI`/E
i'" g r
` :ACORD 25(I.79) ,..
..�.--�,;._..., ._..-,-,.,-",-..?.r----,,a..-.--"...".".+.s....,.....,79,r.-...wwD a 5or,,:.s.,.!Mt.r.!r°-^';z ....�,7..4!.:1..,' �'" :"=a=;,•- 4` irref av: !.:�'t�'.:t•`:
Complete only when this endorsemen t prepared with
the policy or when the effective date c from the policy.
Pol.No.: CL 10 2—119 Eff.: 2/2 0/81 ADDIT1uN AL INSURED
Insured:HUNT . BCH. POLICE OFFICEFS (Owners or Contractors)
ASSOC .
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
G 116
SCHEDULE
Name of Person or Organization
(Additional Insured) Location of Covered Operations
CITY OF HUNTINGTON BEACH Land Owner : 18211 Gothard St.
2000 Main St. Huntington Beach
Huntington Beach , _CA (Pistol & Rifle Range)
Premium Bases Rates Advance Premium
Bodily Injury Liability Cost $100 of cost $
Property Damage Liability Cost $100 of cost $
Total Advance Premium $
It is agreed that:
1. The "Persons Insured" provision is amended to include as an insured the person or organiza-
tion named above (hereinafter called "additional insured"), but only with respect to liability
arising out of (1) operations performed for the additional insured by the named insured at the
location designated above or (2) acts or omissions of the additional insured in connection with
his general supervision of such operations.
2. None of the-exclusions of the policy, except exclusions (a), (c), (f), (g), (i), (j) and (m),
apply to this insurance. „
f> ','(F ' 8. Additional Exclusions This insurance does not apply: •
•
=�; ,. •: (a) to'.bodily injury or property,,damage occuring after .• . _
:(1), all work on the project (other than service, maintenance or repairs) to be performed •
. =s by or"on:behalf.of the additional.insured at the site, of the covered operations has
: been:'completed or :.,•, :x
' 'au�1222 4?a . ,.a•. of Atha mama I '.io,k'"out of .which w lnjur�' d&lna a;fit . of or aria.
n 9zk "n� . :put to,:lta intoode t and; or elrj nbatlaa.`other than another eon.
p y} 4$* •�1�.. �i >;4 ? :' •t `"^ •J � » z., »� ��. s .� •�� tt �'�r, rt.t�+iselplfl�l.+o of•:• .:,�. ,,,w!,,
. , li.10104
�',-,'��� �� .! ,- . _},.'ii'.•,<;,,- - t�}...r: .�;+t`i.�Y.- _ •IVM;F�i4 v L.
f! • � i Mf` 1 ' i' l! $tax of tli'r i4ttiticital ...,.
� 7iitt tit �� � fit# ae't�las.Eaa
Pa�r�ttr 3l er ply «rf irrop rk other than irtavtal .utervialueo of *Ink perfurrotd for the
e4dittoitAl laltured by the named Insured;
(c) to property damage to
(1) property owned or occupied by or rented to the additional insured,
(2) property used by the additional insured,
(3) property in the care, custody or control of the. additional insured or as to which the
additional insured is for any purpose exercising physical control, or
(4) work performed for the additional insured by the named insured.
4. Additional Definition When used in reference to this insurance, "work" includes materials,
parts and equipment furnished in connection therewith.
All other terms of this policy remain unchanged.
American States Insurance Company
American Economy Insurance Company /61-7)`eect:-1.-.
any, R
INDIANAPOLIS, INDIANA President
77 J
Countersigned by_j�C � ././ Iz t NT
Form 9-701 CL, ML Secretary
(7-73)
t�lI
.i...x9, F.y 1'',d " •• ..� �•ii,"ice 5 Y P> N 7+t V- ''M,. r a„ r,,--r,y x, I. '" -{` t '� y ..;."k•- _ '�'z,1S�t
`,tF:i;1°`lv;,Y�t2+h',ta4_L`'', r- ;rA itt' y'„ ' 01' 1. - I' V /. 4. 4a'� .1. C St...
F. Qco a 4,.a,'•;ti gDoici F fg 1 t t:�'. -"ttitfi oriFit�•YtatJ; .T •4°� F , 4',.il . til t, r(k F ry + c�T� •?'"4r '�y:
t' �, HIS C I t CAtE DOE N�5 4 fVD 4 f#Q',O L_..., F... �a it � • .,..pi.-. ..,''4 .i a 't
f"
M' 'NAME AND ADDRESS OF AGENCY ,
V,` • COMPANIES AFFORDING COVERAGES
-..- DANDRUFF & ASSOCIATES - - - --- - - —
T?
' Y`+ P . O . BOX 156 IOMPPNY ?
. AMERICAN STATES
.� Westminster , CA 92683 -- -
--
. r 848-4413 COMPALETTERNr B
y k NAME AND ADDRESS OF INSURED
12. COMPANY C T
„ HUNTINGTON BEACH POLICE OFFICERS ASSOC . LEFTLR
- ---
q,4, 18 211 Gothard S t. coMPAN, ®---------- ---- -----'-----
1-.T.,: c/oP . O . Box 896 LE TIER
-- --- -- - - _ - -----
Huntington Beach, CA COMPANY
s'j LETTER
1.4 1,-
Kn,- This is to certify that policies of insurance listed below have been issued to the insured named above and are in!orce at this tune. Notwithsta^dr g any rcqp.0 ement,term cr condit;en
is."g,' of any contract or other document with respect to which this certificate may be issued or may pertain,the insurance afforded by the pohcles described herein is subject to all the
', terms,exclusions and conditions of such policies. ___,
t 3t" I'(11 IT Y Limits of Liability in Thousands(000)—_
-- v, COMPANY TYPE OF INSURANCE POLICY NUMBER PAC it
.4' Vi i; LET iE17 CXPIRAIION PAT AGGPI GAIF
r _ 17CL41Ef,,f Na --. .—
GENERAL LIABILITY
:r(� ' BODILY INJuRv 1, 0 0 0 ,_ $1 , 0 0 0 ,
ip T A E(COMPREHENSIVE FORM
000 000
'? l��PRCMISE$-OPERATION$ CL 102-119 2/20/80 PROPFRIVDAMAGI: $ $
j"Tt, ����77J. ElEXPLOSION AND COLLAPSE 50 , 000 50 , 000
§ 6 HAZARD
1) 33;4 ❑UNDERGROUND HAZARD
❑ PRODUCTS'COMPLLIED
OPFRAT IONS HAZARD HOUR Y INJUIT, eND
:g.'tti ❑CON I RAC TUAL INSURANCE I'RUF•E R1 Y DAM',,: T F
,T4 t; ❑ BROAD FORM PROPERTY LOMBIN,I`
`N.A.,,.
1t 4w DAMAGE _N�,IF't4'T ❑ INDEPENDENT CONTRA(.TORS -- -- -- --
l',)T', ❑ PERSONAL INJURY I'I"i-' .NAL INJUIP,' $
�`Fx�� E AUTOMOBILE LIABILITY RODII Y IN!lat ;. 4cti.r, ",L%
k.:: j TT ACH.PE P; . 4 N,,, <..,{,':
�OMPRF HE.NSIVC FORM BODILY INJ,!'-r yt hF x
la (EACH ACME': J : ,, ,.
OWNED
T Y..• : ❑ PROPERTY['AMA(;I f ,':,,� t t
f HIRED z r' �
! ::,,A BODILY INJURY AND - dx'h f
47f ,, - ❑ NON-OWNED $ 1 ate`' fix' -
PROPERTYDAMAGE 1.?-1 ; 4,
'. COMBINED
:.,4 EXCESS LIABILITY
•T_.«fis BODILY INJURY AND
❑ UMBRELLA FORM PROPERTY DAMAGE i i
❑ OTHER THAN UMBRELLA - COMBINED '
Y ., FORM A
WORKERS'COMPENSATION' ;J;=' ~�`^s.`-` ..1, '‘;'-, 'STATUTORY
.+, . i,,, ,-,; - err i s 410, _' •t:..:
• ;;p ' ' ,b '' �.'1, >f.,,IV:n 'ar e o-7 i. s'lr.' i ;n: fr�.` ..,., a
�l ' end -•'..) ,{ :`,1: 'J!'.,S(. 'jw.� !'tT..,1-:.:,., .' • rY^;! ,,,=.siF • ".,',1 ,-,. _ .,,4'1' () ^'.•'`'�;.'.•i''r.' '.°r 1'.!: '
LI
ABILITY :id 74.r., `^'`' ;4 0,, 6'+
EMPLOYERS' _...
-- - - - - ---OTHER _. - _____�..._.
,lkr __..
4N,('tAl' � ,..�. �w.�-§x':p� :+T.T{�e... ��,F•.,�- n•rr:2!' � °i; '--'.�.�.muy,.af�m,:v.»..niy,.�;,7C',i,?; �" `g',.; 'xy"r,.
`' r r,s'..t N7. ?3_-??.74 tTe e. _.±G,.A,• :v::_••---,^;:e.•A..:st 1.:.,..:_ .i:-.kL7CS'` .. ;,�:... -,..w+bSn.:'.Vc%.7.-l._..",1':�'� ._.:i..\t_:.'Y s - b..,. .,
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
x LAND OWNER : 18211 Gothard St , Huntington Beach, CA
ti41' Operations : Pistol and rifle range
gt
° .ram — --
�' Cancellation: Should any of the above described policies be cancelled before the ecplratlon date thereof. the issuing ccm-
',I , pany will endeavor to mail 1Q_ days written notice to the below named certificate holder, but failure to
?.f m,,
.;!Y,F = mail such notice shall Impose no obligation or liability of an;kci upon the company
,r
,• .
+ NAME AND ADDRESS OF CERTIFICATE HOE DER•
_Feb . 1.9_i_-1982- -
,,, .' CITY OF HUNTINGTON BEACH
n, HUNTINGTON BEACH , CALIFORNIA I ��;
Z4e7,..e4r..H? fr"
fTslIVr„1rtF1 Y` -- ------ —
+=r,r i' -.AR^;.�.',r-%dES.- 'i`11 frT':=k�"•.c
. :l,Y ... ,_ .. _ .. - .- - w� ., r,- .,..d.>�..��p.•!u.T,3`..G."�i3::,J7�) 1?�t`*.?s. .i. .!,r-�!- 7cF.��,�;,•,�,c•�,•.4'"_
Complete only when this endorsement I prepared with
the policy or when the effective date dif )m the policy.
ADDITI(.,nu AL INSURED
Pol.No.: CL 102-119 Eff.: 2/2 0/8 0
Insured: HUNT. BCH . POLICE OFFICES (Owners or Contractors)
ASSOC .
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
G 116
SCHEDULE
Name of Person or Organization
(Additional Insured) Location of Covered Operations
CITY OF HUNTINGTON BEACH Land Owner: 18211 Gothard St .
Huntington Beach , CA Huntington Beach
(Pistol & Rifle Range)
Premium Bases Rates Advance Premium
Bodily Injury Liability Cost $100 of cost $
Property Damage Liability Cost $100 of cost $
Total Advance Premium $
It is agreed that:-
1. The "Persons Insured" provision is amended to include as an insured the person or organiza-
tion named above (hereinafter called "additional insured"), but only with respect to liability
" . arising out of (1) operations performed for the additional insured by the named insured at the
location designated above or (2) acts or omissions of the additional insured in connection with
;, ' his general supervision of such operations.
2 None of the exclusions of the policy,except exclusions (a), (c), (f), (g), (i), (j) and (tit),
• ,} ; = apply .to.this insurance. -
;; ;Additional Ex� This insurance does not apply:
. `_ ' ' a 'to bads to after��, .�;.,:'f: ;�''- ,.�.�.'-•_ �f.� �� l�►.� jttgrar property,damage oaurin� a . .
• ; , ,:, ,(LE an*oek'te'the pre a .,(othsr:.thani sn , maintenance or repairs) to be performed •
.. .a.fQr'ar o. Wharf.of � iftl !'.,inaiurvd aril`the 'atito of the:amend open has r, "''w
} "9`t �.If a.f..`;' .,,": .;`.. ' '
- it�Mplltet'l �J� l �'1-
1, :•, y� F af'�:1a—din,'Ike,Loa--P'. ' � . V:-'
' c �.+t w •[y' .Allr>i ,IRAs .,amyl. . oar
F 4sa • it i t°., K. S _ _ _ _ , iltANI 4 ltt
} u 1 ' v fl�R I� T y(„ l; y•i' `- ' ,%I. ".,a t t " t✓� t ,
MOWNrely r.. •c�l�i". y� °a j,�;,, �. .`
." i gy���yy� y; �,�R.(, yjt y� .t. -�t i67�c� 1�,' r RfiSl �'A4l4IM ['IF71441
I N�1;'.•i. 7 n IIIEssoesi R taw/j RC1 Ileac � �I�'
{ , astir�,y �' �t;NMp t � dl4 ail 4�ltY6.�+riil;+�II ��
, omit maw* ouswapoit,
(i) topropertydisuse ,1 :•I
:;.'. _ (1) property owned or occupied by or rented to the additional 'insurc<t,
• ' (2) property used by the Additional insured,
(3) property in the care, custody or control of the additional insured or as to which the
additional insured is for any purpose exercising physical control, or
(4). work performed for the additional insured by the named insured.
4. Additional Definition When used in reference to this insurance, "work" includes materials,
parts and equipment furnished in connection therewith.
All other terms of this policy remain unchanged.
American States Insurance Company
2;;I')1 "-""' American Economy Insurance Company
�� INDIANAPOLIS, INDIANA /
President
Countersigned b o GENT
Form 9-701 CL, ML �— Secretary
(7-73)
complete only when this endorsement prepared with
the policy or when the effective date di 'om the policy.
if
PoI.No.: CL- 102-119 Eff:2/20/79
ADDITIONAL INSURED
Insured: HUNT . BCH.POLICE OFFICERS (Owners or Contractors)
ASSOC .
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
G 116
SCHEDULE
Name of Person or Organization
(Additional Insured) Location of Covered Operations
CITY OF HUNTINGTON BEACH Land Owner : 18211 Gothard St.
2000 Main St . Huntington Beach
Huntington Beach, CA (Pistol & Rifle Range)
' Premium Bases Rates Advance Premium
Bodily Injury Liability Cost $100 of cost $
Property Damage Liability Cost $100 of cost $
Total Advance Premium $
. It is agreed that:
1. The "Persons Insured" provision is amended to include as an insured the person or organiza-
tion named above (hereinafter called "additional insured"), but only with respect to liability ,
• arising out of (1) operations performed for the additional insured by the named insured at the
location designated above or (2) acts or omissions of the additional insured in connection with
' his general supervision of such operations.
' • 2. None of the exclusions of the policy, except exclusions (a), (c), (f), (g), '(I), (j) and (in), . -
apply to,this, Insurance. 1.;.
3.1 i)°,7, -S. Additional Excloslotut":Thin insurance'� apply: `',-,.,: ,. ';: • ; :,:: -i1 .,;s t:
:_;, :i . ( '•:to -olr r rin °, -t.
,. tl t� � _ 2r �1� 3u�!. P�-� ;d ;.atcu ic�,aher`:���- ,. ;�, �. fit'
(, ; ,; ' •, i■ all.•work,•.os`.
t,,."..�f�' '4'+�F`�vYSPr,� `I���."`,,� `f.F. r;,��A!. ,�i .the /iaPlt•r`,�oMPW•., �-��;4fi�1�1uaMRt-Yf.' �D to MRC.�JK -�•�•':t•�knt�.`f`,`�`I:
w' ,i 1.' ..`.IM I s,.r}t,90.,l ,,.b w! ,r �lf. '-: 7Alt, # t'r lv-,J'<< r:' :L,'+.;,f lul ;:�•'' 1, ,:"'.,� '''''7+1 .'''*
5 �' .i ;i 1.`wi�,y� ,tl .,:.;,N.t'' "i;' ,` ,J' (''- Yr::i: , yt; .j :'''it ,�,
F- �,. ,1 �#.��.a. ,' '!ABM- �k%l `�'F- ;'�.?!.:y'3i'.''y't. t: .f„'.�.'; 11'i.J;{;. �,,, ,try:. �ti^. 5 .d h'.`iN -'.y.'
+* t .x;���t,: ro�0,r'-1+'4. ; �' 'LrY ,.e tom.,, �'- ,�+'4. �i;:a�',�:'r�" r 5-�,'.-� ° !<�:;:. 7i"°� ��te+8
i 4 - %�1;,f: `i40 17' Ctitabit• 1 ,± k51041 0t)* ',,iiko sue,, ' ` " ;�, �+t4:j t=
S
""; t, r y „, f lam, i1 - ' V + , -{ 11 . F`y •'
t' jyt. t ,..r ,R+ 1 `•ro; - t 'F ,� .11F 1• t p„ {''' ' 1 J,t i 7 5 h ' • -,1' :, *.( ''+.,.y'"'1' Y".F•t .A, K , M«•n,.7f .;- r..", .4.,`„I. �. �' a* t
y 1 J { ` -�1�Y� �£,,�'.g ' , 4.f 1 , y v+ t.�'i , I y9f jj
.'-' 4 - A7'c"r J y q( jt ji f '' ',+ it4�4ifi wo °R:{(toke diort yyt¢ mo,tt . Mt ,,,,,;,,g—.4 LLA 4
-4. , J,I l -.` ) r i'i..s`�i� ^TF �* q `- �I!_�� - •9*Ksto tiowo s 4A'9yf� skof � 7 4. '` 1 ''
'1, tom►' to property mate to , .;r, .: ,' :•• . -
• (1) property owned or eerupled by or rented to the additional Incur 1. .
(2) property used by the additional insured.
(3) property in the care, custody or control of the additional insured or as to which the
additional insured is for any purpose exercising physical control, or
(4) work performed for the additional insured by the named insured. •
4. Additional Definition When used in reference to this insurance, "work" includes materials,
parts and equipment furnished in connection therewith.
All other terms of this policy remain unchanged.
American States Insurance Company f /
/(51-2"keeeig.„....,
�'k. lc ' American Economy Insurance CompanyMormusz
te m /%
z> INDIANAPOLIS, INDIANA President
flttiCountersigned by .oPE�-
AGEIiT Seca
Form 9-701 CL' ML (�
(7-73)
evrelixesate-- lfuteeteutee. . ,
ft
4 — 'g w .. RICAN STATES INSURANCE COMPANY IMERICAN ECONOMY INSURANCE COMPANY
a rs i corn
Indianapolis, Indiana Indianapolis, Indiana
AMERICAN STATES INSURANCE COMPANY OF TEXAS El PREFERRED INSURANCE COMPANY
Dallas, Texas Indianapolis, Indiana
This is to certify that the following policies issued by the company indicated above are in full force and effect as of the date
of this certificate. Nothing in this certificate, attached thereto or made a part thereof, shall be construed to broaden or amend
coverage under such policies beyond the limits, terms, conditions and exclusions contained therein.
Insured HUNTINGTON BEACH POLICE OFFTCF'BS ASSOC.
Address of Insured 18211 GOTHARD ST. , HUNTINGTON 'BEACH, CA.
States in which Workmen's Compensation is provided
15195EF4'TfIIW of 'si1( OPERATTONS ANT) LOCATIONS • LANn OWNER
HAZARDS POLICY EXPIRATION BODILY INJURY LIMITS PROPERTY DAMAGE LIMITS
NUMBER DATE Each Person Each Occurrence Each Occurrence Aggregate
G PREMISES—
E OPERATIONS
CL102=119. 2-2f0-179 1,000 ;000 '. 50 ,000 '. 50 ,000
E OWNERS OR
E CONTRACTORS PROTECTIVE
A
L COMPLETED OPERATIONS
L PRODUCTS AGGREGATE:
BLANKET CONTRACTUAL
BLIABILITY
I CONTRACTUAL LIABILITY
AS DESCRIBED BELOW*
T XCU HAZARDS—EXPLOSION,
Y COLLAPSE & UNDERGROUND
COVERAGE IS PROVIDED UNDER: COMPREHENSIVE GENERAL LIABILITY POLICY ❑ SCHEDULE LIABILITY POLICY
OWNED
A AUTOMOBILES
U
T HIRED
Q AUTOMOBILES
M
p NON-OWNED
B AUTOMOBILES
I
L
E
COVERAGE IS PROVIDED UNDER: 0 COMPREHENSIVE AUTOMOBILE LIABILITY POLICY 0 SCHEDULE AUTO LIABILITY POLICY
WORKMEN'S
W COMPENSATION STATUTORY EMPLOYERS LIA. LIMIT $
$100,000 unless other amount shown:
OCCUPATIONAL DISEASES 0 INCLUDED 0 EXCLUDED UNDER ABOVE W C POLICY
$ ,000. combined single limit Personal Injury, Property Damage and
UMBRELLA LIABILITY Advertising Liability in excess of Primary Insurance listed in Schedule A of the
Policy or a self insured retention of$
$10,000 unless other amount shown.
This certificate is issued to CITY OF HUNTINGTON BEACH
HUNTINGTON .BEACH, CA.
whose address is
In the event of any material change in or cancellation of said policies, the Company agrees to notify the party to whom this
certificate is issued (10) days before such change or cancellation but assumes no responsibility for failure to do so.
*Description of Specific Contract(s) for which Certificate is issued:
Type of Contract or Agreement
Party or Parties
Date of Contract VANDRUFF & ASSOC. ,INS. '
STMINSSTTER, CA.
Date 2-14 �
—78. TV By /���GC�✓? .L°, _)4Z44
AUTHORIZED REPRESS T'ATIVE OR OFFICIAL
9-431 (3-73)
ConiMere only when this endorsement i )repared with
+the policy or when the effective date difi m the policy
Pol.No. Eff.: ADDITIONAL INSURED
Insured:
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
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, main-
tenance or use of the premises designated below, 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 have an interest in
said premises;
2. to structural alterations, new construction or demolition operations performed by or on be-
half of the person or organization designated below.
SCHEDULE
Name of Person or Organization Interest of
Designation of Premises (Additional Insured) Additional Insured
1823.1 GOTISARD ST• CITY orMUNTIUGTO4 nnAca LAUD Matt
nUNTINGTON DRAM, C . NUNMUGTON DZA I,
rorixti-ci
All other terms of this policy remain unchanged. President
American States Insurance Company
,.uir/ American Economy Insurance Company Secretary
EMITRLIEIMMK015 INDIANAPOLIS, INDIANA
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Countersigned by , Kg, G/d/1Zdo NJ� K
Form 9-206 CL, ML, OL >v
(12-67)
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CAN STATES INSURANCE COMPANY RICAN ECONOMY INSURANCE COMPANY
�y^SWrats
LIN E3IID O� Indianapolis, Indiana Indianapolis, Indiana
AMERICAN STATES INSURANCE COMPANY OF TEXAS
Dallas, Texas
This is to certify that the following policies issued by the company indicated above are in full force and effect as of the date
of this certificate. Nothing in this certificate, attached thereto or made a part thereof, shall be construed to broaden or amend
coverage under such policies beyond the limits, terms, conditions and exclusions contained therein.
Insured HUNTINGTON BEACH POLICE OFFICERS ASSOCIATION
Address of Insured 18211 GOTHARD STREET, HUNTINGTON BEACH, CALIFORNIA
States in which Workmen's Compensation is provided
Description of Work PISTOL & RIFLE RANGE ASSOC
HAZARDS POLICY EXPIRATION BODILY INJURY LIMITS PROPERTY DAMAGE LIMITS
NUMBER DATE Each Person Each Occurrence Each Occurrence Aggregate
G PREMISES—
E OPERATIONS CL 857122 2-20-75 1,000,000 50,000 50,000
E OWNERS OR
ACONTRACTORS PROTECTIVE
L COMPLETED OPERATIONS
L PRODUCTS AGGREGATE:
BLANKET CONTRACTUAL
LIABILITY
LCONTRACTUAL LIABILITY
AS DESCRIBED BELOW*
T XCU HAZARDS—EXPLOSION,
Y COLLAPSE 8 UNDERGROUND
COVERAGE IS PROVIDED UNDER: ❑ COMPREHENSIVE GENERAL LIABILITY POLICY ❑ SCHEDULE LIABILITY POLICY
OWNED
A AUTOMOBILES
U
'I' HIRED
O AUTOMOBILES
M
O NON-OWNED
B AUTOMOBILES
I
L
E
COVERAGE IS PROVIDED UNDER: ❑ COMPREHENSIVE AUTOMOBILE LIABILITY POLICY ❑ SCHEDULE AUTO LIABILITY POLICY
WORKMEN'S
W COMPENSATION STATUTORY EMPLOYERS LIA. LIMIT $$100,000 unless other amount shown.
C
OCCUPATIONAL DISEASES 0 INCLUDED ❑ EXCLUDED UNDER ABOVE W C POLICY
$ ,000. combined single limit Personal Injury, Property Damage and
UMBRELLA LIABILITY Advertising Liability in excess of Primary Insurance listed in Schedule A of the
Policy or a self insured retention of $
$10,000 unless other amount shown.
This certificate is issued to C T;Eyr,__ IuNTINGTON B-EACCH
- - H TINGTON BEACH, CALIFORNIA
whose address is
In the event of any material change in or cancellation of said policies, the Company agrees to notify the party to whom this
certificate is issued (10) days before such change or cancellation but assumes no responsibility for failure to do so.
*Description of Specific Contract(s) for which Certificate is issued:
Type of Contract or Agreement
Party or Parties
Date of Contract
VANDRUFF & AS�S9CIATES
Date By Z
AUTHORIZED REPRESENTATIV• ••'OFFICIAV
9-431 (3-73)
+► on only when this endorsement is n;' :pared with
the policy or when the effective date differs the policy. I
Pol.No.: • Eff.: ADDITIONAL INSURED
Insured:_
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
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, main-
tenance or use of the premises designated below, 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 have an interest in
said premises;
2. to structural alterations, new construction or demolition operations performed by or on be-
half of the person or organization designated below.
SCHEDULE
Name of Person or Organization Interest of
Designation of Premises (Additional Insured) Additional Insured
182.11 .GOTHARD STREET. CITY. OF HUNT.IN.GT.ON. .BEACH LAND. OWNER
HUNTINGTON. BEACH.,. .CALIFORN.IA HUN.TIN.GTON. BEACH,. .CALIFORNIA.
All other terms of this policy remain unchanged.
�„ra,z, �smN American States Insurance Company e
American Economy Insurance Company
INDIANAPOLIS, INDIANA /
President
t.:SC\-78
Countersigned by AUTHORIZED AGENT Secretary
Form 9-206 CL, ML, OL
(12-67)
RETURN•ORIGINAL AND THREE COPIES` F` tq ONLY CITY OF HUNTINGTON BEACH'S FORM
COMPLETED CERTIFICATE TO: CERTIFICATE OF INSURANCE OF CERTIFICATE-OF INSURANCE WILL BE
ACCEPTED.
CITY OF HUNTINGTON BEACH c-.7y C![r7z/e TO
P.O. BOX 190 CITY OF HUNTINGTON BEACH, CALIFORNIA
HUNTINGTON BEACH, CALIFORNIA 92648
A MUNICIPAL CORPORATION
This is to certify that the policies of insurance as described below have been issued to the insured by the under-
signed and are in force at this time. If these policies are cancelled or changed in such a manner that will affect this-
certificate, the insurance company agrees to give 30 days prior written notice, by mail, to City of Huntington Beach,
P.O. Box 190, Huntington Beach, California 92648.
Name of Insured Huntington Beach Police Officer's Association,
Address of Insured City Hall, Huntington Beach, Calif.,
Location of Insured Operations Police Pistol Range
Description of Operations Pistol and Rifle Range
POLICIES IN FORCE POLICY DATE LIMITS OF LIABILITY
NUMBER EFFECTIVE EXPIRATION
A. Workmen's Compensation Statutory
WH113554 2/9/71 2/9/72
Employers' Liability $
B. Public Liability:
Bodily Injury:
Manufacturers and
Contractors $ 100,000. Each Person
Comprehensive
General E 72C207782 2/9/71 2/9/74 $ 300,000. Each Accident
(Including products completed
operations)
Property Damage $ 50,0nn. Each Accident
C. Automobile Liability:
Bodily Injury $ Each Person
$ Each Accident
Property Damage $ Each Accident
Does policy cover:
All owned automobiles ( ) Yes ( x) No
Non-owned automobiles ( x ) Yes ( ) No
Hired automobiles ( ) Yes ( x).No
D. Additional Insured Endorsement:
The insured agrees that the City of Huntington Beach and/or members of the City Council or boards or commissions
and elective and appointive officers, servant or employee of the City of Huntington Beach when acting as such, are
additional assureds hereunder.
1E. Hold Harmless Agreement:
The insured agrees to protect, defend, indemnify and save harmless the City of Huntington Beach against loss,
damage or expense by reason of any suits, claims, demands, judgements and causes of action caused by insured, his
employees, agents or any subcontractor arising• out of or in consequence of the performance of all operations covered
by this certificate.
F. Minimum Limits Required:
Public Liability (Products liability, including completed operations)
Bodily injury-each person $250,000.00
each accident $500,000.00
Property damage $100,000.00
G. Remarks:
(Signed) Hartford Insurance Group
JOIdd .r{ aT, Mg,
By
SIGNATURE OF AUTHORIZED REPRESENTATIVE