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1999-1124_CULBERTSON, ADAMS, & ASSOCIATES_Insurance CertificateCI9 j6 3 n S E I f Iia A l4 1" i 57 i C2 �TZN ALLIED n.ROKERSf �i��Y ® ph NFEFB� ��If"a�6�� tl�8y �i� I� TIFICATE 1 EAR,C =-k. 1V ILVFSjjpAN1.,, R�.�. _.� ... -7 5 BARD ANCA PKWY- STF 13 201 F AF-r-O DI COVE GE 1.RVINF.ta y«92618-- - �COMPANY HARTFORD EIRE ..TNS CO CODPAW C UL ER`T`SON ADAMS ASS®C JIB( PC)I,DRN EAGLE IN8CORP C:�i;�PAaAY 85 ARGONAUT #220 c L.., T S O ti7 00 CA 92656 GOM PAN Y < �i � eke-`-y�r ,i :`'.>tix> r� ul ixuixt i#iz<'� � ... ter -. l"r�m F -' uwi-�-r2°'•�_ }`.`"_" """"""""' THS IS TO CFRTIFY THAT' THE POLICIES OF I URANM, i�sTEL; BELOW EDAVF REEN I&SULD TO THE INSURED NAMED ABOVE FOR THE „POLICY PFRIOD INDICATED, NOTWITHSTANDING ANY ifl:Ca13P68E$dEPl7', TERM OR CC' N DMON OF ANY CCBNIRAGT CSFB OTHER DGCEIAAFN] WITH FIFSPEUT TO WRX;H MIS C ERTII=ICAT -TAI" BE ISSUED on M pL-RLA#N THr luso IY–f-, AFFOROEU- SY :THE PM-JGIr-5 E CoCfl3iiEb FI i IFe 19 SLIEUr C'T TO All THF TLFIMR, I:XCA.USEi3 S AND N%Ai8 ONE; Or SUCH POLICIES, LIMITS F�ItiOWN MAY HAVE. Iii:- N IiPOUC.ED 9 ®Ain CIAFus ........ ... DAYP (M M ( mol\Y) LIIdTlB� --- tumiLm '12 2. 9.3 5 8/01/99 8 / 01 0 0 GENERAL A00REGATE s :I , (� 0 (3 a 000 X COP RCI GM I A4, CIARM ITV .. PRODUCT3 COMPIOP AW 11, 0()(), 000 -- _ a LA l" t,� VFASONAC ®, Amer WJUlrr i 1 0 0 0 f10 0 flVdi�IF 33'Ca 6 O4 NTRACToRa NROT --_ -- t t I-occuITfe Nnt l s I (7 O U 000 II #i4 DAMAGE*�canl $ . _ v l) IAny wz�r�€ 0 Q —.... _ _ ._ ... Mw IXP _ 0 () 0 0 ; ®u � 72UUCZP4935 08/01/99 0 0(1 ; , 000, 000 -.�. ANY AUTO COMMNLD 316dGLfl". LIMIT 6 ALL ClIN6dE'D 6ciJY®3 ; SCHEDULED ALlr0S BODILY N.IURY(Per porsam) $ NOmmiLY IN,IUF9Y NON-OWNED AIiTIDs (Pet aead��} GE _ API;OPEFCTY ®A�aIT�ETrr -: _ _ `ANY AUTO � � 077 1pI'i'PIAI!� AUTO c dY j --- - AGfae,''C3PkEffi _ Fx I I 7 2 XI411X d 6 �4 0 6 8/01/99 1. 0 0 flAco-a rr�u�Ila�I�c� . E s1, 0 0 0 0 () ti '_ _ � _ UPoIEIRE E.iR �iF$�j ._- CSt4ii_Dfi. raeAAD.UFAOIaLUA FORM i � E wG say Cm r M&Nnoie Rain � LWC 3 8 3 0 2 2 0 3� flmLOa i3/3�/99 8 31/0UARL"0... 77 r'T IIIE 3lal rt fl s, IDENT ,s 1, 0 o U� a 00 ism RR�:Gurnt xc� rs THE INCL �__.� I( ... ... L'FF F. i - ........... ...,... I I, IiI: FA I rwe c�I s _l , I� CI 0 is U 0 I PRG(G iiMON O ani xaATiCltu�zLsacA 10 DAY NOT ('R POR NON .PAYMEN'T' %)R EIS I TT2 SI OUL D Any OF- OVI» VfSCfflHPn POUCIn 5L CANCZ1.1r D DEFORL nai C i TV OF ISAN LJUAN C.'.AP I.STRANO mAnum nR -iD tpom, woumc COMPANT WILL ILMO AVOR TO MAIL C".AP STR.ANO 4%ALLE—Y W46 I'i,QI� L) I ST -L— DAYS wwmm > -nelb To T tm;aTm r&-w HOLULN NAMED TO YW I.K= T: 32400 F?ASEc) AI_)LLANTO BUT FAILURE Ta MEAN- Sucl/ a cL 5;"AL - WPO" V40 C&l LIGATION On t ftiry AAT N JUAN CAPIS`I"RAC` 9.26 75 OF w Kim � c w�� saw ease r�lP �rera em. — _.. wv�sat� �n . -. F�.�1e�xz La Cr _.. -,_ ...�_..__._.r..Y. ,.ter-.-, _.._ - -• 08/26/98 16:58 FAX 714 5813599 CULBERTSON ,ADAMS IA003/006 1. 2. 3. 4, 5. 6. 7. LTAB11LITY ENDORSEl1UNT CITY OF SAN JUAN CAPISTRANO CAPI,STRANO VALLEY WATER DISTRICT 32400 Paseo Adelanto San Juan Capistrano, California 92675 ATTN: IusuranceCotrtpanyH ado rr Endarsm=t# IpolicyNumber 72LTUCZP4035 sementEffectiveDate.A ssoc, Inc lvameQ=UXru rgonaut 0, Aliso Vie ' o C AddressofNamedlnsured 0 0 0, 0 0 0 1 1 0 0 Limit of Liability Any One occurrence/Aggregate S1 ► General Liability Aggregate (Check one:) Applies "pest occurrence__;_ Is twice the occurrence limit Deductible or Self -Insured Retention (Nil unless otherwise specified). Sn i 1 Coverage is equivalent to: Comprehensive General Liability form GL0002 (Ed 1173) commercial General Liability "claims -made" farm CGO002 Bodily Injury and Property Damage Coverage is: "claims -made" X "occurrence" If claims -made, the retroactive date is B. P-0—L-TaAME-NDMEM This endorsement is issued in consideration of the attached thereto, Notwithstanding agreed in follows: inconsistent statement in the policy to which this endorsement is attached or any other endorsement 1 INSURED. The City and the Water District, its elected or appointed officers, officials, employees and volunteers are included as insureds with regard to damages and defense of claims arisis:g from; (a) activities performed by or n be of the Named Insured, (b} projects and completed operations of the Named insured, or (c) premises used by the Named Insured. 2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insured for or on behalf of the Ci or (b) projects sold by the Named Insured to the City; or (c) premises leased by the Named insured from the City, City -, the insurance afforded by this policy shall be primary insurance as respects the City, its elected or appointed officers, f coverage excess surecs scheduled officials, employees or volunteers; Or tandunbroken outer insurance® maintained byof the the City, its elected ed o'r appointed underlying primary coverage. In e e officers, officials, employees or volunteers shall be in excess of this insurance and shall not contribute with it_ 3. SCOPE OF COVERAGE. This policy, if primary, affords coverage at least as broad as: (1) Insurance Services Office form number GL0002 (Ed. 1/73), Comprehensive General Liability Insurance and Insurance Services Office form number GLO404 Broad Form Comprehensive General Liability endorsement; or, (2) Insurance Services Office Commercial General Liability Coverage, „occurrence" form CG0001 or "claims - made" foram CGO002; ar, 08/20/98 16:57 FAX 714 5813599 CULBERTSON ADAMS 4004/006 (3) if excess, affords coverage which is at least as broad as the primary insurance fortes referenced in the preceding sections (t) and (2). 4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to each insured who is seeking coverage or against whore a claim is made or a suit is brought, except with respect to the Company's limit of liability. 5. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the City and the Water District, its elected or appointed officers, officials, employees or volunteers. 6. CANCELLATION NOTICE. The insurance afforded by this policy snail not be suspended, voided, cancelled, reduced in coverage or limits except after thirty (30) days' prior written notice by certified mail return receipt requested bas been given to the City. Such notice shall be addressed as shown in the heading of this endorsement. Incidents and claims are to be reported to the insurer at ATTN:{Title} (Department) Yeargin Insurance A eco (Company) One Technology J729 (Street Address) Irvine Ca 92618 (Cita) (State) (Zip code) (949)453 1115 (Telephone) Helen Lynn (print/type name), warrant that l have authority to bind the below listed I, insurance company and by my signature hereon do so bind this company. r / I e t� SIGNAT(3RE O Y A UI k1Vid 71) p9S NiATiVE (Original signature required on end6rsement furnished to the City) Yeargin Ins Agency TITLE CiRG�.NiZATION: 949 453 1115 SS: One Technology J729 Irvine 9 TELEPHONE: AMPLE