1999-1007_CULBERTSON, ADAMS, & ASSOCIATES_Insurance CertificatePRODUCER'
INSURED
ALLIED BROKERS/
YEARGIN INSURANCE
15375 BARRANCA PKWY. ,STE —201
IRVINE CA 92618
CULBERTSON ADAMS L ASSOC INC
85 ARGONAUT #220
ALISO VIEJO CA 92656
++� DATE (MM roDrYY)
10/07/9-9
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.
COMPANIES AFFORDING COVERAGE
THIS IS TOCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THt:'POLICY PERIOD
INDICATED, 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,,ML THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. s""'
LTR -1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ^m LIMITS
DATE (MMIDDIYY) DATE (MMIDDIVY)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLA
MS MADE OCCUR
OWNER'S I & CONTRACTOR'S PSOT
AUTOMOBILE LIABILITY
!ANY AUTO
ALL OWNED AUTOS
!SCHEDULED AUTOS
HIRED AUTOS
KION -OWNED AUTOS
GARAGE LIABILITY
!ANY AUTO
GENERAL AGGREGATE $
PRODUCTS - COM PIOP AGG$
PERSONAL R ADV INJURY j $
EACH OCCURRENCE $
FIRE DAMAGE (Any one fire} $
MED EXP (Any one person) $
COMBINED SINGLE LIMIT $
BODILY INJURY ? $
(Per person)
BODILY INJURY $
(Per accidenl)
PROPERTY DAMAGE '.,$
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EXCESS LIABILITY EACH OCCURRENCE $
ROTHER
UMBRELLAFORM
AGGREGATE $ THAN UMBRELLA FORM $
C STAT COMPENSATION AND NWC3 8 3 0 2 2 0 3 8/31/99 8/31/00 OTH-
X WTO UR_v LIMITS! R
M:=LOYr:xs' LtAGILITi EL EACH ACCIDENT $1, 00c) 000
ETHE PROPRIETORI IVE INCL
PARTNERS/EXECUTEL DISEASE•POLICY LIMIT $1, 0 C Q 000
� - -
OFFICERS ARE: X EXCL, EL DISEASE -EA EMPLOYEE $1
OTHER
DESCRIPTION OF OPIRAT€ONSILOCATIONS/VEHICLESISPECIAL ITEMS
10 DAY NOTICE FOR NON PAYMENT PREMIUM
CITY OF SAN JUAN CAPISTRANO
CAPISTRANO VALLEY WATER DISI
32400 PASEO ADELANTO
SAN JUAN CAPISTRACA 92675
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON TIW COMPANY, ITS A9ANTS OR REPRESENTATIVES.
AUTHOREZED REPRESENT1
Helen I QAr-,M-R, A