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1999-0803_CULBERTSON, ADAMS, & ASSOCIATES_Insurance Certificate (2)Ar -CRD, PRODUCER INSURED ALLIED BROKERS/ YEARGIN INSURANCE 15375 BARRANCA PKWY. STE B-201 IRVINE CA 92618 CULBERTSON, ADAMS & ASSOC INC 85 ARGONAUT #220 ALISO VIEJO CA 92656 DAM 08/(03/99 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 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T;H&POLICY PERIOD INDICATED, NOTWITHSTANDING, ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPE6T"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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO ii TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE VOLICY EXPIRATION LIMITS LTR I DATE (MM1DD/YY) { DATE (MM/DDIYY) GENERAL LIABILITY ! 7 2 UUCZP4 9 3 5 8/01/99 8/01/00 GENERAL AGGREGATE 1$1 , 0 t) 0, 0 0 -- X. COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $1 , 0 0 0, 0 0 0 CLAIMS MADE � OCCUR PERSONAL & ADV INJURY $1, 000,000 f j'OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE ... „$.1..,_,000, 000 II. FIRE DAMAGE (Any one fire} $ 3 Q 0 , (} (} 0 ---------- --...............................---- MED EXP (Any one person) $ 10,000 AUTOMOBILE LIABILITY ; 72UUCZP4935 08/01/99 08/01/00 1, 000,000 COMiNNED SINGLE LIMIT $ }_..___I ANY AUTO ALL OWNED AUTOS _ ))SCHEDULED AUTOS X l HIRED AUTOS X NON•OWN ED AUTOS BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE 1$ 'I GARAGE LIABILITY AUTO ONLY -- EA ACCIDENT !- - ANY AUTO I OTHERTHAN AUTO ONLY: -EACH ACCIDENT ! $ [ _..._.__ _ ... .._ AGGREGATE! $ EXCESS LIABILITY 1 72 XHUXM6 4 0 6 8/ 01 / 9 9 8/ 01 / 0 0 EACH OCCURRENCE $1, O O O, 0 0 0 ry_._- -- - - - ---- - ---- - ....._..---............ X UMBRELLA FORM $ AGGREGATE � ............................... OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC STATU- TH-f i TORY LIMITS ER EMPLOYERS' LIABILITY i -- EL EACH ACCIDENT; $ THE PROPRIETOR/ PARTNERSIEXEGLITIVE INCL EL DISEASE -POLICY LIMIT $ _ OFFICERS ARE: EXCL i EL DISEASE -EA EMPLOYEE $ I OTHER DESCRIPTION OF OPERATYONSILOCAT[ONSI11EHiCLES/SPECIAL ITEMS CERTIFICATE HOLDER IS ADDL INSURED PER CG2010; 10 DAY NOTICE FOR NON PAYMENT PREMIUM CITY OF SAN JUAN CAPISTRANO CAPISTRANO VALLEY WATER DIST 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 T11 )ZOMPANY, frY AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA Helen Lvnn 1114 A POLICY NUMBER: 72UUCZP4935 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE® - OWNERS. LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL. LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF SAN JUAN CAPISTRANO, CAPISTRANO VALLEY WATER GIST (If no entry appears above, the information required to complete this endorsement will be shown in the Dec- larations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of your ongoing operations performed for that insured. CG 20 10 10 93 Copyright, Insurance Services Office, Inc. 1993 CULBERTSON, ADAMS &_ASSOCIATI S PLANNING CONSULTANTS Fax Transmittal DATE, fuly iii, 1999 TIME SENT. 2:30 PM_ Dawn M_ Schanderl Deputy City Clerk City of San Juan Capistrano FROM: Kevin Culbertson SUBJECT: Certificates of Insurance FAX NUMBER„ TOTAL PAGES FAXEID TO: (949) 493--1053 FROM- (949) 581-3599 1 in response to your letter dated July 27, 1999 regarding renewal of certificates of insurance with regard to our work on the PMaar bon cif Fnvir. Vital D09i _ in SuPP )_ oL an Applicat� Io Appropriae r Fermi I am advised by our insurance agent that such certificates were mailed to the City the week of July 19 and should now be in your possession.. If such is not the case, please call me at (949) 581--2888 and I will arrange for replacements to be forwarded - Thank you for your attention to this matter! - The in, formation contained in this facsimile i_r privileged and confidential information intended only for the use of the reripiernt(s) named above- lfyou are not the recipient(s) shown above, you are hereby notified that any copying of this communication or dissemination of distribution of this material to anyone other than the recipient(s) is strictly prohibited. If you have received this communication in error, please notify us by telephone IMMEDIATELY and return the original message to us at the address below, via U.S. 1'040a1 Services.