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1998-0918_CULBERTSON, ADAMS, & ASSOCIATES_Certificate of InsuranceFl T DATE (MM0DtYY) r1l: : L 1:: 09/18/98 _0 . ..... PRODUCER THIS CER71FICATE IS ISSUED AS A MATTER OF INFORMATION ALLIED BROKERS/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR YEARGIN INSURANCE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ONE TECHNOLOGY #J729 COMPANIES AFFORDING COVERAW IRVINE CA 92 718 COMPANY A HARTFORD FIRE 1-_­N$URAN�E CO INSURED COMPANY rI CULBERTSON, ADAMS & ASSOC INC I B COMPANY 85 ARGONAUT #220 c ALISO VIEJO CA 92656 COMPANY D RA THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 011 MAY PERTAIN, TIRE 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 ' _P_(_�Cl CO LTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MWDDNY) EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY 72UUCZP4935 8/01/98 8 01 9 9 1 GENERAL AGGREGATE $1,000,000 F X COMMERCIAL GENERAL LIABILITY = PRODUCTS - COMPIOP AGG $1,000,000 CLAIMS MADE -EX I OCCUR PERSONAL & ADV INJURY $ 1 , G 0 0 , 0 0 0 NEWS & CONTRACTOR'S PROT EACH OCCURRENCE $1,000, 000 FIRE DAMAGE (Any one fire) $ 300,000 MED EXP (Any one person) $ 10,000 AUTOMOBILE LIABILITY 72UUCZP4935 08/01/991 1,000,000 ANY AUTO H �08/01/98 COMBINED SINGLE LIMIT $ .1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X [hHMED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE i$ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTOOTHER THAN AUTO ONLY: . . .. . .. . . . . . EACH ACCIDENT $ AGGREGATE $ EXCESS LIABLITY 172XHUXM6406 09/ 10/98 109/10/99 EACH OCCURRENCE $1,000,000 IFX] UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND STATU- TH- TWCRYSLIMITS ERj O EMPLOYERS' LIABILITY $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE -POLICY LIMIT OFFICERS ARE: EXCL I EL DISEASE -EA EMPLOYEE i$ OTHER DESCRIPTION OF OPERATION"OCATIONSNEM]CMISPECIAL ITEMS ADD'L INSURED: THE CITY AND THE WATER DISTRICT, ITS ELECTED OR APPOINTED OFFICERS,EMPLOYEES & VOLUNTEERS ........... .. . . .... .. .. ... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF SAN JUAN CAP ISTRANO EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL AIL CAP ISTRANO VALLEY WATER DIST 3 0 DAYS wvtn-mN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 32400 PASEO ADELANTO BUT FMLUR "eE SHAftr !MPOft NO OftfO" SAN JUAN CAPISTRANO CA 92675 -OF--*b He—eempmw.- m AUTHORIZE ESE p J.M YE .............. .2 (3} if excess, affordsCoverage which is at least as broad as the priest inswW= forms re*renced in the preceding sections (1) and (2). ured tubo is 4. SE�ILIT Y G1~ TN'X'EREST• The insurance afforded by this policy alrplies Separately to each ins seeking coverage or against whom a claim is made or a suit is brought, except with respect to the Company's limit of liability. mlY S. PROVISIONS REGARDING THE INStJI:tED'S DUTIM �ggCCID� the City Oaztd the Water Dism� itsto elected yportiag provisions of the policy sbali not affect coverage provi�o or appointed affietts. officials, etnploy= or voluateets.6. , a$=dedby dhispaIicy shall uotbe suspended, voided, =celled, reduced CANCELLATIClN l�C©nCT. The lnstizaaca cerdW m� return receipt requested � been in coverage or amiss except after�Y (30) days' notice by given to the City. Such notice shalt be addressed as shown in the Reading of tint eodotsemeut Iucidmts and claims are to be reported to the insurer at A,'I'T1V': (p�aa�ttent). ('pitta) Yeargin Insur one Technology J729 (Street Address) Irvine Ca 92616 (city) (State) (Zip code) (949)453 1115 (Telephone) s Y ILI.: • I j.: _s.. . s ' _. litL. a : A. l :. ' " :. 4aE_ Helen Lynn (p tltype named warrant that 1 have authorirf to birA tete bClo,.v 1>wsed insurmce company and by my signature hereon do so bind this company SIGNATURE OF Au 1nVr-V-=v— (Wgival sigaamm required on endorsement tirnisttad to the City) Y°eargin Lns Agency TiTi.E ORGANIZATION. 949 453 1115 ADDRESS: One Technol.ag 5729 irvi 'TELEPHONE. z "d LV0988S6V6 Z# N0S.1d38_M WObd NVES : 0 l 866i—et-6 A. 1. 2. 3. 4. 5. d. 7. 8, LIABILITY WDORszMMNT ary or SAN JUAN C. ISTRANO CA.PISTRA.NO VALLEY WATER. DISTRICT 32400 Pasto AdelA00 San Juan Capistrano, California 92575 ATTN: bst rancecompany. Limit of Liability Any Ont S ' �eatii` . • • � � �'. iinirMtl�liY'1i�CI iisoc, Inc General Liability Aggregate (hock one:) Applies occu Is twice the occurrence limit Deductible or Self -Insured Rttention (Nil unless otherwise specified: Sn z 1 Coverage is equiva{ent to: Comprehensive General Liability form GL0002 (Bd 1173) Commercial General Liability "claizrts•msde" form. CGO002 _ Bodily Injury and Property Damage Covcrage is: "claims -made" "occurrence" If clainis•made, the retroactive date is 935 B. This eztdorsement is issued in consideration of the policy premium. Notwithstanding any inconsistent staten"at A the policy to which tWs endorsement is attached or any other endorsement attached thereto, it is agreed as follows: ts md volunteers are I . XNSURED. The City and the Water District, its elected or appointed Officers, o a acuvitie sloerformed by or n behalf included as insureds with regard to damages and defense qo ns of arising from; ur premises owned, leased or of the Named Insured, (b) projects and completed operations of the Named Insured, or (c) p used by the Named Insured. 2, CUNTRIBLji'I4N 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 (e) premises leased by tate Named Insured from the City, ry' insurance as respects the City, its elected or appointed officers, the insurance afforded by this policy shall be primary officials, employees or volunteers; or stand in an unbroken chain of coverage excess of the Named Insured's scheduledappointed underlyixrg primary coverage. Ira either event, any other insurance maintained by the City, its elected or app officers, officials, employees or volumtom14 shall be in excess of this insurance and shalt not contribute with it. 3. SCOPE OF COVERAGE. This policy, if primary, affords coverage at least as broad as: {1) Insurance Services Office number GL0002 (Ed. in3l Comprehensive General Liability nn=ce and b=rance Services Office form number GL 0404 Broad Forty CozuprehcusivE General Liability or, (2) l�asuraaet Services office Commercial General Liability Carvcrmge, "occurrence" f°rrn CG 0001 ar "ciairns- made" form W0002; or, t 'd L.V0588S6V6 ;�;# N(351i=138 no Wcdii HVdZC = 0 l 266 l —8 l —6