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1998-0925_CULBERTSON, ADAMS, & ASSOCIATES_Certificate of InsuranceHu. �� � � � � � � 8/01/98 8/01/99 nATE (MMrnnrf ) . F � I l .......... � - IA -----_-....- PRODUCTS . COMPlOP AGG 09/25/98 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ALLIED BROKERS/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EACH OCCURRENCE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR YEARGIN INSURANCE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ONE TECHNOLOGY #J729 MED EXP (Any one person) COMPANIES AFFORDING COVERAGE IRVINE CA 92618 COMPANY : I COMBINED SINGLE LIMIT 1,000,000 $ A ..................._— HARTFORD FIRE INSURANCE CO INSURED.... COMPANY ....._......_,_.,._...._ CULBERTSON, ADAMS & ASSOC INC GOLDEN EAGLE INS CORP COMPANY 85 ARGONAUT #220 C AL I S O V I E JO CA 92656 CO ANY � 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 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. € LTo ii D. IN TYPE OF SURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION] LIMITS DATE (MMIDDIYY) , DATE (MM/DDlYY) GENERAL LIABILITY 72U UCZ P4 9 3 5 8/01/98 8/01/99 GENERAL AGGREGATE $1,000,000 COMMERCIAL GENERAL LIABILITY -----_-....- PRODUCTS . COMPlOP AGG �---._._..._—_. $ 1 , 0 0 0 , 0 O 0 CLAIMS MADE C OCCUR . PERSONAL & ADV INJURY $1,000, 000 OWNER'S & CONTRACTOR'S PROTE EACH OCCURRENCE S1,000, 000 FIRE DAMAGE (Any one fire) $ 3 0 0 0 0 0 ^$ MED EXP (Any one person) 10 , 0 o 0 AUTOMOBILE LIABILITY ' 72UUCZP4935 Y 08/01/98 1 08/01/99 : I COMBINED SINGLE LIMIT 1,000,000 $ .AN AUTO ALL OWNED AUTOS 1 SCHEDULEI) AUTOS. X `HIRED AUTOS i� NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE €$ AUTO ONLY - EA ACCIDENT ($[ OTHER THAN AUTO ONLY: .............................. ......... EXCESS LIABILITY 7 2 XHUXM 6 4 0 6 9/10/98 8/01/99 _EACH OCCURRENCE $1 , 0 co 0 00 X UMBRELLA FORM 1 [ AGGREGATE $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND NWC3 8 3 0 2 2 U L '18/31/98 j 8/31/99 X 1 TORYSLIMITS EMPLOYERS' LIABILITY i - ---- EL EACH ACCIDENT L $1, 0 0 0, 0 0 0 THE PROPRIETOR! - INCL PARTNERS/EXECUTIVE ---' EL DISEASE •-._ ICY LIMIT I S 1 , 00 0 , _0 0 0 OFFICERS ARE: X EXCL EL DISEASE -EA EMPLOYEE $1, 000 000 I OTHER I fTi r7CD DESCRIPTION OF OPERATIONSrLOCATION$NEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER IS ADDL INSURED PER CG20.0; 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 CA14CEI; O 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 THE COMPANY, ITS AGENTS OR REPRESENTATIVES. C HL A POLICY NUMBER: 72UUCZP4935 COMMERCIAL GENERAL LIABILITY CG 20 10 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: SCHEDULE CITY OF SAN JUAN CAPISTRANO CAPISTRANO VALLEY WATER DIST 32400 PASEO ADELANTO SAN JUAN CAPISTRANO CA 92675 (if no entry appears above, information required to complete this endorse- ment will be shown in the Declarations 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.