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1995-0307_ORANGE COUNTY TRANSPORTATION AUTHORITY_Insurance Certificates ■ ■'vv•‘ ■/ \VV.I .—%•MAra/` `/1\V■ Orli MNW,V 4IMSROUP �\ E .�` I- '--RIM CERTIFICATE AS TO EVIDENCE INSURANCE ,..a.,-. THIS IS NOT AN INSURANCE POLICY. ,n, IS ONLY A VERIFICATION OF INSURANCE. IT DOES NOT IN ANY WAY AMEND EXTEND OR ALTER THE COVERAGE PROVIDED BY THE POLICIES LISTED BELOW. Named CHARLES R. HAUSWIRTH Insured • DBA:PACIFIC NEIGHBORHOOD TELECENTERS 1503090f1 Address 26611 PASEO DURANGO #200 Policy B•Gen Liab. • SAN JUAN CAPISTRANO, CA 92675 97 07 308 Agent Policy#•Auto Lab. Policy#-CARGO This is to certify that policies for the above named insured are in force as follows: Policy#•Work Comp. This Interim Certificate As To Evidence of Insurance shall expire sixty days from 1 2: 01 M., APRIL 5 , 1995_, unless cancelled prior to such date by written notice to the named insured. ❑/ Please issue a Permanent Certificate • COVERAGE COMBINED LIMITS OF LIABILITY NOT COVERED COVERED LIABIILLITY ❑ ® Owned Bodily Injury $ ,000 each person ❑ © Hired $ ,000 each occurrence ❑ M Non-Owned Property Damage $ ,000 each occurrence ❑ ® Employer's Non-Ownership Contingent Liability Single Limit Liability for Coverages checked ® above $ ,000 each occurrence GENERAL LIABILITY M&C - OLT Bodily Injury $1 , 000, 000,000 each person a* Owners & Contractors $1 , 000, 0 0 0,000 each occurrence ® ❑ Contractual* $2, 00O 0 0 0,000 annual aggregate . products••• Elevators Property Damage $1 , 000, 000,000 each occurrence ® ❑ Products and/or $2 000 000000 annual aggregate Completed Operations products*.. Single Limit Liability for Coverages checked ® above $1 , 000 r 00000 each occurrence $/ r000, 000000 producl ts �r:gote ❑ ® CARGO $ ,000 each vehicle $ ,000 each occurrence ❑ ® WORKERS' COMPENSATION Statutory *Includes Goods or Products Warranty, Written Lease of Premises, Easement Agreement, Municipal Ordinance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by specific endorsement providing additional Contractual Coverage. Descnbed Descnphon ❑ below ❑ w°owed OWNED YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY IDENTIFICATION NUMBER AUTO- MOBILES, LAST 3 IF DIGITS COVERED SHOWN Umbrella Liability $ ,000 retained limit POLICY NUMBER $ each occurrence $ aggregate If this Interim Certificate As To Evidence Of Insurance is to be cancelled prior to the expiration date, we shall provide 60 days advance notice in writing to whom this certificate is issued. *CERTIFICATE HOLDER IS ALSO NAMED AS ADDITIONAL INSURED. Certificate issued to: Name ORANGE COUNTY TRANSPORATION AUTHORI' se/Loan tuber And • PO BOX 1 41 84 Address • ORANGE, CA 92613-1584 ATTN:CONTRACTS ADMINISTRATOR (-7._--- Countersigned ** Not Applicable in Texas. Authorized Representative *** In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations. 56-0514 2-90 W/200 C/1200 PRINTED IN USA L-90 11201 SAFECO SAFECO INSURANCE COMPANIES TE:EPHONE 1-80C-437.3632 CUSTOMER SERVICE DEPARTMENT P 0. 53X 2E150 SANTA ANA. CA 92799-5150 AUTO Policy# A2902938 CERTIFICATE Off' INSURANCE This attests that the auto policy described has been issued as follows: SAFECO INSURANCE COMPANY OF AMERICA Date 04-06-95 Start date of policy: 03-14-86 Name and address of insureds ; CHARLES & AGNES HAUSWIRTH 26611 PASEO DURANGO SAN JUAN CAPISTRANO CA 92675 Agent: Acacia Associates Insurance Services Inc. Agent Phone : 800-437-3682 Veh premium $ 291. 00 Total premium $ 771. 50 Veh# 1 67 CHEVY CAMARO VIN 124677001572 Liability: Physical damage : PACKAGED COVERAGE 300 * COMPREI{ENSXVE 250 3ODILY INJURY & * COLLISION 200 PROPERTY DAMAGE * LOU 18/DAY UNINSURED MTRST 100/100 * WAIVER OF COLL Y This policy is continuous and is atuomatically renewed upon payment of the required premium. Ten days written notice will be given to the addlitional interest in the event the policy is lapsed or cancelled. Additional Interest : CITY OF SAN JUAN CAP I S TRANO ATTN CITY CLERK 32400 PASEO ADELANTO SAN JUAN CAPIS RANO CA 92675 Authorized representative ,Qty 71.-e.A.4:4 (7444-141 ran I$ .JPFNGE:CM?NN!OF AMEF�+ fin Goa5A�{Co uN wwp I4C auMP. Y ET NIA iNBURAMCE cou w. OP M.64CA MET g1IITK mi.lMSUfW10E COMR'Mn'OF..ERICA UFECO LL ,I�COMP NY slag O NE$ UaMPMW Of&LIMP 2d MSd S3DIAd3S 11.431 13 I k S:0T S6. :I ddu INTERIM CERTIFICATE AS TO EVIDENCF OF INSURANCE THIS IS NOT AN INSURANCE POLIC 5 IS ONLY A VERIFICATION OF INSURANCE. IT DC )T IN ANY WAY AMEND EXTEND OR ALTER THE COVERAGE PROVIDED BY THE POL._.__ LISTED BELOW. Named CHARLES R. HAUSWIRTH Insured • DBA:PACIFIC NEIGHBORHOOD TELECENTERS 15030900 Address • 26611 PASEO DURANGO #200 Pol cy r Gen Lab ' SAN JUAN CAPISTRANO, CA 92675 97 07 308 Agent Policy w Auto L.O Policy e•CARGO This is to certify that policies for the above named insured are in force as follows: Policy II.Work Comp This Interim Certificate As To Evidence of Insurance shall expire sixty days from 12: 01 M., APRIL 5 , 1991., unless cancelled prior to such date by written notice to the named insured ❑/ Please issue a Permanent Certificate COVERAGE COMBINED LIMITS OF LIABILITY OT COVERED COVERED LIABIILLITY ❑ ® Owned Bodily Injury $ ,000 each person ❑ ® Hired $ ,000 each occurrence • ❑ ® Non-Owned Property Damage $ ,000 each occurrence ❑ ® Employer's Non-Ownership Contingent Liability Single Limit Liability for Coverages checked ® above $ ,000 each occurrence GENERAL LIABILITY M&C - OLT Bodily Injury $1 , 000, 000,000 each person ** Owners & Contractors $1 , 0 0 0, 0 00,000 each occurrence © ❑ Contractual* $ 0 0 0 0 0 0 000 annual aggregate / s products•• Elevators Property Damage $1 , 000, 000,000 each occurrence ® ❑ Products and/or $20 0 0 (�(� 000 annual aggregate Completed Operations 0, products••• Single Limit Liability for Coverages checked ® above $1 , 000, 000,000each occurrence r $2 ,D 2 • 0 0 0,000 aproducts a•• nnual aggregate ❑ a CARGO $ ,000 each vehicle $ ,000 each occurrence ❑ E WORKERS' COMPENSATION Statutory *Includes Goods or Products Warranty, Written Lease of Premises, Easement Agreement, Municipal Ordinance Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied b) specific endorsement providing additional Contractual Coverage. Descnbed Descnpnan ❑ below ❑ wowed OWNED YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY IDENTIFICATION NUMBER AUTO- MOBILES, IF LAST COVERED DIGITI SHOWP Umbrella Liability $ ,000 retained limit POLICY NUMBER $ each occurrence $ aggregate If this Interim Certificate As To Evidence Of Insurance is to be cancelled prior to the expiration date, we shall provide 60 days advance notice in writing to whom this certificate is issued. *CERTIFICATE HOLDER IA ALSO NAMED AS ADDITIONAL INSURED. Certificate issued to: Name CITY OF SAN JUAN CAPISTRANO Lease/Loan And Number Address •32400 PASEO ADELANTO 'SAN JUAN CAPISTRANO, CA 92675 •ATTN: JENNIFER MURRAY 4.-*t'--------'''*' Countersigned **Not Applicable in Texas. Authorized Representative *** In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations. 56-0514 2-90 W/200 C/1200 PRINTED N USA L-90 11201