1994-1103_CAPITAL & COUNTIES USA_Insurance Certificate SENT SY;SULLPAN & CURTIS UV. ; 4- 5-95 ; 1:571'M ; 714)1ShIn'" U-4uoiuo;l;I, zr o
AC M I1, IF . INSURANCE IssUE DATE(MM/ODJYY)
11/0.i/94
PRODUCER 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 OY THE
SUM ivan 8 Curtis Ins. Brokers POLIGIE2BELOW
2100 Main Street; #1350 COMPANIES AFFORDING COVERAGE
Irvine, CA 9271 ¢
COMPANY A
LETTER CHURN ORANGE
COMPANY c
INSURED LEITER
COMPANY
Capital & Counties U9R, Inc , LETIER G
101 California St. , # 252 GQMPANr
Sale Francisco Cit 94111 LETTER
COMPANY E
LETTER
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST U)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 RE ISSUED OFt 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 PAlO CLAIMS,
CO TYPEOF MIV
SUNANCE POUCY NuMNER POL/CY EFFECTIVE POLICY B7[PIRALQN TLawsLTR DATE(MMtM[NYY) DATE(MMIDPlYYI
GENERAL LIACILITY 35307721 1.1/O:t/94 11/01/95 GENERA.AGGREGATE : 2000000
X GOMME DIAL OE/ERA'.LtAAILTIY PRODUCT3GOMINCP ACO. 3 2000000
CLAIMS&UDE X OCCUR, PERSONALaADV.INJURY 5 1000000
CIwNER'S a CONTRACTOR'S PROT. EACH OCCUNRENCE $ 1000000
FINE CARTAGE(Any one firm) R .5'0000
MED,EXPENSE(A+7 orn Pent $ 5 0 0 0
AUTOMOBILE LIABiITY COMBINED SINGLE
AMY AIYtl7
UNIT
ALL OWNED AUTOS 807ILY INJURY $
SCHEDULED AUTOS (P* Pm )
HIRED AUTOS BODILY INJURY
NG*-QWNEL)AUTOS (kr ecgklenT)
GARAGE LABILITY PROPERTY DAMAGE
EXCESS LIABILITY EACH OCCURRENCE 1
UMBRELLA FORM At I3REGAT£
011101 THAN UMBRELLA FORM
wORXER S cO NSATHQII STATtJLORY LIMITS
EACH ACCIDENT S
AND
DISEASE—POLICY t IUIT i
EMPLOYERS'LIAINLiT"1' otsEASE—EACH EmPLGYEE $
OTHER
DESCRIPTION OF OPERATIONS LOCAT ONSNE7UCLEWBPECWL Imo
RE: LICEINSE AGREEMENT, LOT 216, TRACT 12954
SEE T1TTPCHED CG20I0 FOR ADDITIONAL. INSURED INFORiMATIONi
CERTIFICATE HOLDER CANCEk LAT14N •
SHOULD ANY OF THE ABOVE DESCRIBER POLICIES CE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL 3Eibilakiatopa
CITY IIF SAN U A N! CPPISTRANO MAIL_.3 0 DAYS WRITTEN NOTICE TP THE CERTIFICATE HOLDER NAMED TO THE
DEFT . OF ENG . & BLDG. LEFT, . a.. ->< < r_•.• - - - . •'c' Iii
32400 PASEG AULLRNTU zaxagromeg *,. • e litniceilrtrfflin5RPAYPRW
SANT JUAN CAP1STRANO, CA 92675 _LL
AUTHORIZED ESENTATIVE
b SO
ACORD 2s-$ POH
.�� .
OA I RATION 1990
2 - 76
SENT liT SULL l VAIN & (Tiff I S 110. ; 4 5 95 ; 1 57M ;
714)'8.529762- 9--4931Q53;# 3/ 3
. POLICY NUMBER: 0-, A. .OMMERC AL GENERAL LIASIUW
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM R)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART,
SCHEDULE
Name of Parson or OrmeisatIosi
CITY OF SAN JUAN C 1PISTRANNO
(U no entry appears above.information required to cGxnplete this endorsement ent will be shaven in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED(Section II)eat amendad to it tach as an imwrsd the person or organizabon shown in the
Schedule, but only with respect to liability arising out of..your work"for that insured by or for you.
CG 20101185 Copyright. Insurance Services Office, Inc., 19114 L
SENT BY:SULLIVAN & CURTIS IRV. ; 4- 5-95 ; 1:56PM ; 714)11,5V.:i762-' i-4J011100;* 1/ i
•
SuuivAN&CURrIS
i N S U k A N C E IIPOKERS
•IRVINE
TELEC.OP/ER OUT CVNG ME$ AGE COMER PAGE •PASADENA
•LAS ANEJELE,$
•HONOLQLU
•EEAT171;
FAX # 714-493-1053 DATE: APRIL 5, 1995
FIRM: CITY OF SAN JUAN CAPISTRANO FRO}i: LORRAINE DOPP
TO: KATHLEEN DU COING OFFICE: IRVINE, CA
RE: CERTIFICATE OF INSURANCE FOR # OF PAGES: 3
CAPITAL & COUNTIES USA, INC.
**********************************************yr**************tit e****Ir*
SEE ATTACHED
* Pasadena FAX: 1-818-792-6111 * Honolulu FAX: 1-808-522-5919
* Irvine FAX: 1-714-852-9762 * Santa Barbara FAX: 1-805-687-8851
* Los Angeles FAX: 1-213-628-8852 * South Carolina FAX:1-803-738-9797
art**, *****************************************************************
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to which it is uldriamed and may contain information that is privi-
le ged,confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient,or the
noiployee or agent responsible for delivering the message to the
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Immediately by telephone and reON11 the arigMLut merge to us at the
above address via the U.S.Postal Service_ Thank you.
111) MO WAN Kravxr MINE.CA 92714. 7f17 FAS 7141652-9WSg