05-0307_CREST AUTOMATION_Insurance CertificateAh
`A
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CORD„ CERTIFICATE OF LIABILITY INSURANCE
03 o�izoo5
PRODUCER
Contractors Outpost Insurance Services, Inc.
24338 El Toro Rd
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.
POLICY EXPIRATION
DATE MM/DDM/
Suite E130
INSURERS AFFORDING COVERAGE
Laguna Woods CA 92653 -
CL041801351
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INSURED
INSURERA. Evanston Insurance Com an
EACH OCCURRENCE $ 1,000,000
Crest Automation and Classic
INSURER B:
INSURER C'
2913 El Camino Real #119
MAR 1 0 2005
'I -
INSURER D'.
INSURER E:
Tustin CA 92782—
UUVCKAUCA
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
T.DATE
rypE OFINSURANCE
POLICY NUMBER
POLICY EFFECTIVE
MMIDD/YY
POLICY EXPIRATION
DATE MM/DDM/
LIMITS
x
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE � OCCUR
CL041801351
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01/26/2005
Il��ll
Y.i(((lll!!!
{
01/26/2006
/ /
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE Myope fire 5 50,000
MED EXP (Any one arson) 4 5,000
PERSONAL B ADV INJURY $ 1.000,000
MAR 1 0 2005
'I -
/ /
GENERAL AGGREGATE 8 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER'.
PRODUCTS - COMP/OP AGG B 1x000,000
POLICY JECT 17 LOC
AUTOMOBILE
LIABILITY
ANY AUTO
PUBLIC WORKS
__ _ _
/
_
/ /
COMBINED SINGLE LIMIT
(Ea acAant) $
BODILY INJURY
ALL OWNED AUTOS
/ /
/ /
SCHEDULED AUTOS
(Per person) s
BODILY INJURY
HIRED AUTOS
/ /
/ /
NON -OWNED AUTOS
(Per a=iE np e
PROPERTY DAMAGE
(Per ao�denp $
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT 8
OTHER THAN EAACC $
ANY AUTO
/ /
/ /
AUTO ONLY. AGO $
EXCESS LIABILITY
OCCUR F—I CLAIMS MADE
/ /
/ /
EACH OCCURRENCE e
AGGREGATE e
B
$
DEDUCTIBLE
/ /
/ /
s
RETENTION 3_770T_
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
/ /
/ /
WC $TATU- OTH-
TORY LIMBS ER
E.LEACHACCIDENT $
E L. DISEASE -EA EMPLOYEE $
E. L. DISEASE -POLICY LIMIT 8
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSAEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
•30 day notice of Cancellation, except for non-payment of premium which is 10 days.
"Proof of Insurance".
VA
City of San Juan Capistrano
32400 Paseo Adelanto
Attn: Michelle Perea
San Juan Capistrano CA 926
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
AUTHORIZED REPRESENTATIVE
RD 25S (7197)
INS025S (991o).o1 ELECTRONIC LASER FORMS, INC. -(800)327-0545
3N 1988
Page 1 of 2
*,, INS026S(9910).01 Papel a2
3/22/200522 PM FROM: 949-786-2300 TO: 493-3955 PAC* OF 002
CREST
AUTOMATION �roroRora
2913 EI Camino Real # 119, Tustin, CA 92782
Tel(949)552-6552 Fax(949)786-2300
E Mail: cmotorola@aol.com
3/22/2005.
City of San Juan Capistrano l
Attention: Theresa Abernathy
Fax # 949-493-3955
O0 Paseo Juto
Juan Capistrano
San
CA 92675. ev�Wpe�g�
P�
Dear Theresa,
2 PAGE FAX (INCLUDES THIS COVER SHEET)
Attached please find my Liability Insurance for my Vehicle. I have $1 million
dollars in Vehicle Liability Insurance Coverage.
I thank you for your assistance.
Sincerely
SAUL HIRSCHMANN, dba CREST AUTOMATION, MOTOROLA AUTHORIZED SALES
AND SERVICE.
LICENSED ELECTRICAL CONTRACTORS, LICENSE V 699349.
3/22/20021 PM FROM: 949.786-2300 TO: 493-3955 PAGE02 OF 002
PERSONAL
UMBRELLA
POLICY 7rARMER5 INSURANCE£XCHANCE
DECLARATIONS
AMENDED DECLARATIONS EFFECTIVE: 07/28/2004
1. Named •SAUL HIRSCHMANN
Insured .23 EELMONTE
Address , IRVINE, CA 92720
z. Elfecuve
From 07/28/2004 'fn' 07/28/2005
3, Schedule.1 Underlying brsunnce (Flan. in thousands ol'dolhus)
CARRIER POLICY NUMBER
FIRE INSURANCE EXCHANGE 911460006
FARMERS INSURANCE EXCHANGE 146561719
FARMERS INS. EXCHANGE 146613124
FARMERS
® TRUCK INSURANCE EXCHANGE
Prod,
Count
Prematic Ault No.
97 66 355 015034614
Agan I P.licy Nuotbrr
(mol prior to lime applied (or) 12:01 AM. ltandud Tune, as the addrns of dic named .,n d
COVERAGE UNDERLYING LIMITS
HOMEOWNER 100
AUTO LIABILITY 250/500/100
AUTO LIABILITY 250/500/100
IMPORTANT NOTICE: You have told us war have underlying insunnce policies with liability lirnksInced above, If your undcTlying inuvance policies have lower
limits than Ae%n above, you wifl be eopmteaed for the d,ffemaco. Yuu mus, keep the above coverages and limits in efi at to avoid ib.. gaps in your
Protection.
4, 1Le iinumnce afforded is indicated by the sp v:ific limit and premium charge or charges.
LIMITS OF LIABILITY
S 1 .000.0110 Each Occurrence
S 250 Retained limit
Promium Limits ofLiabilit
s 313.00 $I Million
$2 Million
S3 - 55 Million
313.00 Total Premium
<:ash RccuivJ
299.10 Balance Due U on RrYd .t'
Refund
Anv -To Al balance' m.rade Ivss ilrtn SIAM will ki e1 pb,J
n. vont ... ..o'. am Jn upon
aq�t
.. Monnir„I v, hi:h 111 old>.Il 0111111, vohid n wrhomn.
nwert..rlo..InJ L.. ro.J u.national .rhirlo��
Expo. Quantity
Ower+ -occupied residenau 1
M.Ion"ed vrhida 2
UM/UIM (wberc availably)
Yaull,l.l Driver
(+"likened recra-ationol vchide
Sailboat
Powe'b"a'
Rental Dwelling
On po-nuns 011icv
Ull P¢Inina 011 ire
I u..... I .rs.ur I m dour'.
Ib.c bcr liabilitt Witt. Cor coral Punklinuvr
lradmr I;vbiliry Witbnw Cngmul Pumsh nmto
Inkidknod 16ummg (wml aco')
Ca'.mn land Oncd mn-.1
Rrnn Lind (lm.rl .a n>)
Tann laud Iva d u. Utbar. ('waf
h+ %kid, 56,1
I N'f)111R1.%IIA I'S.11T11("%I%l1 7O'11 IIS 1911 R'. Y. (It M.'whh Ki'."t 10021 or 100251.. 0',
C..orw,.ipw-d 07/08/2004
03/07/2005 10:20
949786-2300 0
PERSONAL
UMBRELLA
POLICY []FARMEPS INSURANCE EXCHANGE
DECLARATIONS
AMENDED DECLARATIONS EFFECTIVE: 07/28/2004
1. N.uned • SAUL HIRSCHMANN
Insured .23 BELMONTE
Address IRVINE,CA 92720
2, Effeetivr
From; 07/28/2004 Tb: 07/28/2005
3. Schedule of Underlying Insurance (Entnes in thousands of dollars)
CARRIER POLICY NUMBER
FIRE INSURANCE EXCHANGE 911460006
FARMERS INSURANCE EXCHANGE 146561719
FARMERS INS. EXCHANGE 146613124
•
® TRUCK INSURANCE FXCHANCF.
PAGE 3/3
FARMERS'
Prod.
Count
Prematic Acd N'o.
97 66 355 015034614
.Agan Iodwy lumber
(not prior to lime applied for) 1291 A.M. Suuulutd lung at the address of the named inmired.
COVERAGE UNDERLYING LIMITS
HOMEOWNER 100
AUTO LIABILITY 250/500/100
AUTO LIABILITY 250/500/100
IMPORTANT NOTICE: You have told us you have underlving insurance policies with liability limits listed above 11 Your underlying insurance policies have lower
limits than drown above, you will be unprotected for the difference. You must keep the above eovmages and limbs m effect to avoid these gaps -ill 'your
Protection.
4. The insurance afforded is indicated by the specific limit and premium charge or charges.
LIMITS OF LIABILITY
$ 1 .000'100 Each Occurrence
$ 250 Retained Limn
Premium
Limits of Liability
S 313.00
$1 Million
$2 Million
S3 - $5 Million
313.00
Total Premium
Caall Received
299.10
Halmte Due Leon Reed u'
Refund
'ft, '10IT I. b.Ibn.r.1111111 Ice. t11un$].00 .ill br:gydlld
n vmun.n bdwzo e,Le—,$7.W nr Anon.u.Ju., uy.1
qp
' Ma1.rmJ.chid, lndud...11l a , u«ks, n +orLnvv..
nw1 n+.i.'G •nJ hi.'u..'al 1'. n'aIInllal n'I.Itl..�u L
Exposure Qoantity
Owner-ocarpial residetur I
Motorized vehicle'* 2
CM/111M (oh, re available)
Youthful Driver
Cidwensed recreational vehicle
5eilloit
Pnwerhoal
Kemal Dvvelhup.
On P .... um s (liner
Oil Prcn.iwe Office
lusurwl as.o Log4,,w,
7iacher liabilhy Will. Cor wood Punishount
T"'be, Iobilily Will Cngmrd 1 41.nunt
Incidental Inning (toad atter)
V.uao land (loud arae)
bean Lod Dotal etc..)
Fano Lod h.ur'11 to Other. (o.d .0 res)
Child (:.,. (- 1 blldna...m.l lar)
b-1 M.i/b+ Y' d
I NI1(Ht11 A11.A"IS API+I ICA611- 10-1111A II(111C1'-Ill Muolbl. P.Iv. ,, 10022 ,, 10025 u1 Oilgun)
Cuatnersiguol 07/08/2004
n X11 .u. Aoa...�v..l G."... •..�n.