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1998-0801_KAISER FOUNDATION HEALTH PLAN INC_Certificate of Insurance - Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MAITIR OF- •.;IIVIATION ONLY AND CONFERS NO RIGHTS UPON YOU`:, .ERITE-ICATE HOLDER THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMENDTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. • ,, _ . . . 7 is:to that_„ ..,. . . . , , , . ,. _ . „ -... -. - •--- LIBERTY THE WHITING-TURNER CONTRACTING COMPANY • ',. I ., . , , • • MUMkL 300 EAST JOPPA ROAD , - , ., , - •;,,,-, ' Name and . i .... .: . . , BALTIMORE,MD 21286 4.---- address of ATTN: JENNIFER TRONE . , , Insured. , • Is,at the issue date of this certificate,insured by the Company under the poliCy(ies),Hated below. The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and conditions and is not altered by any requirement,term or condition of any contract or other document with respect to which this certificate may be issued. . EXP.DATE . ., . 0 CONTINUOUS TYPE OF POLICY 0 EXTENDED POLICY NUMBER LIMIT OF LIABILITY El POLICY TERM WORKERS , COVERAGE AFFORDED UNDER WC I PMPLOYERS_LjARILITY , LAW OF THE FOLLOWING " - COMPENSATION STATES: Bodily Injury By Accident $1,000,000 Each __ AZ CA CO CT DC DE FL GA IL Accident 8-1-99 WA2-63D-004070-018 KS LA MA MD MO NH NJ NY Bodily Injury By Disease . OR PA TN TX VA VT $1,000,000 Policy Limit - Bodily Injury By Disease . ' if . • $1,000,000 Each . Person GENERAL 8-1-99 RG2-631-004070-048 General Aggregate-Other than Products/Completed Operations . LIABILITY - - . $2,000,000 Products/Completed , • :.. Ci OCCURRENCE - - Operations - Contractor Protective Products/Completed Operations Aggregate • •- , Independent Contractual Liability $2,000,000 . . Contractors/ • El CLAIMS MADE . xcu Coverage - Bodily Injury and Property Damage Liability - Per $1,000,000 Occurrence Personal Injury - Per Person/ RETRO DATE $1,000,000 Organization Other $500,000 Other $5,000 Fire Legal Liability Medical Payments AUTOMOBILE Accident-Single Limit . • ,$1,000,000 LIABILITY • - B.I.and P.D.Combined • I. OWNED . . Each Person 8-1-99 ' AS2-631-0040/0-058 rl NON-OWNED Each Accident or Occurrence 10 HIRED • , . _ Each Accident or Occurrence .,.:- _ OTHER , . ADDITIONAL COMMENTS ADDIITONAL INSURED: CITY OF SAN JUAN CAPISTRANO AND,CAPISTRANO VALLEY WATER DISTRICT c I— ,-- ,. -..: -, , , --zi ' ,,,,_ •.:,-‹ ____ c, — 71 • --,---,- *If the certificate expiration date is continuous or extended term,you will be notified if coyeragia•le terminated or reduced before the certificate eXPgatipfisHte. SPECIAL NOTICE-OHIO: ANY PERSON WHO,WITH INTENT TO DEFRAUD OR KNOWING THA, T HE'S FA6ITTATING A FRAUD AGAINST AN INSURER,SUBMITS':,1"- Cl al AN APPUCATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. ..--"z"___, NOTICE OF CANCELLATION: (NOT APPUCABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE " ' THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED . C...0 UNDER THE ABOVE POUCIES UNTIL AT LEAST 3D DAYS Lib ertyMutual Group NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: /(/ • 6..dk,:€ RITY OF SAN JUAN CAPISTRANO ANDOl atf— cEpTiFicxrE CAPISTRANO VALLEY_WATER ..DISTRICT H. Gail H AUTHORIZED REPRESENTATIVE HOLDER 32400 PASEO ADELANTO • - • SAN JUAN CAPISTRANO, CA 92675 Wayne, PA (610) 971-9394 08/01/98 , 1 I OFFICE PHONE NUMBER DATE ISSUED • • . . , . • . This certificate is executed by LIBERTY MUTUAL GROUP as respects such insurance as is afforded by Those Companies, . . BS 772L (FL) FLORIDA IMPORTANT NOTICE TO POLICYHOLDERS AND CERTIFICATE HOLDERS In the event you have any questions or need information about this certificate for any reason, please contact your local Sales Producer, whose name and telephone number appears on the front lower right hand corner of this certificate. The appropriate local Sales Office mailing address may also be obtained by calling this number. • THE WHITING-TURNER CONTRACTING COMPANY ENCLOSED IS A RENEWAL CERTIFICATE FOR THE RENEWAL PERIOD 8/1/98 TO 8/1/99 IF YOU NO LONGER REQUIRE EVIDENCE OF INSURANCE COVERAGE, KINDLY RETURN THIS CERTIFICATE, MARKED "NO LONG REQUIRED", AND WE WILL REMOVE YOUR NAME FROM OUR MAILING LIST. IF CORRECTIONS NEED TO BE MADE TO CERTIFICATE HOLDER'S NAME OR ADDRESS, PLEASE MAKE CORRECTIONS IN RED AND EITHER MAIL --OR TA-X-(610)-971=9535)-TO OUR OFFICE-AND-WE WILL-MAIL BACK TO YOU, THE REVISED,CERTIFICATE AS SOON AS POSSIBLE. THANK YOU FOR YOUR ASSISTANCE. H. GAIL HAGER ACCOUNT SERVICE REPRESENTATIVE NATIONAL ACCOUNTS DEPARTMENT LIBERTY MUTUAL INSURANCE CO 676 E. SWEDESFORD RD., STE 300 WAYNE, PA 19087