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.
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7 is:to that_„ ..,. . . . , , , . ,. _ . „
-... -. - •--- LIBERTY
THE WHITING-TURNER CONTRACTING COMPANY • ',. I ., .
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• • MUMkL
300 EAST JOPPA ROAD , - , ., , - •;,,,-, ' Name and . i
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BALTIMORE,MD 21286 4.---- address of
ATTN: JENNIFER TRONE . , , Insured.
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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
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LIABILITY - - . $2,000,000
Products/Completed , • :..
Ci OCCURRENCE - - Operations - Contractor Protective Products/Completed Operations Aggregate
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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
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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
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OTHER
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ADDITIONAL COMMENTS
ADDIITONAL INSURED: CITY OF SAN JUAN CAPISTRANO AND,CAPISTRANO VALLEY WATER DISTRICT
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*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 "
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THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED .
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UNDER THE ABOVE POUCIES UNTIL AT LEAST 3D DAYS Lib ertyMutual Group
NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO:
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RITY OF SAN JUAN CAPISTRANO ANDOl
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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
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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.
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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