01-0904_AUSTIN-FOUST ASSOCIATES, INC._Insurance Certificate62 6-,,344
INSURED
AL :1
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COVER_NGES _
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ANY REO JREI' -'
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Re: 1.1a
City of
geneT:al
106
L:S Associates, Inc
A'[ Tustin Avenue
1"-i, A 92705
- k LISTED BELOW I
DR CONDIT''ON C . - --
") CE AFFORDED E1
"I iSHOWN MAY H A 4 -
BIC
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AS IAADE
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NSURERS AFFORDING COVERAGE
L '-'arine
_.,I s Ins. Cc:.
' als Insu.L ,n_.e
-`6Hl( INUIUAILD NUI IHSIANU-fiS
1Hl5 ERTIFICATE MAY F- ISSUED OR
IXCL' 31ONSANDCONDI7I,]gSOFSU(,rI
LIMITS
/ $
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CERTIFICA� OF
LIABILITY
INSU CE
DATE (MM/DD/YY)
o��onol
=THIS
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CERTIFICATE
IS ISSUEDASA tdATTER OF INFORMATION
LI'V,
& AssOCl b
ONLY
AND CONFERS NO RIGHTS
UPON THE CERTIFICATE
$
HOLDER
THIS CERTIFICATE DOES
NOT AMEND, EXTEND OR
;i:>Ut,
A".J(=. ,
ALTER
THE COVERAGE AFFORDED
BY THE POLICIES BELOW.
62 6-,,344
INSURED
AL :1
7.:; i 01
5,1
COVER_NGES _
THE PCL --ESI I
ANY REO JREI' -'
MAY PEN FAIN -
POLICIEE AGG
NSR- YPF
LTR
A GENEYALLd: I
X C WMI I
Of
GEN L \GGFI I
F )LIC)
A AUT Z,lCBILI .
- -- P VY At
_L OV /
i ]HEC(
X. IIR DI
A iE LI.1
I N1At I
EK( R IS LIP(
CCUP
EDU('
_ El EAI
B WO )1 EIIS l
4EMIIJY ERS
on isl Pr. I
;iabi I
DESCRIF 1: N DF
Re: 1.1a
City of
geneT:al
106
L:S Associates, Inc
A'[ Tustin Avenue
1"-i, A 92705
- k LISTED BELOW I
DR CONDIT''ON C . - --
") CE AFFORDED E1
"I iSHOWN MAY H A 4 -
BIC
)ABILITY
OCCUR
IES PER:
J LOC
BK
AS IAADE
I ND %hNT.
(nal A3E(
-_—L___ _
AT 0I4S/VEWLES11.)
Servil::el_
Iln Cap.,stI
..ty and 1:1
ADDmoNa.�
uan Capisrrart )
)swald
) Adelanto/,
)is [rano, CA IT
NSURERS AFFORDING COVERAGE
L '-'arine
_.,I s Ins. Cc:.
' als Insu.L ,n_.e
-`6Hl( INUIUAILD NUI IHSIANU-fiS
1Hl5 ERTIFICATE MAY F- ISSUED OR
IXCL' 31ONSANDCONDI7I,]gSOFSU(,rI
LIMITS
/ $
ENCS $3,
, Of)
I)AM4(myoreilm) '$5(
50
.:EIt, I. PAaoalso,) $5,''C''0
:AACCID:NT $
Ihl, ,DV INJURY $3,
.
EAACC $
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UPONTHEINSUREP I':GEJITEO'
IV • •
Policy Number: RP06642703
Owners Lessees or Contractors (Form B)
ADDITIbNAL INSURED
Change(s) Effective: 12/27/01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY. This endorsement modifies insurance policy under the following:
LIABILITY COVERAGE PART:
Schedule
Name of Person or Organization:
City of San Juan Capistrano
Attn: Jill Thomas
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
SECTION II - WHO IS AN INSURED is amended to include as an insured the
person or organization shown in the Schedule, but only with respect to liability
arising out of "your work" for that insured by or for you.
Re: Personal Services Agreement. City
additional insured on the commercial
and non -owned liability .
CL/BF 22 40 03 95
of San Juan Capistrano is
general liability and the hired