03-0326_AUSTIN-FOUST ASSOCIATES, INC._Insurance CertificateACOR M CERTIFICA'
Dealey, Renton & Associates
199 S Los Robles Ave Ste 540
Pasadena, CA 91101
626 844-3070
INSURED
Austin Foust Associates, Inc.
2020 North Tustin Avenue
Santa Ana, CA 92705
OF LIABILITY INSURAMCE DATE (MM/D
03/26/03DNY)
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.
RECEIVE 3 INSURERS AFFORDING COVERAGE
IU03 APA -8 Ito
A: United States Fidelity & Guaranty _
PINSURER e:
American Motorists Ins. Co.**
SAN JUAN CAPIST
INSURERC: Security Ins. Co. of Hartford
CITY CLERK' D:
NSURER E:
�Wv
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 -- - _
LTR TYPE OF INSURANCE
PODCY NUMBER
POLICY EFFECTIVE
DATE M/DD/YY
POLICY E%PIRATION LIMITS
DATE MM/DD/YY
A I
GENERAL LIABILITY
BK01261229
08/15/02
000
08/15/03 EACH OCCURRENCE s3000000
FX ' COMMERCIAL GENERAL LIABILITY
--
Liability
FIRE DAMAGE (Any one fire) $300,000-
(General
CLAIMS MADE occuR
excludes claims
MED EXP (Any one person) $5,000 -
- —
arisingoutof
PERSONAL &ADV INJURY $3,000,D00
the performance
GENERAL AGGREGATE $5000,000
_
GEN'LAGGREGATE LIMITAPPLIES PER:
of professional
"PRODUCTS COMP/OP AGO $5000,000 _
- -
POLICY F_ PEP LOC
services.
A
AUTOMOBILE LIABILITY
BKO1261229
08/15/02
08/15/03
COMBINED SINGLE LIMIT
$•� 000,000
ANY AUTO
(Ea accitlenq
_ - -- - --
ALL OWNED AUTOS
INJURY $
iBODILY
(Per person)-
SCHEDULED AUTOS
X HIRED AUTOSBODILY
INJURY $
NON -OWNED AUTOS
�(Peraccident) F
-
PROPERTY DAMAGE $
-X
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $ _
OTHER THAN EA ACC $
ANY AUTO
--
AUTO ONLY: AGG $
E%CESS LIABILITY
EACH OCCURRENCE _ $
OCCUR _ J CLAIMS MADE
AGGREGATE _ $
DEDUCTIBLE
$ - ---- —
RETENTION $
$
WORKERS COMPENSATION AND
7CW21231606
WC STA
09/01/03 X T RYLIMIT ER
EMPLOYERS' LIABILITY
109/01/02
E.L. EACH ACCIDENT $1,000,000 _
E.L.DISEASE-EA EMPLOYEE $1,000,000 _
i
I E.L. DISEASE -POLICY LIMIT $1,000,000
C
OTHER Professional
'AEE0229522 03/25/03
03/25/04
$1,000,000 per claim
Liability
$2,000,000 annl aggr.
DESCRIPTION OF OPERATIONSILOCAnONSIVEHICLEVEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
** The insurer's payment obligations are backed by a Cut Through Agreement to National
Indemnity Company, an A++ rated Berkshire Hathaway subsidiary. A summary of the Cut
Through Agreement is attached.
Re: Personal Services Agreement.
(See Attached Descriptions)
City of San Juan Capistrano
Attn: Jill Thomas
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETH E EXRRATION
DATE THEREOF, THE ISSUING INSURER WILLAKR58VAJIM MAIL An DAYS WRITTEN
NOTICETOTHE CERTIFICATE HOLDER NAM ED TOTHE LEFT, BX73R JfRfljMj01D=
REPRESENTATI
tz- M.
ACORD 25-S (7/97)1 of 2 #M85519 F JMV O ACORD CORPORATION 1988
DEMOTIONS (Continued from Pa 1)
City of San Juan Capistrano is additional insured on the commercial
general liability and the hired and non-owned liability.
AMS 25.3 (07/97) 2 of 2 #M85519
• Policy Number: BKO1261229
Owners Lessees or Contractors (Form B)
ADDITIbNAL INSURED
Change(s) Effective: 03/26/03
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
Irreura paole•
• 0
Kemp er/National Indemnity
Cut -Through Summary
In the event Kemper receives an order to cease policy payments or is deemed insolvent by a court or
regulatory order:
• For policies where the notice is provided at the policy inception date, National Indemnity
Company NCO) will pay on behalf of Kemper l0o% of policy payment obligations not
previously paid by Kemper.
• For policies where the notice is provided effective mid-term, NICO will pay on behalf of
Kemper 100% of policy payment obligations not previously paid by Kemper for any claim where
damages, loss or offense commences on or after the date on which the notice was provided.
• Claim payments to insureds and claimants, including payments to mortgagees and assignees are
covered, as are legally declared payable dividends, retro premium adjustments and return
premiums
Third parry liability payments will be made upon either legal judgement, approval by Kemper
prior to any order, or NICO approval after such order
• An insured does not have to notify NICO of any claims or suits unless they have received actual
notice of an order issued by a court or regulator
• All policy payment obligations of the original policy continue to apply
• NICO will bear 100% of all reasonable defense costs
• There is no sunset provision on the payment obligation by NICO
• NICO is the lead member of the Berkshire Hathaway Group of insurance companies and is
`A++' rated by A.M. Best and AAA by Standard & Poor's
Disclaimer- This is not intended to be a legal interpretation. yhe actual wording of the notice will always govern the
application of this cut -through notice.