03-0918_AUSTIN-FOUST ASSOCIATES, INC._Insurance CertificateACORQa CERTIFI
Dealey, Renton & Associates
199 S Los Robles Ave Ste 540
Pasadena, CA 91101
626 844-3070
INSURED
2 Austin Foust Associates, Inc.
30 2020 North Tustin Avenue
Santa Ana, CA 92705
COVERAGES
OF LIABILITY INSUMME
DATE MM MY)
09/18/03
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.
INSURERS AFFORDING COVERAGE
INSURER A: United States Fidelity & Guaranty
INSURER B. St. Paul _Fire & Marine Ins. Co. _ INSURER C: Security Ins. Co. of Hartford
INSURER D'.
INSURER E'
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 - _ - POLICY EFFECTIVE POLICY EXPIRATION - - -
LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE IMM13"n LIMITS
A'
GENERAL LIABILITY IBK01261229
08/15/03
06/15/04
EACH OCCURRENCE
$31000,000
X COMMERCIAL GENERAL LIABILITY General Liability
FIRE DAMAGE (Any one tire))
CLAIMS MADE I XII OCCUR excludes claims
MED EXP (Any one person)
js300,000__
1 $5,000
{
7$3,000,000
.arising out of the
, PERSONAL& ADV INJURY
perfOrmanc@ of
GENERALAGGREGATE
$5,000,000
PRODUCTS-COMP/OP AGG
GEN'L AGGREGATE LIM IT APPLIES PER: prof@$$IODBI
,$5,000,000
POLICY JECOT LOC services.
A AUTOMOBILE LIABILITY
BKO1261229 08/15/03
08/15/04
-,
COMBINED SINGLE LIMIT
$3,000,000
ANY AUTO
(Ea accident)
ALL OWNED AUTOS
l
'BODILY INJURY
$
� SCHEDULED AUTOS
(Per person)
X HIRED AUTOS
i BODILY INJURY
X ! NON -OWNED AUTOS
(Per accident)
$
- ------ - - --
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
_-_ - - - - - - -- -
ANY AUTO
--
EA ACC $
OTHER THAN — ---
AUTOONLY: qGG $
EXCESS LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE $
. _
I
_— _ - —
$
DEDUCTIBLE
RETENTION $
$
B WORKERS COMPENSATION AND
WVA7726345 09/01/03 '09/01/04
OTH-
1C TORV LIMITS _ ER _
TORY
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT ' $1,000,000
- -- ---
E.L. DISEASE - EA EMPLOYEE $1,000,000 _
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
$2,00,000 apDl aggr.
0
Z o
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Plan Check Services �Nrno
City of San Juan Capistrano is additional insured on the commercial =
lAl
liability and the hired and non -owned liability. o
general
o ! <
N'71
City of San Juan Capistrano
Attn: City Clerk's Office
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
ACORD 25S (7/97)1 of 1 flM995AS
SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CAN"qLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30DAYSWRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TO DOSOSHALL
IM POSE NO OBLIGATION OR LIABILITY OF ANY KIN D UPON TH E INSURER,ITS AGENTS OR
1"%/ n ACORD CORPORATION 19111A
Policy Number: BKO1261229
Owners Lessees or Contractors (Form B)
ADDITIbNAL INSURED
Change(s) Effective: 09/18/03
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: City Clerk's Office
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: Plan Check Services City of San Juan Capistrano is additional
insured on the commercial general liability and the hired and
non -owned liability .
CL/BF 22 40 03 95