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04-0929_AUSTIN-FOUST ASSOCIATES, INC._Insurance CertificateAMM CERTIFICAN OF LIABILITY INSUGME 1 DAM 1 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 [K6114=10AHay 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 XL Specialty Insurance Co. 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. (NSR rypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DD/YY DATE M/DD/YY A GENERAL LIABILITY BKO1261229 08115/04 08/15/05 EACH OCCURRENCE $1.000.000 X ,, !COMMERCIALLIABILITY_OCCUR DAM AGE (Any one lire) $1,000,000 PRE MAOEER LLLFIRE _ _ (Any one person) $10,000 PERSONALS ADV INJURY_ $1,000,000 _ _ r II GENERAL AGGREGATE s2,000,000 _ IGEN'LAGGREGATELIMITAPPLIESPER'. PRODUCTS_COMPIOP AGG $2000000_ Ilrr POLICY PRO- LOC JECLA AUTOMOBILE LIABILITY BKO1261229 08/15/04 08/15/05 COMBINED SINGLE LIMIT E. accident) $1,000,000 ANY AUTO OWNED AUTOS —I SCHEDULED AUTOS BODILY INJURY (Perpamm) $ X HIRED AUTOS —11 BODILY INJURY --ALL X NON -OWNED AUTOS (Pereccident) $ PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTOEA I OTHER THAN ACC $ AUTO ONLY: AGO $ A EXCESS LIABILITY BKO1261229 08/15/04 08115/05 EACH OCCURRENCE $4,000,000 — X -OCCUR CLAIMS MADE I �� AGGREGATE $4,000,000 _ $ DEDUCTIBLE _ $ RETENTION $ $ B WORKERS COMPENSATION AND WVA7726345 09/01/04 09/01/05 X WCSTATU- OTHH- T RV LIMIT EMPLOYERS'LIABILITY I E.L. EACH ACCIDENT $1,000,000____ _ E.L. DISEASE -EA EMPLOYEEI$1,000,000 E.L. DISEASE -POLICY LIMIT ' $1,000,000 C I OTHER Professional DPR9400354 03/25/04 03/25/05 $1,000,000 per claim (Liability $2,000,000 annl aggr. DESCRIPTION OF OPERATONSILOCATIONS/VEHICLESrEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Re: Plan Check Services City of San Juan Capistrano is additional insured on the commercial general liability and the hired and non -owned liability. City of San Juan Capistrano Attn: City Clerk's Office 32400 Paseo Adelanto San Juan Capistrano, CA 92675 SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3O _DAYSWRITTEN NOTICE TOTHE CERTIFICATE HOLDERNAM ED TOTH E LEFT, BUT FAILURE TO DOSOSHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERJTS AGENTS OR AUTHORIZED 1 of 1 #S112101/M111413 I- JMV 0 ACORD CORPORAgnOl11988 0 0 Policy Number: BKO1261229 Owners Lessees or Contractors (Form B) ADDITIbNAL INSURED Change(s) Effective: 09/29/04 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