05-0331_AUSTIN-FOUST ASSOCIATES, INC._Insurance CertificateIter 3/31/2005
1.
Timer 8:35 AM To: 9 494931053 510-452-2193 Pape. 002-003
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ACORn_ CERTIFICATE OF LIABILITY INSURANCE
3/24/M,°D,YY,
0.4/24/05
PRODUCER
THIS CERTIFICATE IS ISSUED AS A NUTTER OF INFORMATION
Dooley, Renton & Associates
199 S Los Robles Ave Ste 540
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Pasadena ,CA 91101
POLICYEFPECTIVE
626 844-3070
INSURERS AFFORDING COVERAGE
INSURED
Austin Foust Associates, Inc.
2020 North Tustin Avenue
Santa Ana, CA 92705
INSURERA: United States Fidelity & Guaranty
INSURER B: St. Paul Fire & Marine Ina. Co.
INSURER Cr Liberty Insurance Underwriters, Inc.
INSURER D
NSURER E:
FIRE DAMAGE (An,o Ere) $1 OOO
11VVVACCS
THE POLICIES OF INSURANCE IIS T.D BELOW HAVE BEPN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDI
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED O
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCI
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICYEFPECTIVE
POLICYEMeXPIRATION
LIMITS
A
GENERALLIABILITY
BK01261229
08/15/04
09/15/05
EACH OCCURRENCE $1066 W
FIRE DAMAGE (An,o Ere) $1 OOO
X COMMERCIALGENBRALUABILDY
CLAIMS MADS NIOCCUR
MED EXP (Arone non) S10,000
PERSONAL & ADV INJURY 111.000.10)
GENERAL AGGREGAT E 62000000
G E N AG 3REGATE LIM IT APP LIESPE
R:
PRODUCTS CUMP/OPAGG s2,0WAW
17 POLICY PRO
LOC
A
AUTOMOBILE
LIABILITY
ANYAUTO
BKO1261229
09/75/04
08/15/05
COMBINEDSINGLBLIMC �/y�
(Ha wcidm[) I1,00DAW
BODILYINJURY 6
(PEr Aaron)
ALL OWNED AUTOS
SCHEDULRD AUTOS
BODILY INJURY $
(Per mmdeoq
X
X
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAOB S
Termeldent)
GARAGE LIABILITY
AUTOONLY-EAACCIDENT S
OTHERTHAN EA ACC S
ANYAUTC
AUTOONLY: AGO S
A
EXCESSLIABILITY
BKO1261229
06/15/0M 4
�Y�e
06/15/05EACH
OCCURRENCE s4000 00
X OCCUR CLAIMSMADR
ACGREOATB 54000000
S
S
DEDUCIBLE
S
RETENTION S
B
WORKERS COMPENSATION AND
WVA7726M
M.�
09/01/04
Me
09/01/05
X WCSTATIT (YI'H-
EMPLOYERS' LIABILITY
E.L. ?ACH ACCIDENT §7 OOO
R.L.DISRASE SARMPLOYBE $1,000.000
B.L.DISEASE POLICYUMIT 57000
C
OTHER Professional
AEE2001410105
03/25/05
03/25/06
$1,000,000 per claim
lability
$2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLEREXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL 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
SH WID ANYOFTHEABOVE DESCRIBED POLIOS BE CANCELLED BEFORETHE EXPIRATION
DATETHEREOF, THEISSUING INSURER WILLENDEAVOR T0MAIL30_DAYS WRBTEN
NOTICETOTHE CERTIFICATE HOLDERNAMEDTOTHELEFT, BLTFAWIRE TODOSOSHALL
IMPOSE NO OBLIGATION ORLIAB ILITYOF ANY KIND UPON THE INSURER,NS AGENTS OR
I— i . — . omv ........................... 1 .moo
ite: 3/31/2005 Time: 8:35 AM To:"if94931053 510-452-2193
Policy Number: BKO1261229
Owners Lessees or Contractors (Form B)
ADDITIbNAL INSURED
Change(s) Effective: 03/24/05
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
Page: 003-003